HIV Insight: Improving Transgender Health by Building Safe Clinical Environments that Promote Existing Resilience: Results from a Qualitative Analysis of Providers

Background

Transgender (TG) individuals experience discordance between their sex at birth and their gender identity. To better understand the health care needs and characteristics of TG youth that contribute to resilience, we conducted a qualitative study with clinical and non-clinical providers.

Methods

In-depth interviews were conducted of providers (n = 11) of TG youth (ages 13–21). Convenience and purposive sampling were used to recruit participants in the Boston area. All interviews were audio-recorded and transcribed verbatim. An interview guide of 14 open-ended questions was used to guide the discussion. A grounded theory approach was utilized to code and analyze the data, including double-coding to address issues of inter-rater reliability.

Results

Five primary themes emerged: 1) resilience of TG youth 2) lack of access to services that influence health, 3) the critical role of social support, 4) challenges in navigating the health care system, and 5) the need for trans-affirming competency training for providers and frontline staff.

Conclusion

The findings of this study show that providers recognize multiple barriers and challenges in the care of TG youth. However, they also identify the resilience exhibited by many youth. We propose that providers can further enhance the resilience of TG youth and help them flourish by offering them necessary resources via the creation of safe and welcoming clinical environments.

Below: The Crucial Role of Parents, Community, and School in Creating Safe Environments for Transgender (TG) Youth; This figure presents three separate but overlapping spheres of influence in a youth’s development, including parents, school, and community. Positive features or suggestions are listed within each component that would help create an all-around safe environment for TG youth

Below: Recommendations for Improving Transgender (TG) Care Based on Participant Interviews; This figure outlines the challenges and barriers associated with building a safe clinical environment for TG youth and proposes six action steps that can be taken to enhance resilience within this population