TY - JOUR
T1 - Patterns of Healthcare Discrimination Among Transgender Help-Seekers
AU - Romanelli, Meghan
AU - Lindsey, Michael A.
N1 - Funding Information:
The authors thank the respondents of the U.S. Transgender Survey and the members of the Behavioral and Intervention Services Research in Context Lab at the McSilver Institute for their feedback. The preliminary findings of this manuscript were presented as an oral presentation at the National Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) Health Conference in Atlanta, Georgia on May 31, 2019. Author contributions: MR conceptualized the study, analyzed the data, and wrote the original draft of the paper. MAL conceptualized the study, conducted the investigation, and reviewed and edited the paper. No financial disclosures were reported by the authors of this paper.
Publisher Copyright:
© 2019 American Journal of Preventive Medicine
PY - 2020/4
Y1 - 2020/4
N2 - Introduction: Affirmative health care is imperative to address health and mental health disparities faced by transgender communities. Yet, transgender help-seekers experience discrimination that precludes their access to and participation in care. This study uses latent class analysis to examine patterns of healthcare discrimination among transgender help-seekers. Predictors of class membership are investigated to identify subpopulations at highest risk for healthcare discrimination. Methods: Data were obtained from the 2015 U.S. Transgender Survey and analyzed in 2019. Ten healthcare experiences were included as latent class indicators. Latent class analysis and regression were performed in Mplus, version 8 to identify latent subgroups and examine the relationship between respondent characteristics and the latent classes. Results: The final sample included 23,541 respondents. A 3-class model fit best: Class 1 experienced overt discrimination and interfaced with providers with limited trans-competence; Class 2 did not experience healthcare discrimination or report issues related to providers’ trans-competence; and Class 3 did not experience discrimination but had providers with low trans-competence. Transmen and respondents who were out as trans to their providers and reported psychological distress, suicidal thoughts, and disabilities were more likely to be members of Class 1 or 3 than Class 2. Conclusions: Experiences of healthcare discrimination are not homogeneous across transgender help-seekers. Predictors of the latent classes indicated that transgender help-seekers holding an additional marginalized identity may be at higher risk for healthcare discrimination or care from providers with limited trans-competence. Targeted engagement and education interventions might improve these transgender help-seekers’ access to and connections with care.
AB - Introduction: Affirmative health care is imperative to address health and mental health disparities faced by transgender communities. Yet, transgender help-seekers experience discrimination that precludes their access to and participation in care. This study uses latent class analysis to examine patterns of healthcare discrimination among transgender help-seekers. Predictors of class membership are investigated to identify subpopulations at highest risk for healthcare discrimination. Methods: Data were obtained from the 2015 U.S. Transgender Survey and analyzed in 2019. Ten healthcare experiences were included as latent class indicators. Latent class analysis and regression were performed in Mplus, version 8 to identify latent subgroups and examine the relationship between respondent characteristics and the latent classes. Results: The final sample included 23,541 respondents. A 3-class model fit best: Class 1 experienced overt discrimination and interfaced with providers with limited trans-competence; Class 2 did not experience healthcare discrimination or report issues related to providers’ trans-competence; and Class 3 did not experience discrimination but had providers with low trans-competence. Transmen and respondents who were out as trans to their providers and reported psychological distress, suicidal thoughts, and disabilities were more likely to be members of Class 1 or 3 than Class 2. Conclusions: Experiences of healthcare discrimination are not homogeneous across transgender help-seekers. Predictors of the latent classes indicated that transgender help-seekers holding an additional marginalized identity may be at higher risk for healthcare discrimination or care from providers with limited trans-competence. Targeted engagement and education interventions might improve these transgender help-seekers’ access to and connections with care.
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U2 - 10.1016/j.amepre.2019.11.002
DO - 10.1016/j.amepre.2019.11.002
M3 - Article
C2 - 32001051
AN - SCOPUS:85078464816
VL - 58
SP - e123-e131
JO - American Journal of Preventive Medicine
JF - American Journal of Preventive Medicine
SN - 0749-3797
IS - 4
ER -