Personal Healthcare Networks of Transgender and Gender-Diverse Adults After Gender-Affirming Surgery

Transgender and gender-diverse (TGD) individuals face substantial health disparities compared to cisgender (i.e., non-TGD) people, including increased depression, anxiety, substance use, suicidal thoughts and attempts, chronic disease, and HIV. While gender-affirming care, such as surgery, can improve mental health, TGD people live long and complex lives beyond gender-affirming surgery; this intervention does not alleviate the deeply-rooted systemic stigma and prejudice towards TGD people that leads to chronic minority stress and negatively affects their health outcomes. Furthermore, most previous literature focuses on life before or immediately after gender-affirming interventions. To fill these gaps in knowledge, the proposed study seeks to identify barriers and facilitators to resilience for TGD people after gender-affirming surgery. In particular, access to care is a systems-level resilience factor with great potential to intervene upon the health of TGD people across the life course. However, evidence indicates that TGD individuals delay and avoid needed healthcare due to experiences of stigma in healthcare settings. Moreover, current data about access to care in this population is insufficiently detailed. To capture the complex systems and interpersonal factors that intersect in accessing healthcare, this study proposes a unique application of egocentric social network analysis to operationalize access to care as a multifaceted and relational process. By conceptualizing a “personal healthcare network” composed of the varied and multidisciplinary healthcare professionals that a person engages with when seeking healthcare, this research will quantitatively and qualitatively describe concepts that are often insufficiently measured using dichotomous variables. This study focuses on TGD patients’ insider perspectives about their structures of care, centering the experiences of this marginalized population to provide essential insights that are not available in the current literature or with previously-used methods. The specific aims are to (1a) characterize the personal healthcare networks of TGD adults after gender-affirming surgery (N = 100), (1b) examine associations between network characteristics and participant outcomes in mental and physical health, and (2) qualitatively explore TGD people’s experiences of building and accessing a network of healthcare providers after gender-affirming surgery (N = 24). These aims will be achieved by adding new quantitative items to data collection in an existing study of TGD adults one year after gender-affirming surgery, and then recruiting a qualitative subsample from this group for semi-structured interviews. These aims are aligned with NINR’s Research Lenses of Health Equity and Systems and Models of Care. Through the proposed research and training plan, the applicant will receive top-tier mentorship in a research-intensive environment at Columbia University School of Nursing, setting them on the path to becoming an independent nurse investigator. This research will be a significant contribution to access-to-care methods and address the dearth of literature on TGD resilience to minority stress after gender-affirming surgery.