Toward Understanding Culturally Safe Health Care for Transgender People: A Scoping Review of Health Care Provider Knowledge

Transgender is an umbrella term for individuals whose gender differs from the sex assigned at birth. Health disparities among transgender individuals are described in the literature. Concurrently, transgender people describe unmet health care needs due to access barriers, medical mistrust, and fear of mistreatment. These barriers may indicate challenges in providing culturally safe care to this group. Little is known about the knowledge and experiences of health care providers (HCP) in providing culturally safe care for transgender patients. To begin to address this, a scoping review applying Arksey and O’Malley’s methodological framework was undertaken to identify studies involving HCPs and their knowledge and experiences delivering care to transgender patients. Eighteen studies met inclusion criteria. Thematic analysis highlighted system and practice barriers. System barriers included non-inclusive intake processes, which contributed to erasure. As well as communication challenges, including difficulties knowing when to ask about and use correct pronouns. Additional system barriers included financial obstacles to providing care and oppression for those with intersecting identities. Practice barriers included a lack of education, unconscious biases, and medical gatekeeping of gender-affirming medical interventions. HCPs also exhibited a lack of understanding of how health care can contribute to minority stress by stigmatizing transgender individuals and how this can elevate patient health risks. Knowledge deficits were identified, and best practice recommendations were highlighted that, if examined, might improve the provision of culturally safe care for transgender patients thus, reducing stigma and minority stress