Community engagement to improve access to healthcare: A comparative case study to advance implementation science for transgender health equity

Abstract

BackgroundRecent calls to action have been made for Implementation Science to attend to health inequities at the intersections of race, gender, and social injustice in the United States. Transgender people, particularly Black and Latina transgender women, experience a range of health inequities and social injustices. In this study, we compared two processes of transgender community-engagement in Los Angeles and in Chicago. The study addressed inequitable access to care and adapted and extended the Exploration Planning Implementation and Sustainment (EPIS) framework for transgender health equity. MethodsA comparative case method and the EPIS framework were used to examine parallel implementations of transgender community engagement to expand access to care. In order to foster the conceptual development and adaptation of EPIS for trans health equity, the comparative case method required detailed description, exploration, and analyses of the community-engagement processes to expand access to healthcare. In both cities, the unit of analysis was a steering committee made up of local transgender and cisgender stakeholders. ResultsBoth steering committees initiated their exploration processes with World Café-style, transgender community-engaged events in order to assess community needs and structural barriers to healthcare. The steering committees curated activities that amplified the voices of transgender community members among stakeholders, encouraging more effective and collaborative ways to advance transgender health equity. Based on analysis and findings from the Los Angeles town hall, the steering committee worked with a local medical school, extending the transgender medicine curriculum and incorporating elements of transgender community-engagement. The Chicago steering committee determined from their findings that the most impactful intervention on structural racism and barriers to healthcare access would be to design and pilot a transgender employment program. ConclusionIn Los Angeles and Chicago, transgender community-engagement guided exploration, planning, and implementation processes and led to critical insights regarding specific, local structural barriers to healthcare. The steering committee itself represented an important vehicle for individual- and community-level relationship and capacity building. This comparative case study highlights key adaptations of EPIS toward the formation of an implementation science framework for transgender health equity.