![[ Visit Client Website ]](images/banner.gif)
Transgender and nonbinary (TNB) people face significant structural barriers to accessing healthcare, exacerbating existing health inequities that stem from the structural forces of transphobia and cisgenderism. Research regarding TNB health and healthcare access is relatively nascent, and there are few theoretical frameworks designed specifically to explore TNB healthcare access. Rather, most studies use an atheoretical approach or adapt theories developed for other populations or outcomes. Although these frameworks have merit, none of them fully address the unique healthcare access factors experienced by TNB people.
This need led to the creation of the Intersectional Model of Service Use (IMSU) for TNB people. The IMSU builds upon existing theories of healthcare access including Andersen’s Behavioral Model of Health Services Use and Gelberg’s Behavioral Model for Vulnerable Populations by integrating findings from a scoping review to adapt these existing models to the needs and experiences of TNB people. The IMSU represents an important step in theoretical development, providing a population-specific foundation to examine the issue of TNB healthcare access. Due to its recency, however, it is untested beyond its initial conceptualization, and future research is needed to further refine and test the model.
Methods:
As such, this study used a two-stage qualitative focus group design to refine the model and gather direct feedback on the IMSU. Stage one included seven focus groups conducted state-wide in collaboration with local LGBTQ organizations asking TNB participants (n=46) about their experiences accessing and receiving healthcare services. Thematic analysis was employed to analyze transcripts, and findings were used to revise the original IMSU by adding new factors based on focus group themes and removing factors not represented in the data. Upon completion of the first stage, two additional focus groups were held (n=16) to elicit direct feedback on the revised model.
Results:
Participants largely voiced support for the IMSU as originally proposed, while providing evidence to add four new factors (gender markers, body size stigma, models of care, privacy issues) and change four existing factors (splitting non-affirming care into non-affirming providers and environments and adjusting where three factors were positioned in the original model). Furthermore, participants reiterated the importance of intersectionality, prompting changes to the model to more clearly highlight its centrality in any exploration of healthcare access. Visual depictions of the original and revised models will be presented in the conference session.
Conclusions and Implications:
These revisions to the IMSU strengthen its usefulness as a conceptual framework to understand TNB healthcare access. As a model designed for and by TNB people, it highlights the unique experiences of TNB people seeking care, while also considering general access factors that are present across populations. Future research should continue to improve and assess the model, including quantitative research to directly test its effectiveness in predicting healthcare access among TNB people. The IMSU can—and should—also be used to guide advocacy efforts to combat transphobia and improve the experiences of TNB people seeking care.