Barriers and Facilitators to Care for Transgender Patients Experiencing Low Socioeconomic Status and Homelessness

Barriers and Facilitators to Care for Transgender Patients Experiencing Low Socioeconomic Status and Homelessness

Purpose

Discrimination and disparity including increased rates of poverty, homelessness, and lack of access to healthcare, are well-documented in the transgender community. Despite high prevalence of low socioeconomic status (SES), limited health research focuses on this subset of the trans patient population. This study seeks to explore barriers and facilitators to care specific to low SES and homeless trans patients.

Methods

Using a semistructured interview format, transgender patients (n=5) were asked about their experiences accessing care at an urban federally qualified health center. Using a directed content data analysis methodology, interview transcripts were coded using preidentified category labels and novel themes were also identified and coded.

Results

Emerging barriers to care include lack of primary care and post-operative care, miscommunication within the care team, misinformation of Medicaid benefits, referrals to non-affirming healthcare environments, and lack of trans community building. Emerging facilitators include intentional patient panel assignment, a feeling of “moving forward” in transition, and access to health insurance and coverage for transition related care.

Conclusion 

These interviews elucidate the unique clinical experiences of homeless and low SES transgender patients and offer insight for systems-level process modifications that could improve patient experience of healthcare and care coordination. 

PUBLICATION DATE: 2017