UNLV Theses, Dissertations, Professional Papers, and Capstones 5-1-2019 Virtually Healthy: Using Virtual Ethnography to Survey Healthcare Seeking Practices of Transgender Individuals Online Rogelio Arenas Follow this and additional works at: https://digitalscholarship.unlv.edu/thesesdissertations Part of the Sociology Commons Repository Citation Arenas, Rogelio, "Virtually Healthy: Using Virtual Ethnography to Survey Healthcare Seeking Practices of Transgender Individuals Online" (2019). UNLV Theses, Dissertations, Professional Papers, and Capstones. 3564. http://dx.doi.org/10.34917/15778387 This Dissertation is protected by copyright and/or related rights. It has been brought to you by Digital Scholarship@UNLV with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. 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VIRTUALLY HEALTHY: USING VIRTUAL ETHNOGRAPHY TO SURVEY HEALTHCARE SEEKING PRACTICES OF TRANSGENDER INDIVIDUALS ONLINE By Rogelio Armando Arenas Bachelor of Arts - Anthropology Emory University 2005 Master of Arts - Anthropology University of Alaska Fairbanks 2012 A dissertation submitted in partial fulfillment of the requirements for the Doctor of Philosophy - Anthropology Department of Anthropology College of Liberal Arts The Graduate College University of Nevada, Las Vegas May 2019 Dissertation Approval The Graduate College The University of Nevada, Las Vegas April 10, 2019 This dissertation prepared by Rogelio Armando Arenas entitled Virtually Healthy: Using Virtual Ethnography to Survey Healthcare Seeking Practices of Transgender Individuals Online is approved in partial fulfillment of the requirements for the degree of Doctor of Philosophy - Anthropology Department of Anthropology Daniel Benyshek, Ph.D. Kathryn Hausbeck Korgan, Ph.D. Examination Committee Chair Graduate College Dean Jiemin Bao, Ph.D.Examination Committee Member William Jankowiak, Ph.D. Examination Committee Member Georgiann Davis, Ph.D. Graduate College Faculty Representative ii Abstract Virtually Healthy: Using Virtual Ethnography to Survey Healthcare Seeking Practices of Transgender Individuals Online by Rogelio Armando Arenas Dr. Daniel Benyshek, Examination Committee Chair Associate Professor of Anthropology University of Nevada, Las Vegas The use of digital spaces becomes more prevalent as technologies improve and more individuals become connected online. For many, the virtual world may become the primary means by which they engage socially and commercially with larger society. For individuals who identify as transgender or gender nonconforming, the virtual world serves as an environment where the fluidity of identity construction, the security of anonymity, and the physical separation provided by using a digital medium allows for the creation of a secure space for social engagements that may otherwise be discriminatory or infeasible in physical interactions. The stigma, discrimination, and prejudice experienced by transgender individuals not only affects social interactions, but also creates obstacles for transgender individuals seeking necessary services such as healthcare. As a result, many transgender individuals look to online resources for healthcare in order to avoid the ordeal of pursuing healthcare support in person. This study will employ methods drawn from virtual ethnography to investigate the online healthcare- seeking behaviors of transgender individuals. Virtual ethnography is a research methodology designed to incorporate many of the facets of traditional ethnography to the virtual world in order to effectively conduct research and collect data from individuals from interactions with their online representation, or avatar. One of the strengths of virtual ethnography is that it provides a means by which the investigator can communicate with individuals that would iii otherwise not be accessible in person. Through surveys, participant observation, and interviews within the virtual world of the participants’ choice, this study will address how transgender individuals use the internet to access medical information and healthcare, what factors contribute to seeking healthcare online, and how the use of digital spaces affords support that would otherwise not be found in pursuing healthcare in person. The information gathered could potentially not only help to elucidate the health necessities of an overlooked and underserved population, but also provide the means by which healthcare access and support can be improved for the community. iv For Elia v Table of Contents Abstract .......................................................................................................................................... iii List of Tables ............................................................................................................................... viii List of Figures ................................................................................................................................ ix Chapter 1 Introduction .....................................................................................................................1 Problem Statement ............................................................................................................1 Virtual Ethnography .........................................................................................................2 Transgender Health ...........................................................................................................4 Research Aims and Questions...........................................................................................6 Chapter 2 Identity Theory ................................................................................................................8 Transgender Identity .........................................................................................................8 Digital Identity .................................................................................................................14 Transgender Communities Online .................................................................................19 Virtual Ethnography .......................................................................................................20 Chapter 3 Biomedical Theory ........................................................................................................23 Biomedical Anthropology and Transgenderism ...........................................................23 Brief History of Transgenderism in Science and Medicine .........................................26 Transgender Health Today ............................................................................................29 Connected Health .............................................................................................................34 Chapter 4 Methods .........................................................................................................................36 Protection of Human Research Subjects .......................................................................36 Participant Inclusion Criteria .........................................................................................37 Recruitment ......................................................................................................................38 Survey................................................................................................................................39 Interviews..........................................................................................................................40 Participant Observation ..................................................................................................41 Compensation ...................................................................................................................42 Chapter 5 Results ...........................................................................................................................43 Survey................................................................................................................................43 Demographics ..............................................................................................................44 Gender Identity and the Public Sphere ........................................................................47 Transgender Health ......................................................................................................49 Interviews..........................................................................................................................58 Finding Oneself Online ................................................................................................59 Safely Interact with World ...........................................................................................61 Meeting Social Need Online ........................................................................................63 Difficulty Finding Supportive Care .............................................................................65