Geographic Health Access and Health Literacy Differences among Transgender and Nonbinary Communities

Overview: Using data from six focus groups with 40 participants, this presentation analyzes the geographic differences (metropolitan, urban, and rural) in healthcare access and health literacy among transgender and nonbinary (TNB) communities.Proposal text: Transgender and nonbinary (TNB) individuals face unique challenges that impact their ability to access affirming healthcare. These include experiencing discrimination in healthcare settings (Kcomt, 2019), difficulty finding a medical provider that is competent around transition-related healthcare (Obedin-Maliver et al., 2011), having to educate healthcare providers about their needs (Grant et al., 2011), and needing to travel long distances to access affirming care (Whitehead et al., 2016).

Scholars who study health disparities in other marginalized populations (e.g., Black and Hispanic adults in the United States) suggest that improving health literacy may help reduce health disparities (Paasche-Orlow & Wolf, 2010). However, TNB individuals may already have greater than average levels of health literacy to navigate a healthcare system that was not designed to meet their needs. Moreover, these challenges around healthcare access and health literacy may vary based on a TNB person’s geographic location, yet geographic differences are not well documented in the literature. The current study was designed to address this gap.

Six focus groups were held in metropolitan, urban, and rural areas in Colorado with 40 TNB-identified participants. Focus group participants were asked to respond to five questions about their experiences finding and accessing healthcare information and services. Focus groups were recorded and transcribed. Data were then analyzed using an iterative coding process by a team of seven coders, all of whom identify as LGBTQ. This included initial in vivo coding (Padgett, 2008) to determine themes until saturation was reached, resulting in a preliminary codebook. This was followed by a thematic coding process. Any discrepancies in codes were resolved using consensus. A final written description of all codes was sent to study participants for member-checking. Finally, the transcripts were reviewed by a smaller team of coders to examine geographic differences among the themes.

Participants identified as TNB, with identities including trans men, trans women, nonbinary, genderqueer, and intersex. Most participants were in the metropolitan focus groups (n=29) with the remaining 11 participants living in urban and rural areas. Themes that emerged included healthcare access and health literacy. Categories within healthcare access include transportation, distance traveled to access care, and difficulty identifying trans-competent providers. Many of the participants living outside of the metropolitan area were in healthcare apartheids, areas that require participants to travel beyond 10 miles to access healthcare. In terms of health literacy, all participants generally described needing to have higher health literacy than cisgender people. This was particularly pronounced among participants living outside of the metropolitan area or who identified as nonbinary or intersex.

Findings indicate that structural barriers impact TNB individuals’ ability to access general and transition-specific healthcare. Due to navigating a healthcare system that was designed for cisgender people, TNB individuals have higher levels of health literacy due to needing to self-educate and rely on other TNB community members’ healthcare expertise, particularly in non-metropolitan areas. Social workers can advocate for increased training regarding TNB health in their workplaces and for their allied health colleagues to improve access to affirming healthcare for TNB individuals.