Research shows an overrepresentation of trans people in vulnerable socioeconomic situations, primarily due to experiences of discrimination. At the same time, rural or suburban living areas often lack specialized trans-related health care, which a majority of trans people rely on to some extent. Taken together, the lack of both socioeconomic resources and access to trans-related health care can exacerbate health-related distress and impairment for trans people. We illustrate this problem using case vignettes of trans people from rural and suburban areas in (Northern) Germany. They are currently participating in an e-health intervention and randomized controlled trial (RCT) called i2TransHealth, whose case vignettes provided the impetus for the scoping review. The scoping review analyzes the impact of place of residence and its intersection with barriers to accessing trans-related health care. PubMed and Web of Science Data bases were searched for relevant studies using a search strategy related to trans people and remote, rural, or suburban residences. 33 studies were selected after full-text screening and supplemented via reference list checks and study team expertise by 12 articles addressing the living conditions of remotely living trans people and describing requirements for trans-related health care. The literature on trans people living remotely reveals intersections of trans mental health with age, race, gender expression, geographic location, community size, socioeconomic status, discrimination experiences, and attitudes towards health care providers. Several structural health care barriers are identified. The role of health care professionals (HCPs) for remotely living trans people is discussed. There is no need assuming that rural life for trans people is inevitably worse for health and well-being than urban life. Nevertheless, some clear barriers and health disparities exist for trans people in remote settings. Empowering trans groups and diversity-sensitive education of remote communities in private and institutional settings are needed for respectful inclusion of trans people. Facilitating access to trans-related health care, such as through video-based e-health programs with HCPs, can improve both the health and socioeconomic situation of trans people.
Zusammenfassung Hintergrund Es wird geschätzt, dass 20–30 % der Studierenden die Tendenz zeigen, wichtige Aufgaben im Studium aufzuschieben. Diese Tendenz wird im Prokrastination-Gesundheitsmodell mit einer Beeinträchtigung des psychischen Befindens, erhöhtem Stresserleben sowie einem gesundheitsschädigenden Verhalten in Verbindung gebracht. Fragestellung Analysiert wird, ob die vorab postulierten Annahmen des Prokrastination-Gesundheitsmodells sich auch empirisch in einer Stichprobe von Studierenden bestätigen lassen. Material und Methode Im Januar und Februar 2019 wurden 3420 Studierende der Freien Universität Berlin in einer Onlinebefragung zu Prokrastination, Ängstlichkeit und Depressivität, ihrem Schlafverhalten sowie ihrem Stresserleben befragt. Zur Prüfung der Annahmen des Prokrastination-Gesundheitsmodells wurde ein Strukturgleichungsmodell formuliert, dessen Ergebnisse hier berichtet werden. Ergebnisse Die zentralen Annahmen des Prokrastination-Gesundheitsmodells konnten bestätigt werden. Ein hohes Maß an Prokrastination wirkt direkt auf die Ängstlichkeit und Depressivität und wirkt indirekt, sowohl über das Stresserleben als auch über die herabgesetzte Schlafqualität, auf das Befinden (Ängstlichkeit/Depressivität). Schlussfolgerungen Es erweist sich als sinnvoll, neben einer direkten gesundheitsbeeinträchtigenden Wirkung von Prokrastination auch die Auswirkungen vermittelt über das Stresserleben und das gesundheitsbezogene Verhalten in den Blick zu nehmen. Diese Ergebnisse müssen allerdings noch im Längsschnitt bestätigt werden.
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