Transgender and Gender NonConforming in the Emergency Department: Power Inequity, Stigma and Self-Efficacy

Background: A few studies have quantitatively found that individuals with a transgender or gender nonconforming (TGGNC) experience avoid Emergency Departments (EDs) and/or have negative experiences. This study qualitatively examines TGGNC persons’ reasons for use or non-use of the ED, experiences in US EDs and recommendations for improving the emergency care of this population.

Methods: This retrospective, anonymous, written (paper and online), national study started in June 2012 and closed December 2014. 236 responses were analysed using a conceptual framework based on well accepted health behavioural theories. A team of six investigators developed a codebook that emerged from the participants’ responses and was applied to responses using NVivo 10. A data display was created to organize coded data into positive or negative categories and examined for emerging overarching themes.

Results: Using the above methods, the themes of Respect, Self-Efficacy and Power Inequity surfaced. These themes exposed the tension between self-identified TGGNC patients and providers who lack training in nonbinary gender identities or histories. When providers had specific training about this population, participants reported positive care experiences.

Conclusions: The traditional provider-patient power dynamic and trust is disrupted by the exposure of gaps in provider education and training around TGGNC care. Data from this study indicates that systematic training of ED providers, on how to interact with and the specific health issues of this diverse group, is necessary to improve the care of this marginalized population.