They “Don't Know How to Deal with People Like Me”: Assessing Health Care Experiences of Gender Minorities in Indiana
Abstract
Purpose: Within the LGBTQ+ community, the transgender and nonbinary (TGNB) population experience a disproportionate amount of discrimination when seeking health care. Such disparities may arise from lack of proper medical training and resources for providers or biases. In this study, we examine the health care experiences of TGNB individuals living in Southern Indiana.
Methods: We analyzed responses from TGNB respondents to an LGBTQ+ health care needs assessment survey in Southern Indiana. Respondents were asked about demographic data, their self-assessed health status, quality of health care received, whether they have a provider with whom they feel comfortable sharing their gender identity with, and if they have to commute to see their provider. Finally, respondents were asked an open-ended question about their health care experiences while living in Southern Indiana. Responses were coded and several themes emerged and were analyzed.
Results: Eighty-five TGNB individuals completed our survey. Less than half of respondents indicated that they had an LGBTQ+-welcoming provider (44.7%). Individuals with an LGBTQ+-welcoming provider were more likely to report their self-assessed health as excellent/good (p=0.02) and quality of health as excellent/very good (p=0.03) compared to individuals without an LGBTQ+-welcoming provider. Five themes emerged from the write-in responses (n=64): discrimination (34.4%), invalidation (32.8%), distrust (28.1%), logistic concerns (35.9%), and positive experiences (35.9%).
Conclusion: The TGNB community living in Southern Indiana reports numerous barriers related to provider attitudes when obtaining health care. Additional training is needed to address provider biases and improve LGBTQ+ community health disparities.
Get full access to this article
View all available purchase options and get full access to this article.
References
1. Grant JM, Mottet L, Tanis JE, et al. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. National Center for Transgender Equality, 2011. Available at: https://transequality.org/sites/default/files/docs/resources/NTDS_Report.pdf. Accessed February 2, 2021.
2. Beckwith N, Reisner SL, Zaslow S, et al. Factors associated with gender-affirming surgery and age of hormone therapy initiation among transgender adults. Transgend Health. 2017;2:156–164.
3. Lindley L, Anzani A, Prunas A, Galupo MP. Sexual satisfaction in trans masculine and nonbinary individuals: a qualitative investigation. J Sex Res. 2021;58:222–234.
4. Owens C, Hubach RD, Williams D, et al. Exploring the pre-exposure prophylaxis (PrEP) health care experiences among men who have sex with men (MSM) who live in rural areas of the Midwest. AIDS Educ Prev. 2020;32:51–66.
5. Garbers S, Heck CJ, Gold MA, et al. Providing culturally competent care for LGBTQ youth in school-based health centers: a needs assessment to guide quality of care improvements. J Sch Nurs. 2018;34:424–429.
6. Hswen Y, Sewalk KC, Alsentzer E, et al. Investigating inequities in hospital care among lesbian, gay, bisexual, and transgender (LGBT) individuals using social media. Soc Sci Med. 2018;215:92–97.
7. Gonzales G, Driscoll R, Quinones N. Who are the remaining uninsured sexual minority adults under the affordable care act? LGBT Health. 2019;6:319–325.
8. Hswen Y, Zhang A, Sewalk KC, et al. Investigation of geographic and macrolevel variations in LGBTQ patient experiences: longitudinal social media analysis. J Med Internet Res. 2020;22:e17087.
9. Nemoto T, Operario D, Keatley J. Health and social services for male-to-female transgender persons of color in San Francisco. Int J Transgend. 2005;8:5–19.
10. Sperber J, Landers S, Lawrence S. Access to health care for transgendered persons: results of a needs assessment in Boston. Int J Transgend. 2005;8:75–91.
11. Patterson JG, Jabson Tree JM, Kamen C. Cultural competency and microaggressions in the provision of care to LGBT patients in rural and Appalachian Tennessee. Patient Educ Couns. 2019;102:2081–2090.
12. Goldhammer H, Maston ED, Kissock LA, et al. National findings from an LGBT healthcare organizational needs assessment. LGBT Health. 2018;5:461–468.
13. Lurie S. Identifying training needs of health-care providers related to treatment and care of transgendered patients: a qualitative needs assessment conducted in New England. Int J Transgend. 2005;8:93–112.
