Abstract

Research shows an overrepresentation of trans people in vulnerable socioeconomic situations, primarily due to experiences of discrimination. At the same time, rural or suburban living areas often lack specialized trans-related health care, which a majority of trans people rely on to some extent. Taken together, the lack of both socioeconomic resources and access to trans-related health care can exacerbate health-related distress and impairment for trans people. We illustrate this problem using case vignettes of trans people from rural and suburban areas in (Northern) Germany. They are currently participating in an e-health intervention and randomized controlled trial (RCT) called i2TransHealth, whose case vignettes provided the impetus for the scoping review. The scoping review analyzes the impact of place of residence and its intersection with barriers to accessing trans-related health care. PubMed and Web of Science Data bases were searched for relevant studies using a search strategy related to trans people and remote, rural, or suburban residences. 33 studies were selected after full-text screening and supplemented via reference list checks and study team expertise by 12 articles addressing the living conditions of remotely living trans people and describing requirements for trans-related health care. The literature on trans people living remotely reveals intersections of trans mental health with age, race, gender expression, geographic location, community size, socioeconomic status, discrimination experiences, and attitudes towards health care providers. Several structural health care barriers are identified. The role of health care professionals (HCPs) for remotely living trans people is discussed. There is no need assuming that rural life for trans people is inevitably worse for health and well-being than urban life. Nevertheless, some clear barriers and health disparities exist for trans people in remote settings. Empowering trans groups and diversity-sensitive education of remote communities in private and institutional settings are needed for respectful inclusion of trans people. Facilitating access to trans-related health care, such as through video-based e-health programs with HCPs, can improve both the health and socioeconomic situation of trans people.

Highlights

  • Living outside of metropolitan areas often presents a significant challenge when trying to access specialized health care

  • In order to further investigate the potential of e-health approaches, we are currently conducting a randomized controlled trial (RCT) that allows trans people in remote, rural, or suburban areas in the early phase of transition or exploration of gender-related issues to participate in our internet-based health care program i2TransHealth, which provides video consultations by trans-informed health care professionals (HCPs) and local crisis interventions by general practitioners (GPs) and psychiatrists

  • The overarching lens culminates in the three research questions of whether rural environments impose health burdens on trans people, whether these potential health burdens overlap with barriers to health care access that have already been studied in more detail, and whether health burdens can be prevented or reduced in non-urban communities

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Summary

Introduction

Living outside of metropolitan areas often presents a significant challenge when trying to access specialized health care. Accessing health care becomes more complicated when certain factors, such as age, financial insecurity, or lack of education, are added to the difficulties inherent in rural areas Improving this situation could be beneficial for trans people, as research has shown that good experiences with HCPs are positively associated with both general and mental health (2). In order to further investigate the potential of e-health approaches, we are currently conducting a randomized controlled trial (RCT) that allows trans people in remote, rural, or suburban areas in the early phase of transition or exploration of gender-related issues to participate in our internet-based health care program i2TransHealth (https://www.i2transhealth.de/english-landingpage/), which provides video consultations by trans-informed HCPs and local crisis interventions by general practitioners (GPs) and psychiatrists

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