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Healthcare Experiences of Transgender Mississippians: a Qualitative Study

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Healthcare Experiences of Transgender Mississippians: a Qualitative Study Template A v3.0 (beta): Created by J. Nail 06/2015 Healthcare experiences of transgender Mississippians: A qualitative study By TITLE PAGE Micah D. King A Thesis Submitted to the Faculty of Mississippi State University in Partial Fulfillment of the Requirements for the Degree of Master of Science in Sociology in the College of Arts & Sciences Mississippi State, Mississippi December 2018 Copyright by COPYRIGHT PAGE Micah D. King 2018 Healthcare experiences of transgender Mississippians: A qualitative study By APPROVAL PAGE Micah D. King Approved: ____________________________________ Rachel Allison (Major Professor) ____________________________________ Kimberly Kelly (Committee Member) ____________________________________ Nicole E. Rader (Committee Member) ____________________________________ Stacy H. Haynes (Graduate Coordinator) ____________________________________ Rick Travis Dean College of Arts & Sciences Name: Micah D. King ABSTRACT Date of Degree: December 14, 2018 Institution: Mississippi State University Major Field: Sociology Major Professor: Rachel Allison Title of Study: Healthcare experiences of transgender Mississippians: A qualitative study Pages in Study: 107 Candidate for Degree of Master of Science For this study, in-depth, semi-structured interviews were conducted with 16 transgender adults who lived, or had previously lived, in Mississippi and sought healthcare services in the state. The questions asked focused on identifying the barriers to care that these individuals faced as well as the strategies for navigating the barriers they employed. Recommendations for providers were also considered. DEDICATION This thesis is dedicated to the transgender Mississippians who made this project possible. Your willingness to share deeply personal, often painful experiences with incredible honesty, openness, and vulnerability is the reason this data exists. Your candor and willingness to help will hopefully help someone else who may be experiencing what you experienced suffer less from lack of access to healthcare than they would have without your insights and recommendations. I cannot thank you all enough. ii ACKNOWLEDGEMENTS Thank you to my mom, without whose unwavering support and unconditional love I could not have made it this far. Love you mama! And to my best friends, Kristie Holler, Melanie Walsh, Amanda (Snarly) Ready, and Lindsey Shaw – without you guys, I couldn’t have done any of this. Your support during what was the most trying time in my life is the only reason this got done. When I think back on this time, all the best memories I have will include one or all of you. I love you guys so much! Finally, to my academic advisor Dr. Rachel Allison, whose expert advice, patience, and support have made this project a reality. Thank you Dr. Allison! iii TABLE OF CONTENTS DEDICATION ................................................................................................................ ii ACKNOWLEDGEMENTS............................................................................................ iii LIST OF TABLES ......................................................................................................... vi CHAPTER I. INTRODUCTION ............................................................................................ 1 II. LITERATURE REVIEW ................................................................................. 2 State of Trans Health: Mental Health ................................................................. 2 State of Trans Health: Sexual Health ................................................................. 3 Barriers to Care: General ................................................................................... 3 Barriers to Care: Unique .................................................................................... 4 Barriers to Care: Discrimination & Refusal of Care ........................................... 5 Barriers to Care: Institutional Considerations .................................................... 6 Barriers to Care: Provider Knowledge ............................................................... 7 Barriers to Care: Anticipating Discrimination .................................................... 8 Educational & Physicians’ Barriers ................................................................... 8 Barriers to Care: Rurality ................................................................................ 11 Barriers to Care: Gatekeeping .......................................................................... 12 Positive Health Outcomes ............................................................................... 15 Health Outcomes: Community Context Effects ............................................... 16 III. THEORETICAL CONSIDERATIONS .......................................................... 19 IV. MISSISSIPPI .................................................................................................. 24 V. METHODS .................................................................................................... 27 Contribution .................................................................................................... 27 Ontological & Epistemological Considerations................................................ 29 Recruitment ..................................................................................................... 32 Participants ..................................................................................................... 32 Interviews ....................................................................................................... 34 Interview Schedule .......................................................................................... 34 iv Thematic Analysis and Coding Processes ........................................................ 35 VI. RESULTS ...................................................................................................... 38 Theme 1: Barriers to Care ............................................................................... 38 Theme 2: Strategies for Navigating & Accessing Care .................................... 74 VII. RECOMMENDATIONS FOR PROVIDERS ................................................. 82 VIII. DISCUSSION ................................................................................................ 89 REFERENCES ............................................................................................................. 91 APPENDIX A. DEFINITIONS ............................................................................................... 98 B. INTERIEW SCHEDULE ............................................................................. 101 C. RECRUITMENT FLYER............................................................................. 106 v LIST OF TABLES 1 Participant descriptions ................................................................................ 33 vi INTRODUCTION This thesis project is motivated by literature showing that transgender individuals and individuals living in rural areas frequently experience difficulty accessing health care providers and receiving competent, quality care. Recent research estimates the United States’ transgender population at 0.6% of adults, or about 1.4 million people (Flores et al., 2016) and indicates that transgender individuals are more likely than cisgender individuals to live in rural areas (Crissman et al., 2017). Transgender individuals experience discrimination due to their gender identities in a wide variety of settings, and healthcare is no exception. As a result, data reveal that transgender individuals have poorer health outcomes compared to cisgender (please see appendix for definitions) individuals. There is a significant amount of literature that consistently shows these patterns of discrimination and poorer health. What does not currently exist in the literature is research on the experiences of transgender individuals seeking healthcare in the American South, specifically Mississippi. This project seeks to understand the challenges that transgender people experience in accessing and receiving healthcare in Mississippi, as well as the strategies employed to access and receive quality care in a largely rural state. 1 LITERATURE REVIEW State of Trans Health: Mental Health The mental health of transgender individuals is a consistent subject of intrigue in medical and social science research. Significant psychological and psychiatric research has been devoted to comparing trans individuals to cisgender people, with results indicating substantial mental health disparities. In particular, transgender people report higher rates of depression, anxiety, and a host of other mental health conditions. People with gender dysphoria score lower on scales measuring satisfaction with life and psychological well-being than do non-dysphoric individuals (Rabito-Alcon 2016). Results from the largest survey of transgender Americans to date revealed that an astonishing 41% of transgender people report at least one suicide attempt in their lifetime, compared to 1.6% of the general American population. Additionally, 26% of trans people surveyed reported abusing alcohol and/or drugs specifically to cope with stress related to the discrimination experienced due to their gender identity and expression (Grant et al. 2011). Poor mental health is linked to and can indeed lead to poorer physical health, and vice versa (Ohrnberger et al. 2017). Despite a lack of data on the physical health
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