Multilevel Factors Affecting Health Equity for Transgender and Gender Diverse Older Adults

The population of transgender and gender diverse (TGD) older adults in the United States may face inequities in the healthcare system due to factors at multiple levels. Research is needed to identify factors that limit and facilitate equitable healthcare delivery for this population. Therefore, researchers conducted a qualitative descriptive study called Shaping Affirming Futures with Elders of all gender experiences (SAFEage) to identify and explore factors that affect health equity for TGD older adults living in the United States. Through purposeful and snowball sampling, researchers enrolled 20 TGD older adults of diverse gender identities and racial and ethnic backgrounds. In Phase 1 of the study, participants discussed their healthcare experiences during semi-structured interviews. In Phase 2, participants reviewed study findings in individual and group sessions. Researchers coded transcripts of interviews and review sessions both deductively and inductively, conducting a thematic analysis informed by the conceptual framework Intersectionality Research for Transgender Health Justice. With participant input, researchers developed six primary themes describing factors that limit (L) and facilitate (F) health equity at (1) structural, (2) systemic, and (3) social levels of influence: (L1) Oppression driving adverse healthcare experiences; (L2) Gaps in healthcare resources and support; (L3) Disadvantages yielding poor health outcomes; (F1) Health justice promoting affirming healthcare experiences; (F2) Catalysts for change in healthcare; and (F3) Assets fostering agency and well-being. Study findings may inform future research, clinical practice changes, and policies that would promote equitable and inclusive healthcare for TGD older adults.