Developing, Refining, and Testing the Intersectional Model of Service Use: A Transgender and Nonbinary-Specific Model of Healthcare Access

Transgender and nonbinary (TNB) people are more likely to experience negative health outcomes than cisgender (i.e., not TNB) people, but less likely to access healthcare services due to the systemic forces of transphobia and cisgenderism. Despite this, there are few theoretical models of healthcare access specifically designed for TNB people. This three-paper dissertation addresses this gap by developing, refining, and testing the Intersectional Model of Service Use (IMSU), a population-specific framework for researching TNB healthcare access. Manuscript one describes how the initial IMSU was developed from an integrative review of currently available TNB healthcare access literature. This initial IMSU was then revised in manuscript two using qualitative data collected in nine focus group held across the state of Colorado. The revised IMSU was then quantitatively tested in manuscript three using hierarchical logistic regression analyses. Results from manuscript three indicated that the inclusion of TNB-specific healthcare access factors of the IMSU significantly improved its ability to account for healthcare access variance. Specific factors that were significantly associated with healthcare access included self-reporting a disability, sexual orientation, income, the length of time participates needed to wait to access transition-related healthcare, and whether or not participants had changed their gender marker on state-issued identification