Objectives: To evaluate the experienced barriers of care for treatment-seeking trans individuals (TSTG) in three large European clinics. Methods: An online follow-up questionnaire was filled out by 307 TSTG individuals as part of the research protocol of the European Network for the Investigation of Gender Incongruence (ENIGI). Data was collected during follow-up in 2017/2018, around 5 years after participants had their initial clinical appointments in Ghent (Belgium), Amsterdam (the Netherlands), or Hamburg (Germany). Background characteristics, country, treatment characteristics and mental health were analyzed in relation to experienced barriers of care (EBOC, measured though agreement with statements). Results: The majority of participants reported various EBOC, oftentimes more than one. The most-frequently reported EBOCs pertained to the lack of family and friends’ support (28.7%, n = 88) and travel time and costs (27.7%, n = 85), whereas around one-fifth felt hindered by treatment protocols. Also, a significant share expressed the feeling that they had to convince their provider they needed care and/or express their wish in such way to increase their likelihood of receiving care. A higher number of EBOCs reported was associated with more mental health problems, lower income and female gender. Conclusions: A substantial number of TSTG individuals within three European health care systems experiences EBOCs. EBOCs relate to both personal and systemic characteristics. These findings can help health care providers and centers to improve care. More research must be done to better understand the diversity among TSTG individuals and the corresponding barriers experienced. Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1964409

Background: Gender-affirming treatments are reported to improve mental health significantly. However, a substantial number of transgender individuals report a relapse in, or persistence of, mental health problems following gender-affirming treatments. This is due to multiple stressors occurring during this period, and in general as a consequence of widespread stigma and minority stress. Aim: The aim of this pilot study was to identify different coping strategies that transgender individuals use in response to stressors prior to and following gender-affirming treatments, as mediator of mental health. Methods: Qualitative interviews were conducted to better understand the treatment outcomes and healthcare experiences of Dutch transgender individuals who had received gender-affirming treatments. Nineteen participants were included, of which 12 identified as (transgender) male, six as (transgender) female and one as transgender. Outcomes: Inductive coding and theory-informed thematic analysis were used to assess stressors (ncodes = 335) and coping strategies (ncodes = 869). Results: Four stressor domains were identified, including lack of support system, stressors related to transition, and physical and psychosocial stressors post-transition. We identified six adaptive coping strategies of which acceptance, help seeking and adaptive cognitions concerning gender and transition were reported most frequently. Of the seven maladaptive strategies that we identified, social isolation and maladaptive cognitions concerning gender and transition were the most-reported maladaptive coping strategies Clinical implications: The results indicated that transgender individuals may experience significant stress, both transgender-specific and non-specific, prior to and following gender-affirming treatments and, as a result, use many coping strategies to adapt. Increased awareness of stressors and (mal)adaptive coping strategies may help to improve mental healthcare and overall support for transgender individuals. Strengths and Limitations: This is the first (pilot) study to provide insight into the range of stressors that transgender individuals experience during and after gender-affirming treatments, as well as the variety of coping strategies that are used to adapt. However, since this was a pilot study assumptions and generalizations of the evidence should be made cautiously. Conclusion: Results of this pilot study showed that transgender individuals may undergo significant stress during and after gender-affirming medical treatment related to the treatments and the social experiences that occur during this period, and as a result, use a range of coping strategies to adapt to the stress.

Patients with COPD are required to take long-term treatments to treat their chronic disease and avoid further complications. However, lack of adherence is very common and represents major barriers to treatment efficiency. Measuring patient acceptance of their medication should help to better understand and predict patients' medication-taking behavior. Objectives: The objectives of this study are to evaluate the level of acceptance to medication in patients with COPD in real life; to identify issues and to define priorities for action. MethOds: This is an observational, crosssectional study conducted in Europe using Carenity Online Community. Adult COPD patients were invited to complete an online questionnaire including a validated patient reported outcome measure: the 25-item ACCEptance by the Patients of their Treatment (ACCEPT©). It includes one general acceptance dimension (Acceptance/ General) and five multi-item treatment-attribute specific dimensions: Acceptance/ Medication Inconvenience, Acceptance/Long-term Treatment, Acceptance/Regimen Constraints, Acceptance/Side Effects, Acceptance/Effectiveness, scored from 0-100 (lowest to highest acceptance). Patients were categorized according to their main treatment class: adrenergics, inhalants; other drugs for obstructive airway diseases, inhalants; other COPD treatment. Results: 117 patients with COPD were included. Mean Acceptance/General score was of 56.27 ± 33.95. Significant differences (p < 0.05) were found between groups defined by treatment class on Acceptance/ General and Acceptance/Effectiveness. Pearson correlations showed Acceptance/ General to be highly correlated with Acceptance/ Effectiveness (R = 0.64). Having side effects and their unpleasantness were the main reported issues. cOnclusiOns: Treatment acceptance is not satisfactory in COPD. Patients' treatment acceptance is primarily driven by its effectiveness and limitations for COPD. These findings give indications about patients' priorities and unmet needs for COPD.

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