Trans*Forming Access and Care in Rural Areas: A Community-Engaged Approach

Abstract

Research indicates that rural transgender and gender diverse (TGD) populations have a greater need for health services when compared with their urban counterparts, face unique barriers to accessing services, and have health disparities that are less researched than urban TGD populations. Therefore, the primary aim of this mixed-methods study (n = 24) was to increase research on the health care needs of TGD people in a rural Appalachian American context. This study was guided by a community-engaged model utilizing a community advisory board of TGD people and supportive parents of TGD children. Quantitative results indicate that travel burden is high, affirming provider availability is low, and the impacts on the health and mental health of TGD people in this sample are notable. Qualitative results provide recommendations for providers and health care systems to better serve this population. Integrated mixed-methods results further illustrate ways that rural TGD people and families adapt to the services available to them, sometimes at significant economic and emotional costs. This study contributes to the small but growing body of literature on the unique needs of rural TGD populations, including both adults and minors with supportive parents, by offering insights into strategies to address known disparities.

Interventions for Body Composition and Upper and Lower Extremity Muscle Strength in Older Adults in Rural Taiwan: A Horizontal Case Study

“…Due to changes in their living environment and reductions in their number of family members [5], in addition to chatting with the older adults in the village, most of the older adults in rural areas said that they tended to sit at home for long periods, watch TV, and generally live monotonous daily lives [6]. This was consistent with the research of many scholars [1,39,40]. The lack of awareness of the benefits of exercise among older adults in rural Taiwan, resulting in increased physical frailty or obesity, was consistent with the findings of many scholars, and is believed to be related to a lack of physical exercise in this area [25,29,41,42].…”

Instruments used to assess gender-affirming healthcare access: A scoping review

“…Regarding approachability, the most significant factor identified was the lack of service information, as indicated in thirteen of the studies [ 25 – 29 , 38 – 39 , 41 , 46 – 50 ]. Transgender and gender diverse individuals encountered difficulties in sourcing accurate information about service availability and the available interventions.…”

“…These results suggest that cultural and societal values and norms may profoundly influence healthcare behaviour across these groups. Importantly, this dimension highlights the critical role of support and acceptance from family and peers in influencing healthcare access in twelve of the included studies [ 25 , 26 , 28 , 29 , 37 , 39 , 41 , 44 – 46 , 49 , 57 ].…”

“…The present cohort of patients considered affordability as a crucial determinant for accessing healthcare services. Financial cost emerged as the most frequently cited factor impacting access (n = 22) [ 18 , 20 , 25 , 26 , 28 – 30 , 38 , 39 , 41 – 43 , 45 , 47 – 50 , 52 , 55 , 56 , 59 , 61 ]. Financial factors emerged as a predominant concern in studies conducted in the United States, reflecting the American context, where most studies were based.…”

“…In contrast, studies conducted in European settings, highlighted waiting times and the appropriateness of services as prominent factors influencing healthcare access for transgender and non-binary individuals. Issues related to insurance coverage and denial were commonly examined in the included studies (n = 18) [ 17 , 20 , 21 , 26 , 28 – 30 , 37 , 39 , 41 – 43 , 48 , 52 , 55 , 56 , 58 , 59 ].…”