“A transgender person is someone whose sex at birth is different from who they know they are on the inside. Many transgender people are prescribed hormones by their doctors to change their bodies. Some undergo surgery as well.”
This is the official definition of transgender. Not according to Wikipedia, World Professional Association for Transgender Health [WPATH], or the American Psychological Association. This definition of transgender was well crafted from the Goodwin Simon Strategic Research company; According to their website, “Goodwin Simon Strategic Research is a national public opinion research firm that uses cutting-edge research methodologies to unpack emotional reactions and develop effective message frameworks on socially sensitive issues.”
In other words, a focus group was used to craft a public palpable statement to define transgender. This definition was found to have tested well among a control group of participants across both conservative and liberal demographic lines and then was issued in report form to medical facilities, non-profit organizations and other entities that deal directly with people who are transgender.
There were four rounds of focus groups in both Oregon and California. Each round consisted of two-groups: One for men and one for woman. The focus groups in Gresham Oregon were white, straight, cisgender, moderate with a political spectrum ranging from conservative to liberal. The California focus groups were in Santa Ana and Riverside and met the same criteria as the Oregon focus groups, but the participants were Latino.
The study states, “In the focus groups, we tested a variety of messages, messengers, stories and short first-person videos
featuring both transgender and non-transgender people. After each round of focus groups, we revised and strengthened our language and approach based on what we learned.”
“Often, as committed advocates, it is easy for us to believe that simply presented facts and information will help others understand and agree with our goals. We want to put out the full truth of our issues or identities and demand understanding. However, our research showed us that this approach isn’t the most effective way to achieve our goals.”
Let that sink in for a moment and lets ask ourselves why these focus groups are being conducted and what is the data being used for.
Healthy People, Healthy Communities, A Toolkit for Effective Conversations About Transgender Healthcare Access took six months to produce and was put together by Basic Rights Oregon, Transgender Law Center, Fenton, Goodwin Simon Strategic Research and Wild Swan Resources. The outcome of the study resulted in a 19 page booklet sent to healthcare facilities that would help them communicate, in “everyday language,” with their transgender patients as well as an educational resource for non-transgender patients, doctors, nurses and other health care providers and non-profit organizations.
When put in the context of securing policy victories for transgender health care, the study begins to take on a different meaning, but reading the data used to help grow public support for transgender issues and benefits is difficult to digest, especially if you are transgender. Realizing the amount of work it takes to present a person who is transgender to the general public as a likeable human being produces conflicting emotions. Are we grateful for the research or are we discouraged knowing what is being said about us in brightly lit laboratories?
The research will certainly benefit our community and the objectives of the study are very clear. They are:
- Analyzing how advocates and opponents were framing the debate about inclusive transgender health benefits;
- Understanding the psychological dynamics that both facilitated or hindered support for inclusive transgender health benefits; and
- Testing a messaging approach that would foster understanding, encourage empathy, and build support for inclusive transgender health benefits.
In order to achieve these objectives, the researchers did a media audit of nearly 200 articles from print outlets in California and Oregon. More than 800 additional articles from online and alternative sources were evaluated as well as the public reactions in the comments section of the stories.
Besides the focus groups, there was also a review of the public opinion research based on qualitative and quantitative research including academic studies about people who are transgender. Finally, 15 one-on-one interviews were conducted with stakeholders; advocates, policymakers, human resource specialists, business leaders and medical professionals. Combined, the information provided a list of recommendations that are “aimed to equip advocates and activists with frameworks for talking about transgender people and their health care in a way that can help to overcome the empathy gap by promoting understanding and support – building eventually towards empathy.”
The study produced six recommendations to help increase public support for transgender healthcare issues by building “understanding and enable people to own their discomfort [for people who are transgender] as something that is happening inside of them. This current lack of understanding interferes with empathy.”
Building understanding through empathy was the first recommendation. “Empathy and understanding are the gateways to progress with audiences whose support we need to advance public policies in which health care coverage for transgender people is guaranteed.” The study continues, “When we failed to acknowledge that their experience of being exposed to transgender people and issues can feel confusing, people were unable to be supportive of health care coverage for transgender individuals. They remained emotionally stuck and confused. However, we can effectively start people on a journey towards understanding by beginning conversations with two simple yet essential elements – naming and normalizing confusion, and describing what it means to be transgender.”
