Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia.
The Gender Centre, Annandale New South Wales, Australia.
PLoS One. 2021 Jan 28;16(1):e0245889. doi: 10.1371/journal.pone.0245889. eCollection 2021.
This study aimed to explore the experiences of healthcare access in a diverse sample of trans and gender diverse individuals with complex needs using qualitative methods. We recruited 12 individuals using trans community-based networks facilitated by the Gender Centre. Each individual participated in an in-depth, semi structured interview conducted by a peer interviewer. Interviews were analysed thematically.
Participants had a range of complex health needs to manage, including ongoing access to gender-affirming hormones, mental health care and sexual health care. Some also had chronic diseases. Accordingly, scheduling appointments and affording the co-payments required were major preoccupations. Most participants were not in full time work, and economic hardship proved to be a major compounding factor in issues of healthcare access, impacting on the choice of clinician or practice. Other barriers to accessing health included issues within health services, such as disrespectful attitudes, misgendering, 'deadnaming' (calling the person by their previous name), displaying an excessive interest is aspects of the participants' life that were irrelevant to the consultation, and displaying ignorance of trans services such that the participants felt an obligation to educate them. In addition, participants noted how stereotyped ideas of trans people could result in inaccurate assumptions about their healthcare needs. Positive attributes of services were identified as respectful communication styles, clean, welcoming spaces, and signs that indicated professionalism, care and openness, such as relevant information pamphlets and visibility of LGBTIQ service orientation. Participants valued peer-based advice very highly, and some would act on and trust medical advice from peers above advice from medical professionals.
These findings demonstrate a need for comprehensive wrap-around service provision for trans people with complex needs which includes a substantial peer-based component, and addresses physical and mental health and social services conveniently and affordably.
本研究旨在使用定性方法探索多样化的有复杂需求的跨性别和性别多样化个体在医疗保健方面的体验。我们通过性别中心的社区网络招募了 12 名参与者。每位参与者都由一位同行采访者进行了深入的半结构化访谈。访谈内容进行了主题分析。
参与者有一系列需要管理的复杂健康问题，包括持续获得性别肯定激素、心理健康护理和性健康护理。有些人还患有慢性疾病。因此，安排预约和支付所需的共同支付费用是主要关注点。大多数参与者没有全职工作，经济困难被证明是医疗保健获取问题的一个主要加剧因素，影响到临床医生或实践的选择。其他获取健康的障碍包括卫生服务中的问题，例如不尊重的态度、错误称呼、（用当事人的旧名称呼）“deadnaming”、对与咨询无关的当事人生活方面表现出过度的兴趣，以及对跨性别服务的无知，以至于当事人觉得有义务向他们提供教育。此外，参与者还注意到，对跨性别者的刻板印象会导致对他们医疗保健需求的不准确假设。服务的积极属性包括尊重的沟通方式、干净、欢迎的空间，以及表明专业性、关怀和开放性的标志，例如相关信息手册和 LGBTIQ 服务方向的可见性。参与者非常重视基于同行的建议，有些人会接受并信任来自同行的医疗建议，而不是来自医疗专业人员的建议。
这些发现表明，有复杂需求的跨性别者需要全面的综合服务提供，其中包括大量的同行支持部分，并方便且负担得起地解决身心健康和社会服务问题。
