Affiliation:
1. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine Lebanon New Hampshire USA
2. Center for Applied Research and Educational Improvement, College of Education and Human Development University of Minnesota St Paul Minnesota USA
3. Department of Mental Health Law & Policy University of South Florida Tampa Florida USA
4. Department of Health Policy and Management Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
Abstract
AbstractObjectiveTo determine the barriers transgender and gender nonconforming (TGNC) adults face when accessing or receiving healthcare in the United States.Data Sources and Study SettingPrimary data were collected between September 2022 and March 2023 from a purposive sample of TGNC adults (N = 116 participants) using an online survey with a series of open‐ended and closed‐ended questions.Study DesignThematic analysis was employed to extract and analyze participants' responses to an open‐ended question about challenges they experienced when accessing or receiving healthcare. Two members of the research team conducted qualitative data analyses using Dedoose. The quality of each analysis was subsequently reviewed by a third research team member.Data Collection/Extraction MethodsData were collected from responses to one open‐ended question that asked about participants' healthcare barriers as a TGNC individual.Principal FindingsFive main themes surrounding healthcare barriers emerged from the content analysis: (1) acceptability, (2) accommodation, (3) affordability, (4) availability, and (5) accessibility. First, participants who noted acceptability issues reported explicit discriminatory treatment from providers, providers not using their chosen names and pronouns (e.g., misgendering), and provider refusal to provide gender‐affirming care. Second, participants who experienced accommodation challenges identified provider medical training gaps on TGNC patient needs and administrative barriers to care. Third, participants explained affordability issues due to a lack of adequate health insurance coverage. Fourth, participants described availability challenges with accessing hormone therapy prescriptions. Finally, participants noted accessibility issues with obtaining TGNC‐specific care at LGBTQ+‐affirming clinics.ConclusionsThere is a growing interest in the needs of TGNC adults within healthcare settings. This requires that health policies are enacted to ensure that TGNC adults have access to healthcare that is accommodating and accepting/affirming. Study findings may provide insight into the potential impact of current legislation on transgender access and availability.
Funder
Robert Wood Johnson Foundation