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

项目总结 变性人和非双性别者(TGNB)是多样化的，有不同的医疗需求，但 表现出更低的医疗保健利用率水平和更大的延迟所需护理的可能性 顺性同龄人。此外，TGNB的年轻人在利用医疗保健方面遇到了更多的障碍， 与TGNB青少年和老年人相比，更有可能推迟护理。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/民族和 TGNB身份，关于不同的医疗需求和使用模式的研究很少 年轻人中特定种族/族裔和TGNB身份的交集。此外，文献中的一个空白 存在种族/族裔如何与特定TGNB身份相交以创建的细微差异 卫生保健利用方面的障碍，包括在新冠肺炎大流行期间，特别是在年轻人中间。 此外，很少有研究具体地以细微差别和深入的方式检查医疗保健利用的促进者 在种族/少数民族TGNB人中，特别是在青年时期。拟议的研究将使用 一种创新的理论战略，研究领先的医疗保健利用模式中的交叉性。 为了解决研究中的差距，我们将追求以下具体目标：(1)审查 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青壮年；以及(2)查明促进和阻碍 TGNB青年中特定性别认同和种族/民族交集的医疗利用情况 成年人。我们将采用配额抽样的方式，在佛罗里达州有意识地招募105名18至26岁的TGNB年轻人 在跨部门TGNB身份方面是多样化的(35%的跨性别者男性，35%的跨性别者女性，35% 非二进制)和种族/民族(30%非西班牙裔黑人，30%拉丁裔，30%非西班牙裔白人，15%亚洲人)。 样本将主要通过社交媒体平台招募，但也有佛罗里达州的社区合作伙伴 组织、众议院和舞厅社区、佛罗里达大学组织和雪球采样。 参与者将完成一项电话调查和一次深入的、半结构化的定性访谈。我们会 在我们的面试指南的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×种族/族裔群体比较，定量和定性数据的三角测量，以及 在医疗保健利用模式的背景下对研究结果进行解释。这项研究的影响 包括评估扩展的医疗保健利用模式对TGNB年轻人的适用性 经验和评估模型与考虑交叉方法的兼容性 性别和种族/少数民族青年促进高质量医疗保健科学的经验 这群人。

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.