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Factors Affecting Health Care Access Among Transgender People in the United States

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Factors Affecting Health Care Access Among Transgender People in the United States University of Windsor Scholarship at UWindsor Electronic Theses and Dissertations Theses, Dissertations, and Major Papers 8-14-2019 Factors Affecting Health Care Access among Transgender People in the United States Luisa Kcomt University of Windsor Follow this and additional works at: https://scholar.uwindsor.ca/etd Recommended Citation Kcomt, Luisa, "Factors Affecting Health Care Access among Transgender People in the United States" (2019). Electronic Theses and Dissertations. 7785. https://scholar.uwindsor.ca/etd/7785 This online database contains the full-text of PhD dissertations and Masters’ theses of University of Windsor students from 1954 forward. These documents are made available for personal study and research purposes only, in accordance with the Canadian Copyright Act and the Creative Commons license—CC BY-NC-ND (Attribution, Non-Commercial, No Derivative Works). Under this license, works must always be attributed to the copyright holder (original author), cannot be used for any commercial purposes, and may not be altered. Any other use would require the permission of the copyright holder. Students may inquire about withdrawing their dissertation and/or thesis from this database. For additional inquiries, please contact the repository administrator via email ([email protected]) or by telephone at 519-253-3000ext. 3208. Factors Affecting Health Care Access among Transgender People in the United States Luisa Kcomt University of Windsor A Dissertation Submitted to the Faculty of Graduate Studies through the School of Social Work in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy at the University of Windsor Windsor, Ontario, Canada 2019 © 2019 Luisa Kcomt Factors Affecting Health Care Access among Transgender People in the United States By Luisa Kcomt APPROVED BY: ________________________________________ S. E. McCabe, External Examiner University of Michigan ________________________________________ C. J. Greig Faculty of Education ________________________________________ B. J. Barrett Women’s and Gender Studies ________________________________________ J. Grant School of Social Work ________________________________________ D. Levin School of Social Work ________________________________________ K. M. Gorey, Advisor School of Social Work August 14, 2019 iii Declaration of Originality I hereby certify that I am the sole author of this thesis and that no part of this thesis has been published or submitted for publication. I certify that, to the best of my knowledge, my thesis does not infringe upon anyone’s copyright nor violate any proprietary rights and that any ideas, techniques, quotations, or any other material from the work of other people included in my thesis, published or otherwise, are fully acknowledged in accordance with the standard referencing practices. Furthermore, to the extent that I have included copyrighted material that surpasses the bounds of fair dealing within the meaning of the Canada Copyright Act, I certify that I have obtained a written permission from the copyright owner(s) to include such material(s) in my thesis and have included copies of such copyright clearances to my appendix. I declare that this is a true copy of my thesis, including any final revisions, as approved by my thesis committee and the Graduate Studies office, and that this thesis has not been submitted for a higher degree to any other University or Institution. iv Abstract Transgender people experience pervasive interpersonal and structural discrimination within the health care system, which impact their ability to access appropriate and inclusive health care. Their invisibility is sustained by a cultural milieu wherein non-trans identities are privileged and an assumption is made that all people are cisgender. Transgender populations consist of a diverse spectrum of gender and other intersecting identities. Yet, there is a paucity of research about how each subgroup experiences discrimination, especially if they belong to more than one marginalized community. More specifically, transgender men have been underrepresented in research and little is known about the factors which affect their ability to access care. Guided by the theoretical framework of intersectionality and two conceptual models of health care access, the aims of this study are to: (a) compare barriers to health care among transgender men versus transgender women and non-binary/gender queer people; (b) examine factors which may increase the risk of experiencing health care discrimination or potentiate the ability to access care; and (c) examine the interaction of gender identity with other factors that can influence health care access in the United States. It was hypothesized that transgender men were more likely to experience barriers to health care access than transgender women and non-binary/gender queer people. Additionally, it was hypothesized that racial minority group status and living in poverty were risk factors while having health insurance and disclosure of trans identity were protective factors in the ability to access health care. It was further hypothesized that transgender men’s disadvantage would be greater among racial minority group members and those living in poverty, and that the gender identity divide would be smaller among v those who had health insurance or had disclosed their trans identity. Logistic regression analyses were conducted using a non-elder, adult subsample of the 2015 U.S. Transgender Survey (N = 14, 540) which was implemented by the National Center for Transgender Equality. Results found that transgender men experienced greater disadvantage than transgender women in many dimensions of health care access. Living in poverty was a risk factor, while having health insurance was observed to be a protective factor in health care access in the United States. Disclosure of trans identity served as a protective or risk factor, depending on the outcome being examined. Moreover, a significant interaction was observed with gender identity by disclosure. There was evidence to suggest that transgender men who did not disclose their trans status experienced greater vulnerability in health care access. The results of the present study can be used to illuminate the inter and intragroup differences within the transgender population in their health care access and to extend the current knowledge base about the experiences of trans men. Social workers and other health care professionals need to increase their understanding about the complexities and multiplicities of gender, and to develop cultural competency in serving the transgender population. Key words: transgender, trans men, health care access, health care discrimination, intersectionality vi Dedication To all the resilient transgender individuals who have endured adversity in pursuit of an authentic life. To all transgender people who are unable to live publicly for any reason. To all the fierce advocates who work tirelessly in the quest for social justice and equity. vii Acknowledgements Most major achievements are reached as a result of great effort and sacrifice made by unsung heroes. I would like to acknowledge the people who have been instrumental to my success, for they are my heroes from whom I draw inspiration. I am deeply grateful to my parents, Yok-Chan and Lucio Kcomt, for enduring the challenges of transnational migration in the effort to provide their children with better opportunities. I am awed by their bravery and perseverance. My success today is possible because of their hope and courage. I am blessed to have a sister who is also one of my best friends. I thank Marisol Kcomt for believing in me and being my companion on this journey. Her emotional support gives me the energy to keep moving forward, even when the mountain seems too overwhelming to climb. I especially wish to acknowledge Dr. Robert Zalenski who will always be a family of choice. I am not a facile writer; each sentence is constructed slowly and with laborious effort. Dr. Zalenski’s unwavering support, including countless hours of editorial assistance, is invaluable to me. I am indebted to Dr. Kevin Gorey for his mentorship throughout my doctoral education. Because of his steadfast encouragement during this journey of inquiry and discovery, I have learned such valuable lessons—not just about research but also about myself. During moments when I was paralyzed by self-doubt, his words of wisdom sustained me and served as a mantra: 1) tell the story, 2) be passionate, and 3) synthesize original thought with scientific evidence. This dissertation is one way for me to tell the story, with the hope that this work can be used towards advancing equity for sexual and gender minority populations. He has provided me with a transformative learning experience. viii Sincere appreciation also goes to Dr. Betty Jo Barrett, Dr. Jill Grant, and Dr. Dana Levin for their detailed review and critique of my dissertation research. They have served as excellent role models whose engaging feedback has expanded my perspective and shaped my academic identity. I hold immense gratitude and esteem for the National Center for Transgender Equality who shared their 2015 U.S. Transgender Survey dataset with me. Indeed, this was a precious gift. I will endeavor to inform knowledge users and policy makers of my research findings as part of the advocacy efforts to advance the rights of transgender people. To the thousands of transgender individuals who generously volunteered to participate in the
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