i2TransHealth: Interdisciplinary, Internet-based Trans Health Care

November 3, 2022 updated by: Timo Nieder, Universitätsklinikum Hamburg-Eppendorf

Interdisciplinary, Internet-based Trans Health Care (i2TransHealth): A Randomized Controlled Trial

i2TransHealth is a randomized controlled trial that investigates the outcomes of an internet-based health care approach for transgender and gender diverse (TGD) people. As a health services research project, i2TransHealth aims at reducing the structural disadvantage for TGD people [people with transsexualism (TS: ICD-10), gender incongruence (GIC: ICD-11) and/or gender dysphoria (GD: DSM-5)] living in areas lacking specialized transition-related treatment.

Located at the Institute for Sex Research and in cooperation with the Interdisciplinary Transgender Health Care Center Hamburg (ITHCCH), both University Medical Center Hamburg-Eppendorf (UKE), i2TransHealth is an innovative intervention including video consultation and a 1:1 chat with clinical psychologists. By cooperating with the ITHCCH, general physicians and psychiatrists provide first and local access to the specialized treatment provided by the UKE.

In the intervention group, the study participants are invited to use the i2TransHealth e-health platform including a video consultation hour every two weeks and a messenger between the video-meetings. In addition, they have the opportunity to receive medical support close to their home by licensed GPs and psychiatrists according to their needs (especially in case of a somatic or mental health crisis). The waiting group participants will be able to go forward with transition-related care after four months of study participation, as part of regular care.

The primary outcome measure is a reduced symptomatology for TGD people (BSCL). Secondary outcome parameters include quality of life and patient satisfaction as well as healthcare-related costs and cost-effectiveness. Finally, based on a longitudinal design, it will be assessed if the physicians improve their TGD-related expertise by cooperating within the i2TransHealth-network.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

186

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Germany
      • Hamburg, Germany, 20246
        • University Medical Center Hamburg-Eppendorf

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Age 18 years or older
  • Gender different from their assigned sex at birth
  • resident at least 50 km outside Hamburg
  • present themselves with treatment needs (TS/GD) to one of the participating physicians in the i2TransHealth network, or direct contact with institute and/or e-health platform
  • receive the suspected diagnosis TS/GD during an initial interview in the UKE
  • can operate the video chat cognitively, verbally and auditory
  • Able to read, speak, and understand German
  • Written informed consent after written and oral information

Exclusion Criteria:

  • Under 18 years of age
  • Missing informed consent
  • Unable to speak German
  • Indication for inpatient treatment, e.g. due to acute psychotic symptoms (self-report, Prodromal Questionnaire, PQ-B) or severe depressive symptoms (self-report, BDI-II ≥ 29)
  • Acute suicidal tendencies
  • Decrease in intelligence (IQ below 70)
  • Acute drug intoxication
  • Failure to meet technical requirements (no Internet access, lack of IT knowledge)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: intervention group
TGD people (n = 82) receive 4 months of e-health intervention according to the i2TransHealth model of care (intervention group)
Other: i2TransHealth
i2TransHealth: online intervention for TGD people
No Intervention: waiting group
TGD people (n = 82) wait 4 months until they are offered regular care (waiting group), which can include video consultation

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Symptom burden according to BSI-18
Time Frame: Change from Baseline Mental Health Symptoms to the point of time after online intervention (Baseline + 4 months)

References:

Franke, G. H. (2000). Franke, G.H. (2000). BSI. Brief Symptom Inventory - Deutsche Version. Manual. Göttingen: Beltz.
Change from Baseline Mental Health Symptoms to the point of time after online intervention (Baseline + 4 months)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Quality of Life (physical health, psychological health, social relationships, and environment)
Time Frame: Change from Baseline QoL to the point of time after online intervention (Baseline + 4 months)]

QoL is measured using the WHOQOL-BREF (WHO, 1998).

