González Sofía, Veale Jaimie F
Transgender Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand.
Int J Transgend Health. 2024 Jan 22;26(3):640-660. doi: 10.1080/26895269.2024.2303476. eCollection 2025.
Transgender people face serious health disparities associated with underlying social determinants, such as unmet healthcare needs and negative experiences with healthcare providers. Healthcare accessibility dimensions include availability, approachability, acceptability, affordability, and appropriateness. This study aimed to identify the perceived barriers and facilitators that transgender people in Aotearoa/New Zealand experience within these dimensions, as few studies have explored multiple dimensions of healthcare access for transgender people using a large national sample.
Responses to an open-text question in the Counting Ourselves survey ( = 236) were analyzed utilizing qualitative content analysis. A primarily deductive approach was used to identify categories and frame these within a comprehensive healthcare accessibility model.
In line with international research, some prominent barriers were the lack of trans-competent providers (availability/accommodation), experiences of mistreatment (acceptability/appropriateness), and gatekeeping practices (approachability). Facilitators included, among others, providers' willingness to educate themselves (availability/accommodation), an affirming attitude (acceptability/appropriateness), and competence in navigating services (approachability).
Transgender people in Aotearoa/New Zealand see their healthcare experiences affected by barriers across all dimensions of healthcare access. This highlights a great degree of mismatch between their needs and the healthcare system's characteristics, thereby breaching their right to healthcare of adequate standards. We recommend that all healthcare practitioners and administrative staff receive training on transgender health, that there is increased accessibility to information on gender-affirming care services, and that collaborative referral procedures that respect patient decisions are implemented.
跨性别者面临与潜在社会决定因素相关的严重健康差异，例如未满足的医疗保健需求以及与医疗服务提供者的负面经历。医疗保健可及性维度包括可获得性、易接近性、可接受性、可承受性和适宜性。本研究旨在确定新西兰的跨性别者在这些维度中所感受到的障碍和促进因素，因为很少有研究使用全国性大样本探讨跨性别者医疗保健可及性的多个维度。
利用定性内容分析法分析了“统计我们自己”调查（n = 236）中一个开放式问题的回答。主要采用演绎法来确定类别并将其置于一个全面的医疗保健可及性模型中。
与国际研究一致，一些突出的障碍包括缺乏具备跨性别者医疗能力的提供者（可获得性/适应性）、受虐待经历（可接受性/适宜性）以及把关做法（易接近性）。促进因素包括提供者自我教育的意愿（可获得性/适应性）、肯定的态度（可接受性/适宜性）以及服务导航能力（易接近性）等。
新西兰的跨性别者认为他们的医疗保健经历受到医疗保健可及性所有维度障碍的影响。这凸显了他们的需求与医疗保健系统特征之间存在很大程度的不匹配，从而侵犯了他们获得适当标准医疗保健的权利。我们建议所有医疗从业者和行政人员接受跨性别者健康方面的培训，增加性别肯定护理服务信息的可及性，并实施尊重患者决定的协作转诊程序。
