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Qualitative analysis on the trans and gender-diverse primary health-care experiences

Kardinia Health is a progressive health clinic supporting the health needs of our broad community. Data shows that gender-diverse (GD) people, including transgender and non-binary people, have more complex health needs than cisgender people. They are marginalized and at risk and require gender-affirming care (GAC). This care extends beyond mental health support and hormone therapy to be holistic and ongoing. Recent Australian studies highlight disparities in specialist gender clinics, situated in larger cities, that cater to this population specifically by providing gender-affirming care. However, these specialist gender clinics are scarce in regional, rural, and remote areas. Gender-diverse patients rely on primary health services and general practitioners to access their gender-affirming care in those areas. No formal studies have been conducted at the primary care level in those areas in Australia.

Kardinia Health in collaboration with researchers at Deakin University has undertaken a study aimed to identify the barriers and facilitators to the healthcare of regional and rural gender-diverse patients in a regional health service that is inclusive to gender-diverse patients. It also aimed to explore their views on what ideal gender-affirming care looks like.

We recruited ten registered patients that attend Kardinia Health clinic who kindly volunteered their time to be part of the study. Semi-structured individual interviews lasting approximately 40 minutes were conducted. We used an inductive thematic analysis to identify key themes

What did we find?

Six overarching themes emerged from the interviews.

Conclusions:

Kardinia Health successfully provided gender-affirming care to patients who were able to access it. However, patients noted some challenges in terms of accessibility potentially due to the large volume of gender-diverse and other patients seeking care. This suggests that catering to the gender-diverse population’s healthcare needs of hormone replacement therapy management may be achievable in other inclusive primary clinics as well. This could also shorten waitlists in inclusive and specialised clinics.

Congruent with findings from similar research in metropolitan areas, there is a sheer demand for more knowledgeable primary healthcare providers in gender affirmation not only in the Geelong region but other parts of regional and rural areas of Victoria. Implicit in these outcomes is a recognition that the current gender-affirming care in the Geelong region requires improved accessibility and awareness of it.

Kardinia Health is committed to further research in this area and will explore how the knowledge our practitioners and our staff have gained, can be implemented at other clinics throughout Australia.

We’d like to acknowledge the work of Honours student Shogher Dikran, along with her supervisors Erik Martin, Joe Latham, Andrew Sanigorski and Nic Brayshaw.

Included are some participants’ comments to help people understand some of the issues faced by trans and gender diverse people;

‘One of the things that I’ve found was helpful is that [Kardinia Health] is quite holistic in its nature Also, [it is] very affirming and feels quite safe to access care there as a trans person and as a queer person… There’s a lot of visual indicators at Kardinia [Health] about it being inclusive and safe space for queer folk and that makes a big difference… Before I did my legal name change, my preferred name was used extensively… If I got a phone call, I’d be referred to by my preferred name, not my legal name, which was a huge thing… There’s never been any sort of inappropriate language used or inappropriate questions, which I have experienced in other health care services. I think sometimes when you’re a trans or a queer person you’re visible when you walk into a space. Everyone’s curious and wants to ask questions and say the inappropriate things or try and be supportive but make kind of backhanded compliments. I haven’t experienced that at Kardinia [Health]. I felt like they were there to provide me care, and had my best interests in their mind, not their own curiosity’ – Jane 

‘[My expert current GP is] the first doctor I’ve come across with an understanding of trans health… [He] is very knowledgeable about trans health, but he’s also open to learning. So, he will [reach out to learn new information in recent research] from different organizations. If he needs some extra information [and] a patient’s given him a challenge [to which] he can’t answer, [he’ll reach out to sources for information and gather them] … Other doctors won’t do that because they get insulted by the thought that they might have to ask somebody else. [My current GP] will do that. He’s up for learning from whatever source he can get from. So, that’s the person I want to see….There would be half a dozen knowledgeable GPs or endocrinologists in Victoria, and [my current GP] is one of them. [He] is one of the better ones, because he’s open… Also [he] is able to offer things that most other doctors won’t do. So for instance, [he informed me about] inserted pellets for hormones instead of the traditional routes of hormones, but that means he [would] surgically implant them into my abdomen, and [he is able to] do that. Whereas I know a lot of other people who are happy to prescribe, but they won’t carry out that surgical procedure. [With those pellets], you don’t have to worry about anything. It all happens automatically. [You] go back and see him in fourteen months and get the next ones to put in. I know they’re twice as expensive [as the traditional medication for HRT], but I think the convenience factor is well worth it.’ – Ella

‘So, I went [to Kardinia Health clinic] for general GP help which meant that, again, when [the subject of HRT] came up and I wanted to take these steps, I was already linked into that environment. It meant that I could go in that direction with someone I had already trusted from previous experience and, again, that also contributes to the feeling that it’s normal and that this a normal thing that can be a course that people can take. It’s not some scary weird thing that you have to go somewhere else for… It was really nice that I can speak to my usual GP about doing this…I think you can be more hesitant about going [to a specialized gender clinic] or put it off for longer. It makes a big difference.’ – Ivy