References:

Angermeyer, M. C., Kilian, R., & Matschinger, H. (2000). WHOQOL - WHOQOL-100 und WHOQOL-BREF. Handbuch für die deutschsprachigen Versionen der WHO Instrumente zur Erfassung von Lebensqualität.

WHO (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological medicine, 28(3), 551-558.
Change from Baseline QoL to the point of time after online intervention (Baseline + 4 months)]
Treatment satisfaction according to modified version ZUF-8
Time Frame: Treatment satisfaction at the point of time after online intervention (4 months after admission to studies)

References:

Schmidt, J., Lamprecht, F., & Wittmann, W. W. (1989). Zufriedenheit mit der stationären Versorgung. Entwicklung eines Fragebogens und erste Validitätsuntersuchungen. [Satisfaction with inpatient care: Development of a questionnaire and first validity assessments.]. PPmP: Psychotherapie Psychosomatik Medizinische Psychologie, 39(7), 248-255.
Treatment satisfaction at the point of time after online intervention (4 months after admission to studies)
Direct or indirect costs and productivity losses by persons with TS/GD in comparison to the German general population (via CSSRI)
Time Frame: Change from Baseline to the point of time after online intervention (Baseline + 4 months)

References:

Chisholm, D., Knapp, M. R. J., Knudsen, H. C., Amaddeo, F., Gaite, L., Wijngaarden, B. van, & Group, E. S. (2000). Client Socio-Demographic and Service Receipt Inventory - European Version: Development of an instrument for international research: EPSILON Study 5. The British Journal of Psychiatry, 177(S39), s28-s33. https://doi.org/10.1192/bjp.177.39.s28
Change from Baseline to the point of time after online intervention (Baseline + 4 months)
Health-related quality of life (via EQ-5D-5L): quality-adjusted life years (QALYs)
Time Frame: Change from Baseline to the point of time after online intervention (Baseline + 4 months)

References:

Herdman, M., Gudex, C., Lloyd, A., Janssen, MF., Kind, P., Parkin, D., … Badia, X. (2011). Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of Life Research, 20(10), 1727-1736. https://doi.org/10.1007/s11136-011-9903-x
Change from Baseline to the point of time after online intervention (Baseline + 4 months)
Knowledge increase of the cooperating physicians on trans health care (via VSE)
Time Frame: Change from Baseline to the point of time after study completion (Baseline + 18 months)

References:

Raupach, T., Schiekirka, S., Münscher, C., Beißbarth, T., Himmel, W., Burckhardt, G., & Pukrop, T. (2012). Implementierung und Erprobung eines Lernziel-basierten Evaluationssystems im Studium der Humanmedizin. GMS Zeitschrift für medizinische Ausbildung, 29(3), 1-14.
Change from Baseline to the point of time after study completion (Baseline + 18 months)
Satisfaction of the cooperating physicians with the support in the i2TransHealth network (via modified version ZUF-8)
Time Frame: Satisfaction at the point of time after study completion (18 months)

References:

Schmidt, J., Lamprecht, F., & Wittmann, W. W. (1989). Zufriedenheit mit der stationären Versorgung. Entwicklung eines Fragebogens und erste Validitätsuntersuchungen. [Satisfaction with inpatient care: Development of a questionnaire and first validity assessments.]. PPmP: Psychotherapie Psychosomatik Medizinische Psychologie, 39(7), 248-255.
Satisfaction at the point of time after study completion (18 months)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Universitätsklinikum Hamburg-Eppendorf

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 1, 2020

Primary Completion (Actual)

May 31, 2022

Study Completion (Actual)

September 30, 2022

Study Registration Dates

First Submitted

February 26, 2020

First Submitted That Met QC Criteria

February 26, 2020

First Posted (Actual)

February 28, 2020

Study Record Updates

Last Update Posted (Actual)

November 4, 2022

Last Update Submitted That Met QC Criteria

November 3, 2022

Last Verified

November 1, 2022

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • i2TransHealth

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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