Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth
Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth
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DOI：
10.1016/j.jadohealth.2016.03.017
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发表时间：
2016-09-01
影响因子：
7.6
通讯作者：
Breland, David J.
中科院分区：
文献类型：
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作者：
Gridley, Samantha J.;Crouch, Julia M.;Breland, David J.
目的：很少有符合性别肯定治疗条件的跨性别青年真正接受治疗。多学科性别诊所改善了获取和护理协调，但很少见。尽管专家支持对符合标准的青少年使用青春期阻滞剂和跨性别激素，但这些药物并不常见。本研究的目的是了解跨性别青少年及其照顾者在获得性别肯定医疗保健方面面临的障碍。方法：从西雅图的诊所招募跨性别青少年（14-22 岁）和跨性别青少年的照顾者，并从博客和支持小组列表服务中招募读者。通过个人访谈、焦点小组或在线调查，参与者描述了他们获得性别肯定医疗保健的经历。然后，我们使用理论主题分析来分析数据。 结果：65 名参与者（15 名青少年，50 名护理人员）描述了跨越六个主题的障碍：（1）很少有儿科服务提供者接受过性别肯定医疗保健培训； (2) 缺乏一致适用的协议； (3) 所选名称/代词的使用不一致； （四）看管不协调的； (5) 限制/延迟获得青春期阻滞剂和跨性别激素； (6) 保险排除。结论：这是第一项旨在了解跨性别青少年及其照顾者所感知到的护理障碍的研究。护理方面的主题障碍提出了以下建议：(1) 对提供者/工作人员进行性别肯定卫生保健和文化谦逊方面的强制性培训； (2) 制定年轻跨性别患者的护理方案以及家庭路线图； (3)询问并记录所选择的名字/代词； (4) 多学科性别诊所数量增加； (5) 在允许同龄人和谐发展的年龄提供跨性别激素； (6) 为诊所内的跨性别患者指定一名导航员。 (C) 2016 年青少年健康与医学协会。版权所有。
Purpose: Few transgender youth eligible for gender-affirming treatments actually receive them. Multidisciplinary gender clinics improve access and care coordination but are rare. Although experts support use of pubertal blockers and cross-sex hormones for youth who meet criteria, these are uncommonly offered. This study's aim was to understand barriers that transgender youth and their caregivers face in accessing gender-affirming health care.Methods: Transgender youth (age 14-22 years) and caregivers of transgender youth were recruited from Seattle-based clinics, and readerships from a blog and support group listserv. Through individual interviews, focus groups, or an online survey, participants described their experiences accessing gender-affirming health care. We then used theoretical thematic analysis to analyze data.Results: Sixty-five participants (15 youth, 50 caregivers) described barriers spanning six themes: (1) few accessible pediatric providers are trained in gender-affirming health care; (2) lack of consistently applied protocols; (3) inconsistent use of chosen name/pronoun; (4) uncoordinated care and gatekeeping; (5) limited/delayed access to pubertal blockers and cross-sex hormones; and (6) insurance exclusions.Conclusions: This is the first study aimed at understanding perceived barriers to care among transgender youth and their caregivers. Themed barriers to care led to the following recommendations: (1) mandatory training on gender-affirming health care and cultural humility for providers/staff; (2) development of protocols for the care of young transgender patients, as well as roadmaps for families; (3) asking and recording of chosen name/pronoun; (4) increased number of multidisciplinary gender clinics; (5) providing cross-sex hormones at an age that permits peer-congruent development; and (6) designating a navigator for transgender patients in clinics. (C) 2016 Society for Adolescent Health and Medicine. All rights reserved.