Amplify Sprouted: A Community-Based Educational Tool for Gender-Affirming Care Evolved for the Prenatal/Preconception Genetic Counseling Specialty

Abstract

Individuals who are transgender and/or gender diverse (TGD) face disparities in healthcare, including a lack of provider knowledge in transgender healthcare. In the genetic counseling profession, there is a lack of education on gender-affirming care in prenatal/preconception genetics, yet a desire by genetic counselors to be more inclusive of patients in this community. To address this need, we designed, implemented, and evaluated, in collaboration with TGD community members, a prenatal/preconception educational program, Amplify Sprouted, and clinical skill implementation workshop. This tool was based on the validated educational program, Amplify, and was expanded to include gender-affirming care information for the prenatal/preconception genetics. A total of 45 genetic counselors and students completed the 5-module educational tool, Amplify Sprouted, and a pre- and post-education assessment that asked about participant knowledge on gender-affirming care (25 multiple choice questions (MCQs)) and validated self-efficacy questions in providing care to TGD patients (N=35 MCQs). Results showed a statistically significant increase in knowledge for content in 3 of the 5 Amplify Sprouted modules and in overall knowledge with an average percent correct increase of 16% (p<0.001). There was also a statistically significant increase in all self-efficacy competencies with an overall average of 11.6% increase (p<0.001) in score. Genetic counseling specialty nor status (student vs genetic counselor) were significant predictors of knowledge or self-efficacy. A subset of genetic counselors (N=9) were then selected to participate in a workshop and focus group with TGD community members (N=8), allowing for collaborative clinical skill practice and discussion. Deductive analysis on data from verbal transcripts and a pre- and post-workshop assessment that asked about the utility of the workshop revealed seven themes surrounding patient-focused communication, TGD community involvement, expanding inclusive genetic counseling, and being an advocate for patients in all aspects. Amplify Sprouted was successful in increasing participant knowledge and self-efficacy, revealing the utility of the tool in genetic counseling. In addition, the workshop and focus groups successfully provided an opportunity to translate education and enhance clinical skills. Overall, our research found that gender-affirming care is not static; it is dynamic, ever-growing, and must be tailored to patients through open communication. As such, actions must be taken with communities to make gender-affirming changes, not acted upon communities because voices in the TGD community need to be Amplified.