Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.
Ann Behav Med. 2023 Nov 16;57(12):1014-1023. doi: 10.1093/abm/kaad035.
In 2011, the Veterans Health Administration (VHA) established a policy for the delivery of transition-related services, including gender-affirming hormone therapy (GAHT), for transgender and gender diverse (TGD) patients. In the decade since this policy's implementation, limited research has investigated barriers and facilitators of VHA's provision of this evidence-based therapy that can improve life satisfaction among TGD patients.
This study provides a qualitative summary of barriers and facilitators to GAHT at the individual (e.g., knowledge, coping mechanisms), interpersonal (e.g., interactions with other individuals or groups), and structural (e.g., gender norms, policies) levels.
Transgender and gender diverse patients (n = 30) and VHA healthcare providers (n = 22) completed semi-structured, in-depth interviews in 2019 regarding barriers and facilitators to GAHT access and recommendations for overcoming perceived barriers. Two analysts used content analysis to code and analyze transcribed interview data and employed the Sexual and Gender Minority Health Disparities Research Framework to organize themes into multiple levels.
Facilitators included having GAHT offered through primary care or TGD specialty clinics and knowledgeable providers, with patients adding supportive social networks and self-advocacy. Several barriers were identified, including a lack of providers trained or willing to prescribe GAHT, patient dissatisfaction with prescribing practices, and anticipated or enacted stigma. To overcome barriers, participants recommended increasing provider capacity, providing opportunities for continual education, and enhancing communication around VHA policy and training.
Multi-level system improvements within and outside the VHA are needed to ensure equitable and efficient access to GAHT.
2011 年，退伍军人健康管理局（VHA）为跨性别和性别多样化（TGD）患者制定了提供过渡相关服务的政策，包括性别肯定激素治疗（GAHT）。自该政策实施以来的十年中，很少有研究调查 VHA 提供这种循证治疗的障碍和促进因素，而这种治疗可以提高 TGD 患者的生活满意度。
本研究从个人（例如，知识，应对机制）、人际（例如，与其他个人或团体的互动）和结构（例如，性别规范，政策）层面总结了 GAHT 的障碍和促进因素。
2019 年，跨性别和性别多样化患者（n=30）和 VHA 医疗保健提供者（n=22）完成了半结构化的深入访谈，内容涉及 GAHT 获得的障碍和促进因素，以及克服感知障碍的建议。两名分析师使用内容分析对转录的访谈数据进行编码和分析，并采用性少数群体健康差异研究框架将主题组织成多个层次。
促进因素包括通过初级保健或 TGD 专科诊所和知识渊博的提供者提供 GAHT，并提供支持性的社交网络和自我倡导。确定了几个障碍，包括缺乏受过培训或愿意开 GAHT 处方的提供者、患者对处方实践的不满以及预期或实施的耻辱感。为了克服障碍，参与者建议增加提供者的能力，提供持续教育的机会，并加强围绕 VHA 政策和培训的沟通。
需要在 VHA 内部和外部进行多层次的系统改进，以确保公平和高效地获得 GAHT。
