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

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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.