Positive patient-provider relationships among transgender and nonbinary individuals in New York City

Abstract

Background: Transgender and nonbinary (TGNB) individuals have diverse health needs and may face disproportionate barriers to healthcare, including developing positive patient-provider relationships. While there is mounting evidence of gender-based stigma and discrimination in healthcare, little is known about how TGNB individuals develop positive patient-provider relationships.

Aims: To examine TGNB individuals’ interactions with healthcare providers and identify main characteristics of positive patient-providers relationships.

Methods: We conducted semi-structured interviews with a purposive sample of 13 TGNB individuals in New York, NY. Interviews were transcribed verbatim and analyzed inductively for themes related to characteristics of positive and trusting relationships with healthcare providers.

Results: Participants’ mean age was 30 years (IQR = 13 years) and most participants were nonwhite (n = 12, 92%). Receiving peer referrals to specific clinics or providers helped many participants find providers perceived to be competent and created initial grounds for positive patient-provider relationships. Providers with whom participants had positive relationships commonly managed primary care and gender-affirming care and relied on a network of interdisciplinary providers for other specialized care. Providers who were positively evaluated were perceived to possess in-depth clinical knowledge on the issues they were responsible for managing, including gender-affirming interventions, particularly for TGNB patients who perceived themselves to be knowledgeable about TGNB-specific care. Provider and staff cultural competence and a TGNB-affirming clinic environment were also important, particularly early in the patient-provider relationship, and if combined with TGNB clinical competence.

Discussion: Provider-focused training and education programs should combine components of TGNB clinical and cultural competence to facilitate development of positive relationships between TGNB patients and providers, thereby improving the health and wellbeing of TGNB people.

Keywords:

• Gender identity
• patient-provider relationships
• patient satisfaction
• qualitative research
• shared decision-making

Acknowledgments

The authors would like to thank all research participants interviewed as part of this research; research staff at the Program for the Study of LGBTQ + Health; and members of our Project AFFIRM transgender community advisory board.

Disclosure statement

The authors report no conflicts of interest.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This study was made possible through support of the MAC AIDS Fund (MAF CU13-3233, Walter Bockting, PI), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD79603, Walter Bockting, PI), and the National Heart, Lung, and Blood Institute (R01HL151559, Walter Bockting & Donald Edmondson, MPI). In addition, Dr. Emily Paine’s effort was supported by the National Institute of Mental Health (T32MH019139, Theo Sandfort, PI and K01MH128117, Emily Paine, PI). The opinions expressed in this manuscript are the authors’ own and do not reflect the view of the funding agencies, the National Institutes of Health, the Department of Health and Human Services, or the United States Government.