This communication visits the concept of therapeutic patient education (TPE), and explores its relevance to transgender health care. It suggests a novel term, therapeutic education (TE), and defines it as “educational activities essential to the optimization of health, offered by health care providers duly trained in the field of education, designed to help a transgender individual (or a group of individuals and their families) to manage their treatment and prevent avoidable complications, while maintaining or improving their quality of life. It describes the soft and hard skills required for TE, and suggests a classification that can help in structuring TE programs.
Keywords: Gender affirmation, person-centered care, quality of life, transgender care, transgender health, therapeutic education
Therapeutic patient education (TPE) is a well-accepted concept that has found utility in the management of various chronic diseases. The World Health Organization (WHO) has highlighted the need to help health care providers acquire the competencies that are necessary to help patients self manage their chronic disease. TPE is defined as "education activities essential to the management of pathological conditions, managed by health care provides duly trained in the field of education, designed to help a patient (or a group of patients and their families) to manage their treatment and prevent avoidable complications, while keeping or improving their quality to life."1 TPE provides a therapeutic effect additional to that produced by the other interventions, including pharmacological and nonpharmacological therapies.
REWORDING THE DEFINITION
While the definition of TPE in its present form serves the cause of chronic disease, such as diabetes mellitus, it is unsuited to transgender health. The words "pathological" and "patient" are not only inappropriate, but inaccurate as well, while describing the life of transgender persons.2 Negating the relevance of TPE to transgender health, just because of these two words, however, is akin to throwing the baby out with the bath water. A more apt nomenclature may be therapeutic transgender person education, or simply, therapeutic education (TE).
From a transgender health perspective, TE is best defined as "educational activities essential to the optimization of health, offered by health care providers duly trained in the field of education, designed to help a transgender individual (or group of individuals and their families) to manage their treatment and prevent avoidable complications, while maintaining or improving their quality of life."
Transgender health is a complex science, which needs active participation from the transgender individual.3 Learning about one's gender identify, navigating the health care ecosystem and society at large, as well as practicing necessary self-care activities, requires significant education.4 This information and knowledge is best shared through TE.
The competencies required for TE providers and diabetes patients have been described in detail.1 Reference training programs must be crafted for health care providers, based upon robust educational principles and evidence-based medicine. These programs must sensitize them to the need for trans-friendly communication, and equip them with tools for effective teaching. Apart from these soft skills, hard skills such as psychological, social and legal support, as well as endocrine, psychiatric and surgical aspects of transgender care should be covered.
It may be apt to create a hierarchy of competencies required for transgender TE. Primary skills include those required for all transgender persons, such as how to navigate social, legal and health care knowledge related to gender affirmative interventions, while tertiary competencies are a label for information that may be needed for specific issues that impact a few people in an individualized manner
THE WAY FORWARD
The way forward is to integrate transgender health in medical, nursing and paramedical curricula and practice, as well as integrate TE in transgender health. Just as TPE has changed our approach to chronic disease management; a focus on TE will revolutionize our attitude to transgender health and transgender care.
- World Health Organization. Regional Office for Europe. (1998). Therapeutic patient education: continuing education programmes for health care providers in the field of prevention of chronic diseases: report of a WHO working group. World Health Organization. Regional Office for Europe. https://apps.who.int/iris/handle/10665/108151. Last accessed November 15, 2022.
- Miyagi M, Guthman EM, Sun SED. Transgender rights rely on inclusive language. Science. 2021;374(6575):1568-9.
- Majumdar A, Sanyal D, Sukumar S, Kalra S. Transgender endocrinology. Indian J Endocrinol Metab. 2020;24(2):126-7.
- Sharma S, Kalra S, Kumar A. Transgender Health Issues: Children of a Lesser God. Indian J Clin Pract. 2022;33(2):8-9.