Building understanding through shared basic human values is the next step. “when we are confused, the part of our brain called the amygdala [the part of our brain that regulates big negative emotions like fear, anxiety, and anger] is activated. Letting audiences know that it is okay to be confused is the first step in helping people calm their amygdala and access their thinking brain.” Describing, naming and normalizing confusion as to what it is like to be transgender can be difficult if you have never met a person who is transgender. According to recent statistics, only 8% of people polled have ever met a person who is transgender, so people begin to fill in the blanks with what is seen in the media, and this is often based on cartoonish stereotypes of “men in dresses” and “girls who have a special secret.”
“… It is helpful to know where people are starting from, because we can then craft messages that allow our target audiences to reconcile their own personal values with the progress we want to make in the world.” the study points out, “In our focus groups, we saw the power of “judge not” in how it helps our target audiences to get started on their journey toward acceptance.”
Telling stories was the third recommendation because it strengthens to support for a given cause and it allows people to accept new ideas. The message of “We all need different things to be healthy. While one person needs medicine to treat their asthma, another person needs ongoing support for diabetes. Transgender people also have unique health care needs. Unfortunately, insurance companies too often refuse to cover a transgender patient’s unique health care needs such as hormones. This leaves transgender people with big gaps in their coverage making their health care costly or even out of reach.” tested poorly among all of the focus groups. The kick-back being, “that everyone has special health care needs so why should transgender people receive special treatment?”
For round two of the focus groups, the message was revised into a story told from the perspective of a doctor and the “focus group participants not only believed that transgender people indeed might have genuine health care needs, but expressed their support for transgender individuals having health care coverage. Using stories helped participants to understand while calming the fear and confusion they might feel.” Additional stories that were told included ‘Journey Stories,’ ‘Stories that Highlight Struggle,’ ‘Stories with an Antagonist,’ ‘Stories that Embed Transgender People in Their Families,’ and ‘Stories in Effective Sequence.’
You’ve heard the saying Don’t Shoot the Messenger, however, it is often a basic rule in communication that the messenger can be just as important as the message. Using a strategic messenger was listed as the next recommendation in achieving support from the focus group. Although transgender people are important messengers because they are the experts of their bodies, the research team found that the focus groups relied more on the validation from doctors, and family members creating better success in helping to normalize “peoples discomfort” for a person who is transgender.
In previous articles, I’ve labeled it the “transgender merchandising machine.” Bruce Jenner, Laverne Cox, Transparent Series and various other networks running to capitalize on the transgender boon that is currently sweeping the nation. All of this has led to the fostering of familiarity. It’s recommended that “The more people see transgender characters on TV or meet someone in real life, the more prepared they will be to become supporters in our work for justice.”
This recommendation ties in well with the story telling framework previously discussed. According to the research group, these stories and “anecdotes demonstrate the value of mainstream media coverage of transgender people in shifting public opinion to recognize transgender identities as real and normal. Therefore, we believe it should be a continued priority for transgender advocates to find new and creative ways to leverage media to foster familiarity.”
All five of these recommendations culminate into the main point of the study and final recommendation; the ability to contextualize health care coverage for people who are transgender in conversations and stories. As we have witnessed over the last 6 years, the health care debate is a hot-button issue nationally and the general opinion by the public about physical and mental health care issues is that each individual needs to take responsibility and ownership of their health care needs.
In a society that disagrees [and legislates] on whether woman are even capable of making decisions around their own reproductive rights, the focus groups “showed that persuading the general public to support coverage for transition related surgery will be tough to do in the near future.” The only real movement in the focus groups was a general support in providing coverage for hormone replacement therapy.
The research finally concluded that “The biggest thing we can do right now to build support for transgender health care coverage is to build a sense of shared humanity with transgender people using the approaches described in this “tool kit” employ powerful stories about transgender people’s lives that can decrease confusion and discomfort, increase understanding, and foster familiarity.”
As a person who is transgender and know the importance of health care for the transgender community, this “tool kit” was incredibly painful to read. Having your life thrown into a focus group setting in the same manner that Coke and Pepsi utilize focus groups to decide what tastes more refreshing can be demoralizing, but you begin to realize that a study like this is necessary if we want to continue to receive wide spread support for our needs and win victories related to our safety and health.
So what did this research produce? It took 5 companies, 4 focus groups, 200 print articles, 800 online articles, and 6 months to produce a single page of a politically correct term for transgender simply titled, “How to Describe ‘Transgender’.”
Atticus Finch, the main character in Harper Lee’s To Kill a Mockingbird, may have said it best: “You never really know a man until you understand things from his point of view, until you climb into his skin and walk around in it.”