Health professionals’ identified barriers to trans healthcare: a qualitative interview study

Mikulak, Magdalena ORCID: https://orcid.org/0000-0002-1519-7673, Ryan, Sara ORCID: https://orcid.org/0000-0002-7406-1610, Ma, Richard, Martin, Sam, Stewart, Jay, Davidson, Sarah and Stepney, Melissa (2021) Health professionals’ identified barriers to trans healthcare: a qualitative interview study. British Journal of General Practice, 71 (713). e941-e947. ISSN 0960-1643

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Abstract

Background: Trans people face multiple barriers within healthcare. Primary care practitioners are key to trans healthcare but they often lack training in, and understanding of trans identities, and healthcare options. Few studies have examined health professionals’ understanding of the barriers that exist in healthcare for trans people. Aim: To map out barriers to providing good quality healthcare to trans and gender diverse people and ways to address them. Design and setting: A qualitative interview study involving 20 health professionals working with trans and gender diverse people. Method: Participants were recruited through purposive and snowball sampling. Data were generated using semi-structured qualitative interviews. A thematic analysis involved coding and categorising data using Nvivo software and further conceptual analysis in which developing themes were identified. Results: The study identified four barrier domains to good quality care for trans and gender diverse people: structural (related to lack of guidelines, long waiting times, shortage of specialist centres), educational (based on lack of training on trans health), cultural and social (reflecting negative attitudes towards trans people) and technical (related to information systems and technology). Conclusion: There is an urgent need to address the barriers trans and gender diverse people face in healthcare. Structural level solutions include health policy, professional education and standards; at the practice level, GPs can act as potential drivers of change in addressing the cultural and technical barriers to better meet the needs of their trans and gender diverse patients.