Assessing Health Provider Perspectives Regarding Barriers American Indian/Alaska Native Transgender and Two-Spirit Youth Face Accessing Healthcare

Abstract

Assessing health provider perspectives regarding barriers American Indian/Alaska Native transgender and Two-Spirit youth face accessing healthcare Alessandra AngelinoChair of the Supervisory Committee:Background: American Indian/Alaska Native (AI/AN) youth disproportionately face barriers accessing healthcare when compared to non-AI/AN youth. Additionally, youth who identify as both AI/AN and transgender or Two-Spirit face higher rates of mental health issues and suicidality, along with increased rates of non-communicable and communicable disease. These disparities primarily result from severe health inequity and historical trauma. There is therefore a need to assess what barriers exist among AI/AN transgender and Two-Spirit youth.Understanding both provider and patient-side barriers in this vulnerable population has implications for improving patient care and reducing health disparities for AI/AN transgender and Two-Spirit youth.Objectives: This project evaluated health provider knowledge of LGBTQ2S health and historical context surrounding gender identity in AI/AN communities. It assessed provider perspectives of provider-side and patient-side barriers accessing care, in order to gain insight and develop suggestions for improvement. Provider type, clinic affiliation, and clinic location were also evaluated to determine impact on provider perspectives.Methods: Semi-structured interviews (SSI) and focus group discussions (FGD) were held among providers affiliated with three reservation-based tribal health centers and a non-tribal 4 tertiary children's hospital in the Pacific Northwest. The question guide used was developed using a community-based participatory research conceptual model, considering the impact of context, partnerships, and community knowledge on barriers to care and provider perspectives.SSI and FGD lasted for 30-60 minutes, were audio-recorded, and transcribed verbatim. All providers cared for AI/AN youth (< 18 years) who identify as transgender or Two-Spirit. SSI and FGD were analyzed using a grounded theory approach to understand barriers and themes. This project received exemption from the University of Washington IRB and approval from each tribal ethical and/or research committee.Results: Twenty healthcare providers participated in this study and represented a number of geographic settings, provider types, and ethnic backgrounds. Participant knowledge regardingLGBTQ2S health and historical context surrounding gender in Native communities varied, although participants felt their understanding and comfort was limited. The long-standing effects of settler colonialism, trauma, and systemic issues such as marginalization and an antiquated medical system presented as overarching concepts. Participants also presented a number of patient-side and provider-side barriers impacting access to care for these patients, and suggested solutions to reduce these barriers at the provider, patient, and systemic levels. Geography, and occasionally provider type, appear to influence barriers and the solutions prov...

Health Care Access and Lived Experience of American Indian/Alaska Native Two Spirit and LGBTQ+ Participants in the Pride and Connectedness Survey, 2020

“…While health care providers working in Native health care settings receive some training in Indigenous culture, many do not receive training in Two Spirit and LGBTQ+ care or the limitations of colonial approaches to gender and sexuality as they relate to Indigenous concepts, including the nuances of Two Spirit identity, which transcends gender identity. 3 Moreover, the participants’ experienced fear associated with gender identity/sexual orientation exposure in the health care system echoes the findings of national surveys from 2015 1 and 2020, 23 reaffirming the need for gender-affirming environments in the health care system, especially when considering the unique health care needs of gender-diverse people. As some participants in our study indicated, their health care providers were unsure and unaware of how to treat and care for them once their gender identity was disclosed.…”

“…1,2 Furthermore, stigma, discrimination, and lack of gender-affirming care limit the ability of AI/AN people who are transgender and Two Spirit to engage in and benefit from health care settings. 3 Although gender identity and diversity within Native communities was once widely accepted and venerated, the process of colonization often altered the status of Two Spirit people in their communities, forcing assimilation into a Eurocentric culture that rejected such diversity. 4 Today, as a result of such colonization, AI/AN 2SLGBTQ+ people are often associated with health and social disparities, which are likely traceable to barriers to seeking and accessing health care, especially for Two Spirit and transgender people.…”

“…1,2 Furthermore, stigma, discrimination, and lack of gender-affirming care limit the ability of AI/AN people who are transgender and Two Spirit to engage in and benefit from health care settings. 3…”

Oppressions et barrières systémiques en relation d’aide pour les populations marginalisées

“…ex., Sue et al, 1992;Shin et al, 2016;Rachédi, et Taïbi, 2019;Gouveia et Zanello, 2019), le colonialisme (p. ex., Angelino et al, 2020;Rachédi, et Taïbi, 2019;Nelson, et Wilson, 2018), le sexisme (p. ex., Foster, et May, 2003), le patriarcat (p.…”

Caring for American Indian and Alaska Native Children and Adolescents

“…Lesbian, gay, pansexual, bisexual, transgender, gender queer, intersex, and Two-Spirit AI/AN youth experience exponential increases in risk for health disparities. [60][61][62][63] "Two-Spirit" is a unifying term that encompasses both gender identity and traditional Indigenous understandings of identity and is a widely used term in Indigenous communities across North America. In the 2015 US National Transgender Health Survey, AI/AN transgender respondents reported having experienced harassment (86%), physical assault (51%), and sexual assault (21%).…”