Healthcare disparities are exacerbated among rural, transgender populations, study shows

It's already well-documented that West Virginians in rural pockets of the state face limitations to accessible and quality healthcare. For members of the transgender and gender diverse populations, those disparities are exacerbated, according to West Virginia University research.

Up to 61% of participants in a study said they had to travel out of state for gender-related care, while over one-third reported they avoid seeking healthcare altogether for fear of discrimination, suggests research led by Megan Gandy, BSW program director and assistant professor at the WVU School of Social Work.

Transgender and gender diverse folks have a difficult time getting their basic healthcare needs met because of discrimination and avoidance of care due to fear of discrimination. This avoidance of healthcare likely leads to less preventative healthcare service usage and can exacerbate existing health issues if they aren't treated in a timely manner."

Megan Gandy, BSW program director and assistant professor, WVU School of Social Work

Gandy and her team examined the question "What do transgender and gender diverse people need from medical providers in order to have their healthcare needs met in West Virginia?" They interviewed participants whose ages ranged from 6 to 62 (experiences of minors under the age of 18 were reported in conjunction with their parent or guardian).

These populations are less researched than their urban counterparts. Therefore, the researchers set out to focus on the healthcare needs of transgender and gender diverse people in a rural Appalachian American context. The findings are published in the open-access journal International Journal of Environmental Research and Public Health.

Quantitative results indicate that travel burden is high, affirming provider availability is low, and there are notable impacts on both the physical and mental health of these populations.

A main takeaway from the study, Gandy said, is the need for more healthcare providers to educate themselves on gender-inclusive care, entailing sexual or reproductive health services for patients to feel comfortable and supported.

"One-third of participants reported that their providers probably or definitely do not have knowledge regarding gender-related care," Gandy said. "This was the No. 1 theme in open-ended responses to the question concerning what one thing providers should know about providing care to transgender and gender diverse patients.

"Our research shows that transgender and gender diverse patients do best in an affirming environment, which includes knowledgeable providers. If you don't know whether or not your provider has the knowledge to care for your specific needs, how likely is that you are going to trust that provider?"

Ways providers can improve care for these populations is by using chosen names and pronouns and seeking professional education around transgender and gender diverse issues, the study noted.

Gandy hopes this research can lead to policy implications. For instance, only 26% of the respondents reported that their insurance covers gender-related care.

"We must advocate for policies that expand coverage and remove barriers to coverage," Gandy said. "For example, someone who had been transitioned for 20-plus years (and received hormone treatment for nearly as long) had a new insurance provider who said that they must see a therapist for a year before insurance would cover their hormone treatment. It was ridiculous to think that the person who has had gender-related hormone treatment for the majority of their life should have to suddenly see a therapist just to get their medical treatment covered by insurance."

As a result, that person must travel out of state to a provider not covered by their insurance in order to get care, Gandy said.

On the heels of this research, Gandy will work with Molly Fechter-Leggett, special projects director for Gender-Affirming Care at WVU Medicine, and Dr. Kacie Kidd, a co-author of the study and medical director of the Gender and Sexual Development Clinic at the WVU School of Medicine. Together, they will work on training WVU Medicine staff on the basics of gender-inclusive care.

"This is an exciting outcome of the research because it provides a real translation of the research into direct practice, right here in our state," Gandy said.

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