14. Bonvicini KA. LGBT healthcare disparities: what progress have we made? Patient Educ Couns. 2017;100:2357–2361.
15. Keuroghlian AS, Ard KL, Makadon HJ. Advancing health equity for lesbian, gay, bisexual and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments. Sex Health. 2017;14:119–122.
16. Nowaskie DZ, Patel AU, Fang RC. A multicenter, multidisciplinary evaluation of 1701 healthcare professional students' LGBT cultural competency: comparisons between dental, medical, occupational therapy, pharmacy, physical therapy, physician assistant, and social work students. PLoS One. 2020;15:e0237670.
17. Fisher CM, Irwin JA, Coleman JD. LGBT health in the midlands: a rural/urban comparison of basic health indicators. J Homosex. 2014;61:1062–1090.
18. Rosenkrantz DE, Black WW, Abreu RL, et al. Health and health care of rural sexual and gender minorities: a systematic review. Stigma Health. 2017;2:229–243.
19. Liszewski W, Peebles JK, Yeung H, Arron S. persons of nonbinary gender—awareness, visibility, and health disparities. N Engl J Med. 2018;379:2391–2393.
20. Seelman KL, Colón-Diaz MJP, LeCroix RH, et al. Transgender noninclusive healthcare and delaying care because of fear: connections to general health and mental health among transgender adults. Transgend Health. 2017;2:17–28.
21. Jaffee KD, Shires DA, Stroumsa D. Discrimination and delayed health care among transgender women and men: implications for improving medical education and health care delivery. Med Care. 2016;54:1010–1016.
22. Strauss AL. Qualitative Analysis for Social Scientists. Cambridge, UK: Cambridge University Press, 1987.
23. Leavy P. Research Design: Quantitative, Qualitative, Mixed Methods, Arts-Based, and Community-Based Participatory Research Approaches. New York, NY: The Guilford Press, 2017.
24. James SE, Herman JL, Rankin S, et al. The report of the 2015 U.S. transgender survey. Available at: https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf. Accessed February 20, 2021.
25. Lykens JE, LeBlanc AJ, Bockting WO. Healthcare experiences among young adults who identify as genderqueer or nonbinary. LGBT Health. 2018;5:191–196.
26. Kattari SK, Bakko M, Hecht HK, Kattari L. Correlations between healthcare provider interactions and mental health among transgender and nonbinary adults. SSM Popul Health. 2019;10:100525.
27. Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. JAMA. 2011;306:971–977.
28. Nowaskie DZ, Fogel RS, Fogel JM. Impact on patient satisfaction and importance of medical intake and office staff in a multidisciplinary, one-stop shop transgender program in Indianapolis, Indiana. J Multidiscip Healthc. 2019;12:665–673.
29. Dugdale DC, Epstein R, Pantilat SZ. Time and the patient–physician relationship. J Gen Intern Med. 1999;14(Suppl 1):S34–S40.
30. Ranji U, Beamesderfer A, Kates J, Salganicoff A. Health and access to care and coverage for lesbian, gay, bisexual, and transgender individuals in the US. Washington, DC: Henry J. Kaiser Family Foundation, 2014.
31. Mansh M, White W, Gee-Tong L, et al. Sexual and gender minority identity disclosure during undergraduate medical education: “in the closet” in medical school. Acad Med. 2015;90:634–644.
Cite this article as: Newsom KD, Riddle MJ, Carter GA, Hille JJ (2022) They “don't know how to deal with people like me”: Assessing health care experiences of gender minorities in Indiana, Transgender Health 7:5, 453–460, DOI: 10.1089/trgh.2021.0027.
Information & Authors
Information
Published In
Copyright
Copyright 2022, Mary Ann Liebert, Inc., publishers.
History
Published online: 7 October 2022
Published in print: October 2022
Published ahead of print: 1 September 2021
Topics
Authors
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.
Metrics & Citations
Metrics
Citations
Export Citation
Export citation
Select the format you want to export the citations of this publication.
View Options
Access content
To read the fulltext, please use one of the options below to sign in or purchase access.⚠ Society Access
If you are a member of a society that has access to this content please log in via your society website and then return to this publication.