Document Type

Capstone Experience

Graduation Date

5-2025

Degree Name

Master of Public Health

Department

Health Promotion

First Committee Member

Dr. Melissa Tibbits

Second Committee Member

Dr. Marisa Rosen

Third Committee Member

Dr. Chad Abresch

Abstract

BACKGROUND: Transgender and gender diverse health is significantly under attack in the United States and there is a continued need to further research to identify ways to increase their access to both inclusive care as well as gender affirming care. The purpose of this study was to explore barriers and supportive factors that professionals and community leaders perceive surrounding the availability and accessibility of inclusive and gender affirming care for transgender and gender diverse people in Mahoning County, Ohio.

METHODS: Key informant interviews were conducted with professionals and community leaders who could be considered “facilitators” helping transgender and gender diverse people in their community find what they need to access care. A semi-structured interview guide was created to understand the state of gender affirming care and inclusive care access in Mahoning County, Ohio. Interviews were conducted using a video conferencing platform or in-person and lasted between 15 to 45 minutes. Interviews were recorded, transcribed, and analyzed. A thematic analysis was conducted to identify key themes.

RESULTS: Most, but not all, interviewees felt distress concerning the state of gender affirming and inclusive care access in their community. Participants identified several social determinant factors that act as barriers and supportive factors to individuals seeking care. This includes social trust, fear of discrimination, provider risk aversion, lack of community knowledge, data limitations, and education. Numerous systemic, institutional, and informal institutions that function as barriers hampering providers’ ability to help transgender and gender diverse community members access care were also identified. (DISCUSSION) Overall, this study found a need for greater education for community members, providers, and leaders in their community and the need for increased access to care, as well as information about care that would be useful to them in their efforts to support care access for transgender and gender diverse community members. It also identified a need for policy change at the institutional and systems levels, including challenging persistent and harmful informal practices.

PUBLIC HEALTH IMPLICATIONS: These findings could help inform local institutional policy decisions to help make care more accessible for patients and information easier to find for the professionals that are helping them find access to care. Additionally, these findings have implications for health equity as they reveal existing disparities at the community level that need to be addressed to improve the public’s health for the transgender and gender diverse population. Further research will be needed to address remaining gaps in knowledge and explore the role of “facilitators” in helping people access gender affirming and inclusive care in greater detail.

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