Stigma and healthcare access among transgender and gender‐diverse people: A qualitative meta‐synthesis

Abstract

AIM: To describe the experience of stigma among transgender and gender-diverse (TGD) people accessing care. DESIGN: A qualitative meta-synthesis. DATA SOURCES: CINAHL, Medline, PubMed and PsycINFO were used to retrieve English-language, peer-reviewed qualitative studies from September 2016 to September 2021. REVIEW METHODS: The methods for this qualitative meta-synthesis included four steps. Step 1: Form the clinical question and purpose of synthesis to define and refine search terms. Step 2: Evaluate the literature using PRISMA. Step 3: Appraise the literature using Lett's Critical Review Form. Step 4: Conduct a reciprocal translation to synthesize the results. RESULTS: Of the 12 articles that met the inclusion criteria, 3 were from nursing journals. The articles included were studies conducted in U.S.A., Brazil, Canada, Colombia, Mozambique, Sweden, Uganda and United Kingdom, and most recruited transfeminine-identifying participants. Three main themes emerged: stigma experienced within the individual, interpersonal and structural socio-ecological levels among TGD people accessing care. CONCLUSION: Stigma is a significant public health issue as it limits healthcare access among TGD people. Stigma experienced at various socio-ecological levels contributes to health disparities. Nurses must create and implement interventions informed by the lived experiences of TGD people. IMPACT: Extant literature on this topic is limited in the nursing literature. This qualitative meta-synthesis illuminates TGD identity stigma-related experiences using a socio-ecological framework. While stigma is often experienced at the individual and interpersonal levels, oppressive systems that value cisgender cultural norms over other gender identities allow structural-level stigma to occur. Nurses are morally, ethically and professionally responsible for challenging systems that create and sustain stigma. Understanding how stigma is experienced when accessing care can help deliver critical information needed to improve healthcare access among TGD people and other historically oppressed communities.

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