Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington.
Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington.
J Adolesc Health. 2023 Aug;73(2):367-374. doi: 10.1016/j.jadohealth.2023.04.007. Epub 2023 Jun 9.
Both affirming environments and access to gender-affirming medical care have a positive impact on the mental health of transgender and gender diverse (TGD) youth, however, many TGD youth experience barriers in accessing this care. Pediatric primary care providers (PCPs) can play an important role in expanding access to gender-affirming care for TGD youth; however, few currently provide this care. The purpose of this study was to explore pediatric PCPs' perspectives regarding barriers they experience to providing gender-affirming care in the primary care setting.
Pediatric PCPs who had sought out support from the Seattle Children's Gender Clinic were recruited via email to participate in semistructured, one-hour Zoom interviews. All interviews were transcribed and then subsequently analyzed in Dedoose qualitative analysis software using a reflexive thematic analysis framework.
Provider participants (n = 15) represented a wide range of experiences with respect to years in practice, number of TGD youth seen, and practice location (urban, rural, suburban). PCPs identified both health system and community-level barriers to providing gender-affirming care to TGD youth. Health system-level barriers included: (1) lack of foundational knowledge and skills, (2) limited clinical decision-making support, and (3) health system design limitations. Community-level barriers included (1) community and institutional biases, (2) provider attitudes regarding gender-affirming care provision, and (3) challenges identifying community resources to support TGD youth.
A multitude of health system and community-level barriers must be overcome in the pediatric primary care setting to ensure that TGD youth receive timely, effective, and more equitable gender-affirming care.
肯定环境和获得性别肯定的医疗保健都对跨性别和性别多样化（TGD）青年的心理健康产生积极影响，但是，许多 TGD 青年在获得这种护理方面存在障碍。儿科初级保健提供者（PCP）可以在扩大 TGD 青年获得性别肯定护理的机会方面发挥重要作用；但是，目前很少有提供者提供这种护理。本研究的目的是探讨儿科 PCP 提供性别肯定护理时所经历的障碍的看法，以及在初级保健环境中提供这种护理。
通过电子邮件招募寻求西雅图儿童性别诊所支持的儿科 PCP 参加半结构化的，一个小时的 Zoom 访谈。对所有访谈进行转录，然后在 Dedoose 定性分析软件中使用反思性主题分析框架进行分析。
提供者参与者（n=15）在实践年限，看过的 TGD 青年人数和实践地点（城市，农村，郊区）方面具有广泛的经验。PCP 确定了向 TGD 青年提供性别肯定护理的卫生系统和社区层面的障碍。卫生系统层面的障碍包括：（1）缺乏基础知识和技能，（2）有限的临床决策支持，以及（3）卫生系统设计限制。社区层面的障碍包括：（1）社区和机构偏见，（2）提供者对提供性别肯定护理的态度，以及（3）确定支持 TGD 青年的社区资源的挑战。
必须克服儿科初级保健环境中的多种卫生系统和社区层面的障碍，以确保 TGD 青年获得及时，有效和更公平的性别肯定护理。
