Section of General Internal Medicine, University of Chicago, Chicago, IL, USA.
Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA, USA.
J Gen Intern Med. 2019 Oct;34(10):2068-2074. doi: 10.1007/s11606-019-05179-0. Epub 2019 Aug 5.
Transgender people and racial/ethnic minorities separately report poor healthcare experiences. However, little is known about the healthcare experiences of transgender people of color (TPOC), who are both transgender and racial/ethnic minorities.
To investigate how TPOC healthcare experiences are shaped by both race/ethnicity and gender identity.
Semi-structured, in-depth individual interviews (n = 22) and focus groups (2; n = 17 total); all taken from a sample of TPOC from the Chicago area. All participants completed a quantitative survey (n = 39).
Interviews and focus groups covered healthcare experiences, and how these were shaped by gender identity and/or race/ethnicity. The interviews and focus groups were audio recorded, transcribed verbatim, and imported into HyperRESEARCH software. At least two reviewers independently coded each transcript using a codebook of themes created following grounded theory methodology. The quantitative survey data captured participants' demographics and past healthcare experiences, and were analyzed with descriptive statistics.
All participants described healthcare experiences where providers responded negatively to their race/ethnicity and/or gender identity. A majority of participants believed they would be treated better if they were cisgender or white. Participants commonly cited providers' assumptions about TPOC as a pivotal factor in negative experiences. A majority of participants sought out healthcare locations designated as lesbian, gay, bisexual, and transgender (LGBT)-friendly in an effort to avoid discrimination, but feared experiencing racism there. A minority of participants expressed a preference for providers of color; but a few reported reluctance to reveal their gender identity to providers of their own race due to fear of transphobia. When describing positive healthcare experiences, participants were most likely to highlight providers' respect for their gender identity.
TPOC have different experiences compared with white transgender or cisgender racial/ethnic minorities. Providers must improve understanding of intersectional experiences of TPOC to improve quality of care.
跨性别者和少数族裔分别报告了较差的医疗保健体验。然而，对于跨性别有色人种（TPOC）的医疗保健体验知之甚少，他们既是跨性别者，也是少数族裔。
调查 TPOC 的医疗保健体验如何受到种族/民族和性别认同的影响。
半结构化深入的个人访谈（n=22）和焦点小组（2；共 17 人）；均取自芝加哥地区的 TPOC 样本。所有参与者都完成了一项定量调查（n=39）。
访谈和焦点小组涵盖了医疗保健体验，以及这些体验如何受到性别认同和/或种族/民族的影响。访谈和焦点小组进行了录音，并逐字转录，然后导入 HyperRESEARCH 软件。至少有两名评审员使用基于扎根理论方法创建的主题代码本独立对每个转录本进行编码。定量调查数据记录了参与者的人口统计数据和过去的医疗保健经验，并进行了描述性统计分析。
所有参与者都描述了提供者对他们的种族/民族和/或性别认同做出负面反应的医疗保健体验。大多数参与者认为，如果他们是顺性别或白人，他们会得到更好的治疗。参与者普遍认为，提供者对 TPOC 的假设是负面体验的关键因素。大多数参与者寻求被指定为女同性恋、男同性恋、双性恋和跨性别（LGBT）友好的医疗保健场所，以避免歧视，但担心在那里会遇到种族主义。少数参与者表示更喜欢有色人种的提供者；但也有少数人报告说，由于担心跨性别恐惧症，他们不愿向自己种族的提供者透露自己的性别认同。在描述积极的医疗保健体验时，参与者最有可能强调提供者对他们性别认同的尊重。
TPOC 的经历与白人跨性别者或顺性别少数族裔不同。提供者必须提高对 TPOC 交叉体验的理解，以提高医疗质量。
