当疼痛非常剧烈，或者我觉得自己快要死了的时候": 城市地区跨性别和性别多样化人群的就医行为和就医经历。
"When the pain is so acute or if I think that I'm going to die": Health care seeking behaviors and experiences of transgender and gender diverse people in an urban area.
机构信息
GW Cancer Center, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States of America.
GW Cancer Center, School of Nursing, The George Washington University, Washington, DC, United States of America.
出版信息
PLoS One. 2021 Feb 23;16(2):e0246883. doi: 10.1371/journal.pone.0246883. eCollection 2021.
INTRODUCTION
Approximately 1.4 million transgender and gender diverse (TGD) adults in the United States have unique health and health care needs, including anatomy-driven cancer screening. This study explored the general healthcare experiences of TGD people in the Washington, DC area, and cancer screening experiences in particular.
METHODS
Twenty-one TGD people were recruited through word of mouth and Lesbian Gay Bisexual Transgender Queer (LGBTQ)-specific community events. Participant interviews were conducted and recorded via WebEx (n = 20; one interview failed to record). Interviews were transcribed using Rev.com. Two coders conducted line-by-line coding for emergent themes in NVivo 12, developed a codebook by consensus, and refined the codebook throughout the coding process. Member checking was conducted to ensure credibility of findings.
RESULTS
Three major themes served as parent nodes: health-care seeking behaviors, quality care, and TGD-specific health care experiences. Within these parent nodes there were 14 child nodes and 4 grand-child nodes. Subthemes for health care seeking behaviors included coverage and costs of care, convenience, trust/mistrust of provider, and provider recommendations for screening. Subthemes for quality of care included professionalism, clinical competence in transgender care, care coordination, provider communication, and patient self-advocacy. Overall, transgender men were less satisfied with care than transgender women.
CONCLUSIONS
Results suggest a need for improved provider communication skills, including clear explanations of procedures and recommendations for appropriate screenings to TGD patients. Results also suggest a need for improved clinical knowledge and cultural competency. Respondents also wanted better care coordination and insurance navigation. Overall, these findings can inform health care improvements for TGD people.
简介
美国约有 140 万跨性别和性别多样化（TGD）成年人，他们有独特的健康和医疗保健需求，包括基于解剖结构的癌症筛查。本研究探讨了华盛顿特区地区 TGD 人群的一般医疗保健体验，特别是癌症筛查体验。
方法
通过口碑和男女同性恋、双性恋、跨性别和 queer（LGBTQ）特定社区活动招募了 21 名 TGD 人。通过 WebEx 进行了参与者访谈并进行录音（n=20；一次访谈未能录音）。使用 Rev.com 进行转录。两位编码员使用 NVivo 12 对新出现的主题进行逐行编码，通过共识制定代码簿，并在整个编码过程中不断完善代码簿。进行成员检查以确保研究结果的可信度。
结果
三个主要主题作为父节点：寻求医疗保健的行为、优质护理和 TGD 特定的医疗保健体验。在这些父节点中有 14 个子节点和 4 个孙节点。寻求医疗保健行为的子主题包括护理的覆盖范围和成本、便利性、对提供者的信任/不信任以及提供者对筛查的建议。优质护理的子主题包括专业性、跨性别护理方面的临床能力、护理协调、提供者沟通和患者自我倡导。总体而言，跨性别男性对护理的满意度低于跨性别女性。
结论
结果表明，需要提高提供者的沟通技巧，包括向 TGD 患者清楚地解释程序和建议适当的筛查。结果还表明需要提高临床知识和文化能力。受访者还希望更好的护理协调和保险导航。总体而言，这些发现可以为 TGD 人群的医疗保健改善提供信息。
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