Inclusivity is critical to equitable healthcare.
When I’m writing any kind of public-facing materials I believe it’s important to be inclusive of and sensitive to all possible audiences.
I think this is especially true when the project is for eLearning because there’s a baked-in inference that the content is authoritative and models the preferred future behavior of the learner.
But what do you do when you sense that your source SME materials might be suboptimal in this regard? Should you shrug your shoulders and defer to the expertise of the SME? Or should you ask questions and do research to ensure that your materials do the best possible job of representing the subject and modeling the best practices for learners?
The Challenge
A while back, I was writing training materials for CareAcademy, a leader in the home healthcare industry, teaching caregivers how best to work with elderly and infirm patients. One series of lessons in particular taught caregivers to respectfully and sensitively work with patients in the LGBTQI community, particularly those who are trans.
As usual, I was working from existing SME documentation from experts whose professional experience and expertise would guide my lesson-building. One passage that I needed to integrate read:
“A male who has made a transition to being a female could be facing unique challenges.”
As soon as I read this my radar went up.
Why?
The sentence assumes that the subject was initially male which, based on my experience with friends and family in the community, does not represent their experience. They might have been assigned male at birth, but that’s very different from representing that they were gendered male.
My initial thought was to simply edit it to “A transgender woman could be…”
But I also have to keep in mind who my audience is; in this case, learners who are likely low-information on this topic and might struggle to understand whether a “transgender woman” was previously assigned female or is currently identifying as female.
Which, I’m sure, is why the SME had opted for a more explicit passage. After all, they were the expert, right? They should know the best practices and terminologies for this topic.
Right?
Maybe. But maybe their insights have become dated. Perhaps they aren’t a member of the community in question. It could be they’re using phrasing that was taught to them by someone who wasn’t really sure.
The Research
Not being transgender myself, it seemed best to reach out to both my writer colleagues and friends in the trans community for some guidance.
So I went to Facebook and posted my edit:
Friends who are well-informed on #transgender language and/or healthcare issues… I’m editing a doc to train healthcare pros on caring for older LGBT clients. Here’s how I would word it: “A transgender woman — that is, a person who was assigned male at birth but is now transitioning to female — could be…” Does that work for you?
I got some pretty quick and thoughtful responses:
“Assigned male at birth” is a great turn of phrase and gets around a lot of bioessentialist language. You could even edit it to say “a person who was assigned male at birth but now identifies as female” unless you want to imply that this person is undergoing some sort of biological transition (surgical or hormonal).
This felt like a good catch. I’d inadvertently inferred the subject was “transitioning.”
Then another friend, a transgender woman herself, replied:
I think the challenge with the phrase “assigned at birth” is that for some that implies a “legitimate identity” that is being altered, and for many transfolks that “legitimacy” is an additional barrier to adopting the identity they feel is actually authentic. What about “An individual who has transitioned to identify as female”?
This was an invaluable insight from someone who was far closer to the lived experience than I could ever be, no matter how much research I might do.
Addressing Sexual Orientation and Caregiver Bias
The SME document also acknowledged the possibility that a caregiver may not be comfortable with a client’s sexual orientation but still needs to provide respectful care. It included sentences like:
“Provide dignity and respect to LGBT clients, despite any feelings or concerns you have about their sexual orientation.”
But in that sentence, the “T” in the acronym isn’t about sexual orientation. The “T” is for transgender, which has nothing to do with sexual preference. Letting that sentence ride would telegraph two harmful things:
- That the learning provider — my client — doesn’t understand the difference between gender identity and sexual preference, calling into question the value and authority of the content.
- And it would teach our learners an incorrect understanding of the clients they’re trusted to care for.
Again, my tribe stepped up and gave me guidance, suggesting the phrase “who they are.”
“Provide dignity and respect to LGBT clients, despite any feelings or concerns you have about who they are.”
That, to me at least, was an elegant and respectful solution. It has a nice “person first” ring to it.
Tackling “Lifestyle” References
In my source SME doc, the authority wrote:
“Be sure the client knows you’re comfortable with their lifestyle choices.”
“Respect their lifestyle choices.”
Do you see the problems?
First, the caregiver may or may not be “comfortable” with the identity of their client. And in fairness, they don’t have to be. But they do have to give equitable care to their clients despite their level of comfort. So right away, there’s an edit on the horizon.
More importantly, I’ve personally always been troubled by the term “lifestyle choice.” Being an outdoorsy person who loves camping is a lifestyle choice. Spending free time gaming online is a lifestyle choice. Attaching “lifestyle choice” to the lives of LGBTQ clients carries a subtext that orientation and gender are a choice.
So when are “lifestyle” and “lifestyle choices” appropriate phrases, and when are they not?
Both GLAAD and Trans Media Watch provide terrific resources for understanding current preferences within the community and give guidance for writers and journalists.
At the time of my project, GLAAD stated:
There is no single lesbian, gay, or bisexual lifestyle. Lesbians, gay men, and bisexuals are diverse in the ways they lead their lives. The phrase “gay lifestyle” is used to denigrate lesbians, gay men, and bisexuals suggesting that their orientation is a choice and therefore can and should be “cured”.
Offensive: “gay lifestyle” or “homosexual lifestyle”
Preferred: “gay lives,” “gay and lesbian lives”
GLAAD
Why This Matters
As eLearning writers, especially writers who are refining SME materials provided by authorities, we tread a fine line. We’re not the Subject Matter Experts… but we are experts at simplifying and communicating complicated ideas. Chances are, we’re better at it than the SME is.
That’s why we get hired… to make smart people sound even smarter, and help them better share their expertise with non-expert audiences.
So it’s not just our job to edit unruly sentences into ensmoothened sentences.
It’s our job to keep in mind not only our clients’ goals but the needs of the learners who will ultimately consume the materials. We need to understand the level of expertise they come to the course with, what outcomes the training needs to deliver, and how that new knowledge will serve them.
So we need to be willing to go the extra mile when we see potentially troublesome SME content and either ask our clients to clarify, or dig in and educate ourselves so we can deliver the best possible materials.
This particular project wasn’t just a lesson that mentioned LGBTQI clients… it was specifically about respecting and caring for those clients. So it was extra critical to be sure the language was current and accurate.
It’s what my clients, the SMEs, and the learners deserved.
Engage
I’d love to hear your thoughts on this article.
And if you’d like to learn more about what I do, please check out how I write for elearning.
Chip Street - Writey Guy 