An Exploration of Transgender and Gender Diverse People's Positive Experience of Primary Health Care in Aotearoa New Zealand

Research exploring the experiences of transgender and gender diverse (TGD) patients engaging with primary health care systems is minimal, with very few studies examining positive health care experiences of TGD people. Of the limited research on TGD health care interactions, there are many barriers to care and anticipation of mistreatment by medical professionals. Transgender and gender diverse people experience a range of disparities compared to cisgender people, including higher rates of mental ill health and lower rates of stable housing and employment.. The aim of this study was to explore the positive experiences of TGD adults engaging with their General Practitioners (GPs), to identify good practice, and to inform future best practice for GPs with what works for TGD communities and individuals within an Aotearoa New Zealand-specific context. A qualitative study, using semi-structured email interviews, was conducted to explore the experiences of a national sample of TGD adults. Recruitment was achieved through social media advertising and word of mouth. A purposive sample of 11 participants completed an email interview after expressing an interest in participating via an online demographics and eligibility questionnaire. Māori, non-European and migrant identities were prioritised during selection for interviews to enhance diversity. The email interviews were analysed using thematic analysis, and three themes were identified. In the theme called The Sad State of Care, TGD participants described a disenfranchising health care context in which their relatively rare positive experiences with GPs existed. While participants experienced barriers to care, they also advocated for themselves and their communities in a variety of ways, described in the theme called Sphere of Control. The theme called the Gradient of Positive Experiences described the ways positive experiences ranged from GPs acting with basic professionalism through to GPs working to improve healthcare pathways for TGD communities. The term reactive self-determination was created to capture how TGD people are proactive in trying to improve their access to positive experiences in response to systemic failures and social disenfranchisement. There are many ways these research findings are practically applicable. System-level changes to funding, pathways to knowledge for health care providers, and improvements to medical school curriculum are critical to ensuring quality care for TGD patients. There are also individual-level opportunities for increased positive experiences, such as GPs increasing and signalling their competencies and making intake questions more trans-friendly. Increased access to telehealth and improved best practice documents are some recommendations for systemic changes. The results can also inform continuing education for practitioners. Together these approaches will assist GPs to meet the Medical Council of New Zealand’s Good Medical Practice requirements, and improve the experience of TGD patients in Aotearoa-New Zealand