Recommendations from Transgender Healthcare Consumers in Rural Areas

Knutson, Douglas; Martyr, Meredith A.; Mitchell, Travis; Arthur, Tori; Koch, Julie M.

doi:10.1089/trgh.2017.0052

Cited by 46 publications

(41 citation statements)

References 27 publications

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“…5 However, much of the research on the transgender population has been primarily conducted in urban areas and is very limited within rural communities. 6 There is also evidence that transgender individuals experience barriers to health care in the form of lacking equitable access to quality health insurance, are more likely to be uninsured, and have no usual source of health care when compared to the cisgender population. 7 In addition, there is little research regarding the specific sexual and reproductive health needs of this population.…”

Section: Introductionmentioning

confidence: 99%

Do Transgender and Gender Diverse Individuals Receive Adequate Gynecologic Care? An Analysis of a Rural Academic Center

2020

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The transgender population faces disparities accessing gynecologic health care services, especially in rural settings. There is limited knowledge among medical providers regarding transgender-specific gynecologic care. Methods: A retrospective chart review of 255 transgender and gender diverse patients at a rural, academic center and associated ambulatory clinics was performed. Demographics, insurance status, and utilization rates of screening services, including cervical cancer, breast cancer, human papillomavirus (HPV) vaccination status, and contraceptive status, were analyzed using descriptive statistics. These rates were compared with national rates of cisgender individuals. Chi-square tests were performed to assess the association of insurance status with receipt of services. Results: Prevalence of HPV vaccination was lowest among transgender men (20%) compared with transgender women (60%) and gender nonbinary/nonconfirming and gender diverse individuals (60%), p < 0.001. Our cohort was significantly less likely to receive Papanicolaou smears (51% vs. 81%, p < 0.05) and contraception (48% vs. 65%, p < 0.05) than cisgender individuals. Around 18% of transgender women had a documented pelvic examination in the past year. There was no significant difference in utilization rates based on insurance status. Conclusion: In our rural setting, there is lower utilization of gynecologic services among transgender and gender diverse individuals. Although participants in our study had high rates of access to insurance and health care providers, they still had lower rates of gynecologic screening and prevention services. To address these disparities, we advocate for developing transgender-specific gynecologic health maintenance guidelines, robust provider education, and an inclusive electronic medical record to ensure appropriate gynecologic health screening.

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Section: Introductionmentioning

confidence: 99%

Do Transgender and Gender Diverse Individuals Receive Adequate Gynecologic Care? An Analysis of a Rural Academic Center

2020

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“…People who are trans or gender non-binary can experience many challenges in their daily lives that can significantly impact upon their general and psychosocial well-being. Healthcare experiences vary worldwide where transgender-specific needs and requirements are being increasingly recognised and specific stigma-related barriers to healthcare identified [ 27 , 29 , 32 , 40 , 42 , 43 ]. The impact of discrimination and prejudicial societal attitudes and behaviours can result in issues related to minority stress further compounded by marginalisation and social exclusion experiences [ 30 , 31 , 33 , 34 , 38 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

“…Each study could score ‘high’ ‘medium’ or ‘low’ depending on specific criteria. A total of sixteen studies achieved ‘high’ scores [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Medium scores were achieved by two studies [ 43 , 44 ].…”

Section: Methodsmentioning

confidence: 99%

Experiences and Perceptions of Trans and Gender Non-Binary People Regarding Their Psychosocial Support Needs: A Systematic Review of the Qualitative Research Evidence

McCann

Donohue

Brown

2021

IJERPH

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People who identify as trans and gender non-binary experience many challenges in their lives and more interest is being paid to their overall health and wellbeing. However, little is known about their experiences and perceptions regarding their distinct psychosocial needs. The aim of this systematic review is to critically evaluate and synthesize the existing research evidence relating to the unique psychological and social experiences of trans people and identify aspects that may help or hinder access to appropriate psychosocial interventions and supports. The PRISMA procedure was utilized. A search of relevant databases from January 2010 to January 2021 was undertaken. Studies were identified that involved trans people, and addressed issues related to their psychosocial needs. The search yielded 954 papers in total. Following the application of rigorous inclusion and exclusion criteria a total of 18 papers were considered suitable for the systematic review. Quality was assessed using the MMAT instrument. Following analysis, four themes were identified: (i) stigma, discrimination and marginalization (ii) trans affirmative experiences (iii) formal and informal supports, and (iv) healthcare access. The policy, education and practice development implications are highlighted and discussed. Future research opportunities have been identified that will add significantly to the body of evidence that may further the development of appropriate health interventions and supports to this population.

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“…Rural settings often lack specialty clinics and trained clinicians for transgender patients. Instead, care is provided by clinicians who are unfamiliar with transgender people and their specific healthcare needs [3][4][5]. Transgender patients may avoid seeking medical care due to a history of traumatizing interactions with healthcare providers [6] and the inability to locate affirming providers.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Use of the Consolidated Framework for Implementation Research to Evaluate the Creation of a Rural Center of Excellence in Transgender Health

Tinc

Wolf-Gould

et al. 2020

IJERPH

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Background: Transgender people face numerous barriers to accessing care, particularly in rural settings. Transportation, travel time, a lack of providers offering transgender care, and discrimination all contribute to these barriers. The Gender Wellness Center was established in New York State, USA, to fill a gap in rural transgender care and was subsequently awarded a Robert Wood Johnson Foundation grant to establish a Center of Excellence. This study examined the implementation of the Center of Excellence, a complex intervention, to assess barriers and facilitators to implementation over 18 months. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to develop baseline and follow-up surveys. These were distributed to members of the core implementation team at the Gender Wellness Center at the midpoint and conclusion of the Robert Wood Johnson Foundation grant. Responses were largely open-ended and analyzed qualitatively. Results: Results are presented in terms of CFIR domains and constructs, as well as the relative outlook (positive or negative) of implementation. Overall, there were improvements over time, with more encouraging feedback and examples of success at follow-up. Though true, organizational culture and individual beliefs about the provision of transgender care challenged implementation of the Center of Excellence throughout the project. Conclusions: This study highlights the importance of organizational culture on implementation efforts, as well as the need for complex, multifaceted interventions to overcome such challenges in order to improve care for marginalized populations.

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Recommendations from Transgender Healthcare Consumers in Rural Areas

Cited by 46 publications

References 27 publications

Do Transgender and Gender Diverse Individuals Receive Adequate Gynecologic Care? An Analysis of a Rural Academic Center

Do Transgender and Gender Diverse Individuals Receive Adequate Gynecologic Care? An Analysis of a Rural Academic Center

Experiences and Perceptions of Trans and Gender Non-Binary People Regarding Their Psychosocial Support Needs: A Systematic Review of the Qualitative Research Evidence

Longitudinal Use of the Consolidated Framework for Implementation Research to Evaluate the Creation of a Rural Center of Excellence in Transgender Health

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