Facilitators of and barriers to healthcare utilization among racially and ethnically diverse transgender and gender nonbinary young adults

项目摘要 跨性别和性别非二元（TGNB）的人是多样化的，有不同的医疗保健需求，但 显示出较低的医疗保健利用水平和更大的可能性，延迟所需的护理比他们 顺性别对应物。此外，TGNB年轻人在医疗保健利用方面遇到更多障碍， 比TGNB青少年和老年人更有可能延迟护理。尽管有限的研究表明 TGNB人群的医疗需求和医疗利用模式可能因种族/民族而异， TGNB身份，很少有研究存在不同的医疗保健需求和利用模式的基础上， 年轻人中特定种族/族裔和TGNB身份的交叉点。此外，文献中的空白 存在关于种族/民族如何与特定的TGNB身份交叉的细微差异，以创建 医疗保健利用的障碍，包括在COVID-19大流行期间，尤其是在年轻人中。 此外，很少有研究专门以细致入微和深入的方式研究医疗保健利用的促进因素 在少数种族/少数民族TGNB人中，特别是在年轻的成年人中。拟议的研究将使用 一个创新的理论策略，检查领先的医疗保健利用模式内的交叉性。 为了弥补研究中的空白，我们将追求以下具体目标：（1）检查 扩展的医疗保健利用模型，包括每个模型域的特定交叉因素， 种族/民族多样化的TGNB年轻人;（2）确定促进者和障碍的模式， TGNB年轻人中特定性别认同和种族/民族交叉的医疗保健利用情况 成年人了我们将使用配额抽样，在佛罗里达有意招募105名18至26岁的TGNB年轻人， 在跨性别TGNB身份方面存在差异（35%的变性男性，35%的变性女性，35%的变性女性）。 非二元）和种族/民族（30%非西班牙裔黑人，30%拉丁裔，30%非西班牙裔白色，15%亚洲人）。 样本将主要通过社交媒体平台招募，但也有佛罗里达社区合作伙伴 组织，众议院和舞厅社区，佛罗里达大学组织，和雪球抽样。 参与者将完成一个电话调查和一个深入的，半结构化的定性访谈。我们将 在我们的面试指南设计中使用交叉性框架，定性的分层主题编码 数据，性别认同x种族/民族群体比较，定量和定性数据的三角测量，以及 在医疗保健利用模型的背景下解释研究结果。这项研究的影响 包括评估扩大的医疗保健利用模式对TGNB年轻人的适用性 经验和评估模型与交叉方法的兼容性， 性别和种族/少数民族年轻人的经验，以推进科学的优质医疗保健， 这个人口。

PROJECT SUMMARY Transgender and gender nonbinary (TGNB) people are diverse and have distinct healthcare needs, yet demonstrate lower levels of healthcare utilization and greater likelihood of delaying needed care than their cisgender counterparts. Further, TGNB young adults experience more barriers to healthcare utilization and are more likely to delay care than TGNB adolescents and older adults. Though limited research indicates healthcare needs and patterns of healthcare utilization among TGNB people may vary by race/ethnicity and TGNB identity, little research exists on distinct healthcare needs and utilization patterns based on the intersection of specific race/ethnicity and TGNB identity among young adults. Further, a gap in the literature exists regarding nuanced differences in how race/ethnicity intersects with specific TGNB identities to create barriers to healthcare utilization, including during the COVID-19 pandemic, especially among young adults. Also, few studies have examined facilitators of healthcare utilization in a nuanced and in-depth way specifically among racial/ethnic minority TGNB people, particularly during young adulthood. The proposed study will use an innovative theoretical strategy that examines intersectionality within a leading healthcare utilization model. To address gaps in the research, we will pursue the following specific aims: (1) Examine the applicability of an expanded healthcare utilization model that includes specific intersectional factors for each model domain for racially/ethnically diverse TGNB young adults; and (2) Identify patterns in facilitators of and barriers to healthcare utilization by the intersection of specific gender identity and race/ethnicity among TGNB young adults. We will use quota sampling to intentionally recruit 105 TGNB young adults in Florida aged 18 to 26 who are diverse in terms of intersectional TGNB identity (35% transgender men, 35% transgender women, 35% nonbinary) and race/ethnicity (30% non-Hispanic Black, 30% Latinx, 30% non-Hispanic White, 15% Asian). The sample will be recruited mostly through social media platforms, but also Florida community partner organizations, House and Ballroom communities, Florida university organizations, and snowball sampling. Participants will complete a telephone survey and an in-depth, semi-structured qualitative interview. We will use an intersectionality framework in the design of our interview guide, layered thematic coding of qualitative data, gender identity x race/ethnicity group comparisons, triangulation of quantitative and qualitative data, and interpretation of the study findings in the context of the healthcare utilization model. The impact of this research involves evaluating the applicability of an expanded healthcare utilization model to TGNB young adult experiences and assessing the compatibility of the model with an intersectional approach that considers experiences of gender and racial/ethnic minority young adults to advance the science on quality healthcare for this population.