Seattle Children's Hospital, Seattle, Washington.
University of Washington School of Medicine, Seattle, Washington.
Pediatrics. 2023 Oct 1;152(4). doi: 10.1542/peds.2023-062210.
Transgender and gender-diverse (TGD) adolescents experience barriers to receiving gender-affirming care. Delivering services in the pediatric primary care setting may help facilitate improved access. With this study, we aimed to explore TGD adolescents' and caregivers' experiences receiving primary care services and their perspectives regarding gender-affirming care delivery in pediatric primary care.
TGD adolescents aged 14 to 17 and caregivers of TGD adolescents currently receiving gender-affirming medical care participated in 1-hour-long, semi-structured, individual, virtual interviews. Each interview was recorded and transcribed. Transcripts were then individually coded, and themes were generated iteratively by using a reflexive thematic analysis framework. Recruitment of each group continued until thematic saturation was reached.
A total of 33 participants (15 adolescents and 18 caregivers) completed interviews. Adolescent participants (mean age of 15.7 years) predominantly identified as transmasculine or trans male (73%), and caregiver participants were predominantly mothers (83.3%). Four themes were identified, which included (1) barriers, such as microaggressions and poor psychosocial support, (2) benefits, such as existing trusted relationships with primary care providers (PCPs) and convenience, (3) improvement strategies, such as training and interdisciplinary collaboration, and (4) opportunities for integrating primary care and specialty gender-affirming care.
TGD adolescents and their caregivers reported previous negative interactions with PCPs; however, some desired to receive gender-affirming care in this setting, citing increased convenience, efficiency, and availability. Participants highlighted an ongoing need for further work to provide resources, education, and training to PCPs and their staff and improve PCP-to-specialist communication and collaboration.
跨性别和性别多样化（TGD）青少年在获得性别肯定护理方面面临障碍。在儿科初级保健环境中提供服务可能有助于改善获得服务的机会。本研究旨在探讨 TGD 青少年及其照顾者在接受初级保健服务方面的经验，以及他们对儿科初级保健中性别肯定护理服务的看法。
年龄在 14 至 17 岁之间的 TGD 青少年和正在接受性别肯定医疗护理的 TGD 青少年的照顾者参加了时长 1 小时的半结构化、个体、虚拟访谈。每次访谈都进行了录音和转录。然后对转录本进行单独编码，并使用反思性主题分析框架迭代生成主题。每个组的招募工作一直持续到达到主题饱和为止。
共有 33 名参与者（15 名青少年和 18 名照顾者）完成了访谈。青少年参与者（平均年龄 15.7 岁）主要自我认同为跨男性或男性（73%），照顾者主要是母亲（83.3%）。确定了四个主题，包括（1）障碍，例如微侵犯和较差的心理社会支持；（2）益处，例如与初级保健提供者（PCP）现有的信任关系和便利性；（3）改进策略，例如培训和跨学科合作；以及（4）将初级保健和专科性别肯定护理整合的机会。
TGD 青少年及其照顾者报告了之前与 PCP 之间的负面互动；然而，一些人希望在这种环境中获得性别肯定护理，理由是增加了便利性、效率和可及性。参与者强调需要进一步努力为 PCP 及其工作人员提供资源、教育和培训，并改善 PCP 与专家之间的沟通和合作。
