Gender-Affirming Primary Care Access Among Rural Transgender and Gender Diverse Adults in Five Northeastern U.S. States.

Purpose: Little is known about the prevalence and predictors of gender-affirming primary care (GAPC) access among rural transgender and gender diverse (TGD) adults. This study therefore sought to characterize the prevalence and predictors of GAPC within a sample of rural TGD adults. Methods: A nonprobability convenience sample (n = 244) of rural TGD adults was recruited across five Northeastern U.S. states (Connecticut, Massachusetts, New Hampshire, New York, Vermont) and completed a health needs assessment from March 2019 to October of 2019. Results: Transgender women and men had higher odds of accessing GAPC than nonbinary and gender diverse respondents. Respondents aged 25-39 had higher odds of accessing GAPC than those 18-24 years old. Conclusion: This study found high prevalence of barriers to GAPC among rural TGD people, highlighting system-level improvement opportunities.

Gender-Affirming Mental Health Care Access and Utilization Among Rural Transgender and Gender Diverse Adults in Five Northeastern U.S. States.

Purpose: Transgender and gender diverse (TGD) populations are burdened by substantial mental health disparities. The mental health needs of TGD people in rural areas remain largely unknown. This study sought to characterize gender-affirming mental health service access and utilization in a sample of TGD adults from predominantly rural areas in the northeastern United States. Methods: A nonprobability sample of 241 TGD adults was recruited from 25 counties across Connecticut, Massachusetts, New Hampshire, New York, and Vermont. Participants completed a cross-sectional computer-administered survey, including self-reported mental health and mental health care needs. Bivariate and multivariable models were fit to examine the association of mental health service utilization with: sociodemographics; health insurance coverage; name and gender marker change; mental health symptoms; perceived stigma; mental health, substance use disorder, and somatic diagnoses; and violence victimization. Primary outcomes were utilizing either psychotherapy or psychopharmacology, both, or neither service. Results: Around 68.9% of the sample resided in rural areas. Fifty-one percent of respondents currently utilized at least one gender-affirming mental health service (48.5% psychotherapy, 18.7% psychopharmacology, 16.2% both services). Common barriers to gender-affirming mental health services were lack of trained providers, lack of mental health integration with primary care, financial costs, difficulty scheduling, distances that were too far, and transportation issues. Factors most important in choosing a mental health care provider were health insurance, gender-affirming care, rapport, and availability. Conclusion: Access to and utilization of gender-affirming mental health services was suboptimal in this sample. Achieving mental health equity will require addressing barriers experienced by TGD people in rural areas.

Understanding community member and health care professional perspectives on gender-affirming care-A qualitative study.

BACKGROUND: Transgender and gender diverse (TGD) people experience significant barriers to accessing affirming health services. There is a paucity of literature examining how both community members and health care professionals (HCPs) understand potential causes and solutions for these barriers, particularly in non-urban settings. OBJECTIVE: We present the first systematic examination of perspectives from community members and HCPs regarding barriers to and solutions for promoting access to gender-affirming health care. DESIGN: Study activities were conducted through the Plan and Act for Transgender Health (PATH) Project, a health needs assessment of TGD people. Community members in the catchment area were recruited to participate in focus group discussions about access to gender-affirming health care and optimal health service delivery models in March-October 2019. HCPs were recruited to participate in focus group discussions or in-depth interviews about experiences working with TGD clients. Data were analyzed using an inductive grounded theory approach. SETTING: 25 rural counties in Massachusetts, New York, Connecticut, Vermont, and New Hampshire. PARTICIPANTS: Study participants included 61 adult TGD community members and 23 HCPs working in the catchment area. RESULTS: Both community members and HCPs spoke of the need for connectedness and linkages among disparate health system components for gender-affirming health care. Participants expressed this priority through calls for systems-level improvements within existing services (e.g., expanded data collection, expanded mental health services, inclusive and affirming health care environments, and TGD staff). They also expressed the need for expanded TGD community outreach and engagement (e.g., incorporation of a patient feedback process, TGD health navigators, and resource mapping). LIMITATIONS: Findings specifically reflect the perspectives of community members and HCPs in the rural New England area. Furthermore, the study sample was predominantly White non-Hispanic. CONCLUSION: Interventions to achieve accessible gender-affirming health care must address the diverse perspectives and needs of both community members and HCPs.