Providing culturally appropriate, quality health care to transgender populations: Meeting the needs of an underserved population

Access to quality healthcare for transgender patients is greatly diminished for a variety of reasons. The two main factors include: (1) lack of provider knowledge and understanding of the healthcare needs of this specific population; and (2) the general stigma against transgender persons. There is a paucity of research regarding transgender patients and their healthcare needs. Healthcare providers have scant knowledge which can cause transgender patients to experience stigma while seeking healthcare. The research that has been conducted has demonstrated that access to quality healthcare, lack of adequate screening tools, mental health services, hormonal therapy, surgeries and discrimination can cause transgender individual's to delay or avoid necessary healthcare services, in turn, placing their overall health at severe risk. In this first phase of a two-part study, the medical records of a random sample of 100 male-to-female transgender clients (40% of total clients registered) of a primary health clinic Transgender Health Program were reviewed to identify 1) the most common medical health and behavioral health issues facing these clients; and 2) the types of healthcare services provided to these clients by the program. The researchers used a structured form to collect quantitative and qualitative data. After having been pilot tested with 10 record, the data collection tool comprised twelve categories: 1) demographics, 2) patient and family medical history, 3) mental health history, 4) immunizations, 5) alcohol and other drug abuse, 6) HIV/AIDS, 7) sexual/physical abuse history and status, 8) hormonal therapy/silicon use, 9) living arrangements, social activities, and social support, 10) medication use, allergies, and their complications, 11) surgical history, and 12) laboratory results. The findings include the following types of health care conditions and related issues common among the population: family medical history of coronary artery disease, hypertension, diabetes mellitus, and smoking; human immunodeficiency virus (HIV) and other sexually transmitted infections; alcohol and/or other drug abuse; and current and previous sexual and physical abuse. The study also pointed to important methodological findings related to record-keeping for this population. The findings have implications for education and continuing training of healthcare providers, for development of screening and referral forms for transgender populations and revision of general client intake forms and procedures to ensure that the health needs of this population are addressed. The findings of this component have been used to design the second component of the study, which comprises in-depth qualitative interviews with a sample of the Transgender Health Program's clients.