Thesis Format

Integrated Article

Toward Understanding Culturally Safe Health Care for Transgender People: A Scoping Review of Health Care Provider Knowledge

Author

Terrie Butler-Foster, The University of Western OntarioFollow

Degree

Master of Science

Program

Nursing

Supervisor

Kimberley T Jackson

2nd Supervisor

Tara Mantler

Co-Supervisor

Abstract

Transgender is an umbrella term for individuals whose gender differs from the sex assigned at birth. Health disparities among transgender individuals are described in the literature. Concurrently, transgender people describe unmet health care needs due to access barriers, medical mistrust, and fear of mistreatment. These barriers may indicate challenges in providing culturally safe care to this group. Little is known about the knowledge and experiences of health care providers (HCP) in providing culturally safe care for transgender patients. To begin to address this, a scoping review applying Arksey and O’Malley’s methodological framework was undertaken to identify studies involving HCPs and their knowledge and experiences delivering care to transgender patients. Eighteen studies met inclusion criteria. Thematic analysis highlighted system and practice barriers. System barriers included non-inclusive intake processes, which contributed to erasure. As well as communication challenges, including difficulties knowing when to ask about and use correct pronouns. Additional system barriers included financial obstacles to providing care and oppression for those with intersecting identities. Practice barriers included a lack of education, unconscious biases, and medical gatekeeping of gender-affirming medical interventions. HCPs also exhibited a lack of understanding of how health care can contribute to minority stress by stigmatizing transgender individuals and how this can elevate patient health risks. Knowledge deficits were identified, and best practice recommendations were highlighted that, if examined, might improve the provision of culturally safe care for transgender patients thus, reducing stigma and minority stress.

Summary for Lay Audience

Transgender is an umbrella term for individuals whose gender (including genders outside of the male/female binary) differs from the sex assigned to them at birth. The term transgender is inclusive of many descriptors, including, but not limited to, trans, trans*, transgender and gender nonconforming (TGNC), and non-binary. Cultural safety involves the creation of environments where people receiving care are not disadvantaged, estranged, or treated inferiorly, and where needs/identities are recognized. Health disparities among transgender individuals are described in the literature. At the same time, transgender people describe unmet health care needs due to access barriers, medical mistrust, and fear of mistreatment. These barriers may indicate challenges in providing culturally safe care to this group. Little is known about the knowledge and experiences of health care providers (HCP) in providing culturally safe care for transgender patients. To begin to address this, a scoping review using Arksey and O’Malley’s methodological framework was undertaken to identify studies involving HCPs and their knowledge and experiences delivering care to transgender patients. Eighteen studies met inclusion criteria. System and practice barriers were identified from the literature. System barriers included challenges and obstacles that exist widely across health care system infrastructure and in society. Subthemes included the impacts of intake forms and assessment tools on communication, funding barriers, and systemic oppression which was compounded for those with intersecting identities. Practice barriers included challenges that exist at the practitioner knowledge level. Practice barrier subthemes included lack of education and training, pathologizing and gatekeeping, stigma and bias. HCPs exhibited a lack of understanding of how health care can contribute to minority stress by stigmatizing transgender individuals and how this can elevate patient health risks. Knowledge deficits were identified, and best practice recommendations were highlighted that, if examined, might improve the provision of culturally safe care for transgender patients, thus reducing stigma and minority stress.

Recommended Citation

Butler-Foster, Terrie, "Toward Understanding Culturally Safe Health Care for Transgender People: A Scoping Review of Health Care Provider Knowledge" (2022). Electronic Thesis and Dissertation Repository. 8877.
https://ir.lib.uwo.ca/etd/8877