Date of Award

12-16-2024

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Blake McGee

Second Advisor

Jiwon Lee

Third Advisor

Kristie Seelman

Fourth Advisor

Melissa Osborne

Abstract

Within the United States, about 1.4 million individuals (0.6%) identify as transgender. People who identify as transgender or gender-diverse experience societal challenges like unacceptance, isolation, judgment, and discrimination which can impact healthcare utilization. While their perceived experiences of seeking healthcare services have been detailed with qualitative studies, quantitative research examining factors that may be associated with primary healthcare use is scarce. The purpose of this study was to use concepts from Self-Determination Theory (SDT; i.e., autonomy, competence, and relatedness) to explore transgender and gender-diverse individuals’ motivations to use routine primary healthcare services. Additionally, the gender-affirming actions desired from their healthcare providers was also explored.

A cross-sectional, correlational design was used and individuals self-identifying as transgender or gender-diverse, at least 18 years of age, and living in the United States were recruited via flyers distributed in communities, social media posts, and snowball sampling. Data were collected via surveys administered through an online platform. Data were analyzed using descriptive statistics and logistic regression analyses. Participants were given the opportunity to describe the gender-affirming actions they desired from healthcare providers through responses to an open-ended question. The responses were then reviewed and categorized for dissemination.

Participants (N = 62) ranged in age from 18 to 67 and mostly identified as trans-masculine, had some college or higher education, had healthcare coverage, and were married, partnered, or had multiple partners. In multivariable analysis, participants with lower reported competence to navigate the healthcare system and/or higher perceptions of discrimination had increased odds of avoiding healthcare due to fear of disrespect or mistreatment from a healthcare provider. Responses to an open-ended question about desires for gender-affirming practices included a need for providers to be more educated on trans-related healthcare, to honor and use correct pronouns, and to educate their patients on every step of their medical journey.

Addressing the obstacles transgender and gender-diverse persons encounter in healthcare may lead to them receiving better primary care to manage or prevent health problems and reduce physical and mental health disparities. Findings from this study may give direction for interventions designed to facilitate positive healthcare interactions that may result in increased routine primary healthcare use by the transgender population.

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