Perceived Barriers and Facilitators to Transgender Health Care Access: A Systematic Review

Background/Rationale

Transgender individuals experience high levels of health disparities.  Transgender people are often reluctant to seek out health care since many transgender individuals have reported past discriminatory treatment from health care service providers (Lombardi, 2001).  In the U.S., only 30-40% of transgender individuals utilize any type of regular medical care (Feldman & Bockting, 2003).  Since transgender individuals often do not conform to traditional roles of sex and gender, they are more likely to experience discrimination within the health care setting while being at risk for many health-related problems (Lombardi, 2001).  Few studies have explored what has led to vast health disparities among transgender individuals. The current study seeks to examine the burden and prevalence of transgender health care disparities in order to make recommendations for better comprehensive care for this vulnerable population.         

Methods

This current study is a systematic review of both the qualitative and quantitative literature on the perceived barriers and facilitators to health care help-seeking among transgender individuals.  Four databases (GoogleScholar, PubMed, PsyhInfo, and Cochran) were searched in August and September 2014 using specific key words.  These key words reflected the concepts of “health care use” and “transgender.”  The initial search rendered 1,219 published English-language abstracts. Both researchers screened the abstracts and excluded studies that did not 1) address barriers or facilitators to health care use among transgender individuals from the patient perspective and 2) meet several pieces of inclusion criteria (empirical in nature/data driven, patients were not explicitly asked about barriers and facilitators to using health care, the study was not conducted in the U.S., study participants were not transgender identified).  This process resulted in a total of 14 studies for inclusion into the review.  Topics specified as barriers or facilitators to health care seeking in the papers were coded respectively under 15 different barrier and 9 different facilitator themes

Results

             The most frequently mentioned barrier (about two-thirds of the studies) indicated issues related to provider lack of knowledge of transgender identity issues.  Previous negative experiences with the health care system or the anticipation of these experiences was the next most common barrier and appeared in half of the studies.  One-third of studies referenced transgender patients’ inability to afford or to pay for health care services.  Over a quarter of studies referred to provider refusal of health care services.  The importance of integrating health and social services was the top rated facilitator.

Conclusions and Implications

Medical professionals need to receive education on better understanding transgender identity.  One potential approach could involve evidence-based curriculum designed to increase provider competence.  Medical professionals could also contract with insurance companies that cover transgender specific health needs.  Providing competency trainings around preferred gender pronouns and proper usage of names would be another way that medical professionals could better help transgender individuals access health care services.  Barriers and facilitators may fluctuate across the different stages of a transgender person’s lifespan. A more extensive investigation of these facilitators and barriers is critical in order to advance knowledge in the field.