"We Are Doing the Absolute Most That We Can, and No One Is Listening": Barriers and Facilitators to Health Literacy within Transgender and Nonbinary Communities.

C Riley Hostetter,Jarrod Call,Donald R Gerke,N Eugene Walls,Brendon T Holloway,Jennifer C Greenfield

doi:10.3390/ijerph19031229

C Riley Hostetter, Jarrod Call + Show 4 more

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https://doi.org/10.3390/ijerph19031229

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Abstract

Transgender and nonbinary (TNB) individuals face disparities in nearly every aspect of health. One factor associated with poor health outcomes in other marginalized populations is health literacy, yet no identified studies examine health literacy in TNB samples. Moreover, most health literacy frameworks focus primarily on the capacities of individual patients to understand and use healthcare information, with little attention given to provider literacy and environmental factors. In partnership with a statewide LGBTQ advocacy organization, we recruited 46 transgender and nonbinary individuals to participate in seven focus groups conducted in urban, suburban, and rural locations throughout Colorado. TNB participants consistently engaged in efforts to increase their own health literacy and that of their medical providers yet faced multiple barriers to improve care. Difficulty identifying and physically reaching care, insurance and out-of-pocket expenses, negative experiences with healthcare providers and staff, provider incompetence, discriminatory and oppressive practices, and exclusionary forms and processes emerged as barriers to enacted health literacy among participants. Conversely, facilitators of enacted healthcare literacy included positive experiences with healthcare providers and staff, and inclusive forms and processes.

Highlights

IntroductionTransgender and nonbinary (TNB) people experience substantial barriers accessing appropriate healthcare [3,4], including having doctors refuse to treat them due to their gender [3], experiencing nonaffirming or discriminatory care [5], encountering difficulty getting insurance to cover medically necessary procedures [6], and needing to educate providers who have not received training on TNB health [7,8]
Transgender and nonbinary (TNB) people are individuals whose gender does not match their sex assigned at birth and includes people who identify as men/masculine, women/feminine, as well as identities outside of the gender binary such as nonbinary, genderqueer, bigender, or agender [1]
As of 2016, there were approximately 1.4 million people in the United States who identified as TNB [2], and this is likely an undercount resulting from high levels of discrimination and violence directed toward TNB people

Summary

Introduction

TNB people experience substantial barriers accessing appropriate healthcare [3,4], including having doctors refuse to treat them due to their gender [3], experiencing nonaffirming or discriminatory care [5], encountering difficulty getting insurance to cover medically necessary procedures [6], and needing to educate providers who have not received training on TNB health [7,8]. These healthcare access barriers exacerbate already significant health disparities TNB people experience as a result of the systemic and structural forces of transphobia and cisgenderism [9,10]. Research on poor health outcomes in other marginalized populations suggests that increasing patient health literacy can help reduce barriers to healthcare and

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