Gender Affirmation, Quality of Life, and Access to Care: A Mixed-Method Longitudinal Investigation

项目摘要/摘要 近年来，性别少数群体(GM)在美国社会中获得了更大的知名度。然而，身体上的 转基因个体的心理健康仍然是一个关键的公共卫生问题。通用汽车面临持久的耻辱， 歧视，以及影响他们一生健康和福祉的服务障碍。性别 肯定是承认一个人的性别认同和表达的过程，这可能包括情感 支持以及社会和医疗干预；它与心理健康和福祉有关。 在通用汽车中，性别肯定的需求未得到满足与更大的风险行为和更差的自我照顾有关， 尤其与艾滋病毒风险和治疗有关。在提供性别肯定方面接受过专门培训的临床医生 服务可能处于独特的地位，可以支持通用汽车个人的情感需求，有可能 对个人在与医疗保健提供者互动、参与方面的信任和舒适度产生长期影响 以及在照顾中的保持，以及影响一个人一生健康轨迹的自我照顾行为。 缺乏关于转基因患者手术后医疗需求的证据，他们的 心理社会适应在这一阶段的身份发展，他们的生活质量，和长期 身体和精神上的健康。这项前瞻性、混合法、纵向队列研究的目标是 在性别肯定手术后和长期的GM身份发展方面建立丰富的证据基础 GM个人的医疗需求，检查生活质量的多个领域的变化以及他们的 与医疗保健提供者的关系。采用定量和定性相结合的方法，我们的 具体目标是： 1.记录转基因个体随时间的变化(N=300名从性别肯定的手术后招募的人 家庭保健计划)术后心理社会发展，包括(I)性别 和性认同发展，(2)亲密关系和关系，(3)社会和社区支持，(4) 就业和财务福利，以及(V)对环境的掌握和生活目标。 2.检查转基因患者术后与健康相关的生活质量的变化，包括以下领域 (一)身体健康；(二)精神健康和社会福利；(三)性功能、满足感和健康；(四) 健康行为和自我护理，以及(V)参与和保留医疗保健以及与 医疗保健提供者。 3.确定总经理个人参与自我照顾和参与的障碍和促进者，以及 由于性别相关和其他健康问题，留在家中和随后的医疗保健。 这项研究将解决目前关于支持转基因个人的最佳做法的证据中的一个重大差距 在关键的生命历程转变期间，有可能提高他们在护理方面的参与度，并减轻 影响这一人群的医疗保健获取、结果和生活质量方面普遍存在的差距。

PROJECT SUMMARY/ABSTRACT Gender minorities (GM) have gained greater visibility in U.S. society in recent years. However, the physical and mental health of GM individuals remains a critical public health issue. GM face persistent stigma, discrimination, and barriers to services that affect their health and wellbeing over the life course. Gender affirmation is a process of recognizing a person’s gender identity and expression, which may include emotional support as well as social and medical interventions; it has been associated with mental health and wellbeing. Unmet needs for gender affirmation have been linked to greater risk behavior and poorer self-care among GM, particularly related to HIV risk and treatment. Clinicians who are specially trained in providing gender-affirming services may be uniquely positioned to support the emotional needs of GM individuals, with the potential to have a long-term impact on a person’s trust and comfort in interacting with healthcare providers, engagement and retention in care, and self-care behaviors that influence one’s health trajectory over the life course. There is a dearth of evidence on the healthcare needs of GM individuals after surgery, their psychosocial adjustment during this phase of their identity development, their quality of life, and long-term physical and emotional wellbeing. The goal of this prospective, mixed method, longitudinal cohort study is to build a rich evidence base on GM identity development after gender-affirming surgery and the long-term healthcare needs of GM individuals, examining changes in multiple domains of quality of life and their relationships with healthcare providers. Using a combination of quantitative and qualitative methods, our specific aims are to: 1. Document changes over time in GM individuals’ (N = 300 recruited from a gender-affirming, post-surgical home healthcare program) psychosocial development after surgery, including such domains as (i) gender and sexual identity development, (ii) intimacy and relationships, (iii) social and community support, (iv) employment and financial wellbeing, and (v) environmental mastery and purpose in life. 2. Examine changes in GM individuals’ health-related quality of life after surgery, including such domains as (i) physical health, (ii) mental health and social wellbeing, (iii) sexual function, satisfaction and health, (iv) health behaviors and self-care, and (v) engagement and retention in healthcare and relationships with healthcare providers. 3. Identify barriers and facilitators to GM individuals’ engagement with their self-care and engagement and retention in home and subsequent healthcare for both gender-related and other health concerns. The study will address a significant gap in the current evidence on best practices to support GM individuals during a pivotal life course transition, with the potential to improve their engagement in care and mitigate the pervasive disparities in healthcare access, outcomes, and quality of life affecting this population.