"This Helps Explain Our Life Situation": Trans Navigation of Physical/Mental Health Care

Background: Transgender and gender diverse (T/GD) populations experience greater health disparities than the general LGB (lesbian, gay bisexual) population and the cisgender heterosexual population. Although T/GD individuals face many of the same barriers and facilitators to healthcare experienced by the LGB community, additional unique experiences include mistreatment from medical staff, discomfort with gendered facilities and restrooms, misgendering, dead-naming, and electronic medical records that do not accurately reflect names or pronouns. In this CTSC-funded translational health pilot study, CLDs created using group model building practices with several LGB community groups were compared to the models created with T/DG groups to further explicate how connections and disconnections to healthcare occur for T/GD.

Methods: Four community groups (3 LGBTQ-focused and 1 T/GD-focused) were engaged in conversations around connection and disconnection with physical and mental healthcare. Participants were recruited through a formal research partnership with the LGBT Center of Greater Cleveland. Three data gathering and validation sessions were conducted with each community group. In the first session, participants were encouraged to share their experiences regarding their connection and disconnection to healthcare systems while simultaneously viewing their narratives being drawn as a causal loop diagram. Participants were encouraged to identify feedback loops and connections between various factors. The core modelling team used an iterative and group consensus process to refine the initial causal loop diagram and it was shared to the community group in session number 2. Feedback from the community was then integrated into the model. The final session consisted of the core modelling team presenting the final model to the community group facilitator/coordinator. Analysis consisted of synthesizing the causal models and comparing the pathways of connection/disconnection for care experienced by the TG/D community with those of the LGB community.

Results: Comparison of the synthesized causal loop diagrams of the T/GD group with that of the LGB group identified several unique factors experienced by the T/GD community. These include structural barriers such as transphobia and specifically Trans-misogyny for Transwomen. Interpersonal factors included exclusion from the labor market, and therefore being compelled to engage with means of income outside of the system- often leading to engagement with the criminal injustice system and lack of insurance. Individual barriers included practices of misgendering and dead naming by providers and office staff. Two factors emerged that promote (re)connection to healthcare: Community Generated Interventions including community elders sharing knowledge and technologies and LGBTQ2IA Holistic Healthcare.

Conclusions and Implications: Analysis comparing pathways unique barriers and facilitators for healthcare for T/GD populations highlights the impacts of structural, institutional and interpersonal intersectionality within the society along with the resourcefulness of TG/D individuals to circumvent such barriers. It is only by meeting the needs of the most marginalized members of our community that we be able to progress the call of equity for all.