Understanding community member and health care professional perspectives on gender-affirming care—A qualitative study

Abstract

Background Transgender and gender diverse (TGD) people experience significant barriers to accessing affirming health services. There is a paucity of literature examining how both community members and health care professionals (HCPs) understand potential causes and solutions for these barriers, particularly in non-urban settings. Objective We present the first systematic examination of perspectives from community members and HCPs regarding barriers to and solutions for promoting access to gender-affirming health care. Design Study activities were conducted through the Plan and Act for Transgender Health (PATH) Project, a health needs assessment of TGD people. Community members in the catchment area were recruited to participate in focus group discussions about access to gender-affirming health care and optimal health service delivery models in March-October 2019. HCPs were recruited to participate in focus group discussions or in-depth interviews about experiences working with TGD clients. Data were analyzed using an inductive grounded theory approach. Setting 25 rural counties in Massachusetts, New York, Connecticut, Vermont, and New Hampshire. Participants Study participants included 61 adult TGD community members and 23 HCPs working in the catchment area. Results Both community members and HCPs spoke of the need for connectedness and linkages among disparate health system components for gender-affirming health care. Participants expressed this priority through calls for systems-level improvements within existing services (e.g., expanded data collection, expanded mental health services, inclusive and affirming health care environments, and TGD staff). They also expressed the need for expanded TGD community outreach and engagement (e.g., incorporation of a patient feedback process, TGD health navigators, and resource mapping). Limitations Findings specifically reflect the perspectives of community members and HCPs in the rural New England area. Furthermore, the study sample was predominantly White non-Hispanic. Conclusion Interventions to achieve accessible gender-affirming health care must address the diverse perspectives and needs of both community members and HCPs.

Barriers to Accessing Health Care in Rural Regions by Transgender, Non-Binary, and Gender Diverse People: A Case-Based Scoping Review

“…In a recent qualitative interview study of 2021 with 61 adult transgender and gender diverse people and 23 HCPs of all ages 18 and older, all from 25 different rural U.S. counties, trans people cite urgent community mental health needs such as, in addition to moving away from binary settings, increased accessibility of MHPs through more flexible solutions such as e-health approaches ( 55 ). HCPs of the same study did not come up with this idea, focused on existing approaches and systems in ensuring mental health care, but criticize that rural care cannot keep up with urban centers for health care ( 55 ). Meanwhile, qualitative interview data from Australia and the United States show that the Internet has become an important resource of information and community building for trans people seeking help ( 41 , 43 ).…”

“…Therefore, in light of previous articles and assessments, expanding online (and offline) trans support groups ( 41 ) as well e-health approaches ( 3 , 4 ) could have a beneficial effect on trans-related health care, reduce financial burdens, and optimize the internet’s health care potential. Trans people themselves also expect e-health approaches to improve health care in terms of better accessibility and flexibility ( 55 ).…”

Prevalence and Factors Associated With Gender-Affirming Surgery Among Transgender Women & Transgender Men in a Community-Based Clinic in Metro Manila, Philippines: A Retrospective Study

“…Given the high utilization of gender-affirming services in VLY and the high prevalence of self-medication and peer-prescribing, there is a need to upscale peer-led community-based medical interventions to increase healthcare access among transgender adults, especially that this approach facilitates familiarity and decreases the perception of healthcare-related stigma. 42 , 47 Moreover, the growing evidence of increased uptake of HIV testing, prevention, and care services, 48 , 49 mental health services, counseling, and peer support in community-based settings, 50 have reinforced the idea of a multi-service, one-stop-shop, all-inclusive approach as cost-effective mechanisms to facilitate healthcare access among transgender people.…”

Gender-Affirming Telepsychology During and After the COVID-19 Pandemic: Recommendations for Adult Transgender and Gender Diverse Populations

“…Next, verbally confirm the patient's affirmed name and pronouns listed on the intake packet. Providing Sam with the intake packet and verbally checking back with Sam about the information on the intake packet, and the health service psychologist’s self-disclosure of pronouns, informed Sam that the health service psychologist had an awareness of gender-affirming practices (Loo et al, 2021 ; Sequeira et al, 2021 ).…”