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CMAJ. 2019 Jan 21;191(3):E63-E68. doi: 10.1503/cmaj.180839.

Routine collection of sexual orientation and gender identity data: a mixed-methods study.

Author information

1
The Upstream Lab (Pinto), Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Kiran), Faculty of Medicine and Dalla Lana School of Public Health (Pinto, Abramovich, Nisenbaum), University of Toronto; Centre for Urban Health Solutions (Aratangy, Devotta, Nisenbaum, Wang, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health; Health Quality Ontario (Kiran), Toronto, Ont. andrew.pinto@utoronto.ca.
2
The Upstream Lab (Pinto), Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Kiran), Faculty of Medicine and Dalla Lana School of Public Health (Pinto, Abramovich, Nisenbaum), University of Toronto; Centre for Urban Health Solutions (Aratangy, Devotta, Nisenbaum, Wang, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health; Health Quality Ontario (Kiran), Toronto, Ont.

Abstract

BACKGROUND:

Sexual orientation and gender identity are key social determinants of health, but data on these characteristics are rarely routinely collected. We examined patients' reactions to being asked routinely about their sexual orientation and gender identity, and compared answers to the gender identity question against other data in the medical chart on gender identity.

METHODS:

We analyzed data on any patient who answered at least 1 question on a routinely administered sociodemographic survey between Dec. 1, 2013, and Mar. 31, 2016. We also conducted semistructured interviews with 27 patients after survey completion.

RESULTS:

The survey was offered to 15 221 patients and 14 247 (93.6%) responded to at least 1 of the sociodemographic survey questions. Most respondents answered the sexual orientation (90.6%) and gender identity (96.1%) questions. Many patients who had been classified as transgender or gender diverse in their medical chart did not self-identify as transgender, but rather selected female (22.9%) or male (15.4%). In the semistructured interviews, many patients expressed appreciation at the variety of options available, although some did not see their identities reflected in the options and some felt uncomfortable answering the questions.

INTERPRETATION:

We found a high response rate to questions about sexual orientation and gender identity. Fitting with other research, we suggest using a 2-part question to explore gender identity. Future research should evaluate the acceptability and feasibility of administering these questions in a variety of care settings. These data can help organizations identify health inequities related to sexual orientation and gender identity.

Conflict of interest statement

Competing interests: Andrew Pinto reports receiving personal fees from the University of Toronto, the Department of Family and Community Medicine at St. Michael’s Hospital, and from the Li Ka Shing Knowledge Institute at St. Michael’s Hospital and the Physicians’ Services Incorporated Foundation, outside the submitted work. Kimberly Devotta reports receiving grants from the Toronto Central Local Health Integration Network, during the conduct of the study. Tara Kiran reports receiving personal fees from the Toronto Central Local Health Integration Network, the Department of Community and Family Medicine at St. Michael’s Hospital and the University of Toronto, Health Quality Ontario and the Canadian Institutes of Health Research, outside the submitted work. At the time of the study, she was the Board Chair for the St. Michael’s Hospital Academic Family Health Team. No other competing interests were declared.

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