Article Figures & Data
Tables
Characteristic No. Clients (N = 9) Location of interview Regina 3 Saskatoon 3 Rural 3 Interviewee Client 8 Parent 1a Age group ≤12 years 1b 13-17 years 1 18-25 years 2 26-35 years 3 ≥36 years 2 Genderc Trans woman 3 Trans man 3 Nonbinary or otherwise gender diverse 3 Health care practitioners (N = 9) Location of practice Regina 4 Saskatoon 4 Rural 1 Profession Family physician 2 Internist 1 Registered nurse 2 Counselor 2 Pharmacist 1 Dietitian 1 Themes and subthemes Source of theme Client quotes HCP quotes Overarching theme: PTGD experience structural barriers to health care that are ameliorated by navigators Clients and HCPs Tanner: “[The navigator] was really good. He was very helpful. Made things a lot easier for me.”
Charlie: “The experiences, the access to services […] it has without exaggeration felt like I’m living for the first time. To say it changed my life might be the wrong term, it feels like it started it.”
Sam: “It’s a necessary [sic], should be permanent, full-time position.”
Wallace: “I think it’s great—my impression of it, is that it’s there to support people, and to close that gap between HCP and patients.”
Eleanor: “It’s phenomenal. I think it’s definitely something that’s sorely needed in Saskatchewan […] I’m so sad that it’s not continuing.”
Eleanor: “I feel honored that I was able to get in our [HCP education] days […] the feedback that I’ve gotten from it and the overwhelming positivity from the staff who participated.”
Subtheme: Shared experiences of structural transphobia between clients and navigators allowed for empathy Clients and HCPs Taylor: “[receiving bad news] is different coming from someone who’s been on the receiving end … It’s a lot less lonely of an experience when you have someone to kind of empathize [with].”
Jude: “It was really helpful just to have another trans person who had understood [sic] the limitations of our system in Saskatchewan and the barriers, and how difficult it is to even find a health care provider who’s supportive. And so, there were just questions that I could innately ask [him] that other people wouldn’t understand.”
Jude: “Here was a sense of mutuality, which is really important in creating the health care [I need] and in advocacy stuff that I’ve gone to him about too, it’s understanding what it is to fight for our rights, and that he innately understands that.”
Mike: “It kind of reflected a [basic] understanding of it from a nonacademic side […] understanding people’s lived experiences […] ‘cause there’s really no proxy for that.”
Ollie: “There is value in that shared identity, ‘Okay, I don’t have to explain this to you, you’re going to explain it to me,’ […] so it’s going to be maybe more compassionate, maybe less medical, maybe more holistic.”
Subtheme: Navigators reduced stress by helping PTGD to access services and providing reliable information to both PTGD and HCPs Clients and HCPs Lux: “[The navigator connected me with] a doctor […] a psychologist […] some pharmacy recommendations and someone for laser esthetician needs.”
Charlie: “That support provided an expectation of what [hormone therapy] would look like.”
Jenna (a new family physician): “Almost all my referrals [for new patients] are coming [from the navigator], because so many of the trans clients don’t have family doctors … I think it’s really helpful for patients to have someone to reach out to, because … I don’t know that they would be able to find me on their own…”
Laurie: “[The navigator] was able to give more, direct information about things. Especially for younger people who maybe haven’t gone to see a doctor by themselves before. A lot of the youth that I referred out to [the navigator] reported back that it was very useful for them to know.”
Ollie: “[Some of the] information that I have … is out of date, and the navigators have that ability to keep up to date. I need to have an awareness, but I’m not going to have the fine details. … [The navigator] knew … little details that help a person plan for … their transition.”
Subtheme: Navigators helped PTGD to mitigate stresses associated with structural health care barriers Clients and HCPs Taylor: “It was nice to be able to have someone to talk that [coming out to my family] through with … it was a nervewracking experience.”
Taylor: “[I] felt like [the navigator] was genuinely there for me. He would meet me after work at 7 or later because I would work late some days. And I knew I was going to be supported cause that’s the part that is the program, but it surprised me just how well I was supported.”
Casey (parent of trans child): “So pleasantly surprised when I said to [the navigator], ‘I’m looking for someone that [my child] can talk to, just somebody who can let [them] know that life is hard for everybody.’ [The navigator] said, ‘I could talk to [them] that’d be awesome.’ That didn’t occur to me. I thought this position was to just answer my questions, not counsel [my child].”
Horton: “[Navigators are] being a support person for other people who are trans and sort of feeling overwhelmed or stressed or not sure, not feeling understood by people and having the trans navigators as a support person for those people.”
Subtheme: PTGD experience structural barriers to mental health care that are ameliorated by navigators. Clients and 2 HCPs (both mental health care professionals) Bellamy: “[Working with the navigators] definitely has [impacted my life] in a positive way. I feel more myself … I’m just starting to feel happier, and more hopeful, even in the face of the world. I wouldn’t be this far along without all this help.”
Taylor: “[Working with the navigator] alleviated a lot of the potential for microaggressions. I have to explain a little less ‘cause [the navigator is] there to kinda do it for me and take some of that stress off—that was a huge benefit to my mental health.”
Laurie (mental health care professional): “That dual support … took off that extra pressure that was on that looming waitlist, right? And just offered this way that people needing some immediate support could actually start to receive a lot quicker.”
HCP = health care practitioner; PTGD = people who are transgender or gender diverse.
Note: Quotations have been edited for clarity or brevity where necessary. In quotes from the transcripts, all interviewees are referred to with pseudonyms and they/them pronouns. The 2 peer health navigators both use he/him pronouns, which have been retained; both are referred to as “the navigator” in quotations from interviews to avoid identifying the interviewee or the navigator.
Additional Files
SUPPLEMENTAL MATERIALS IN PDF FILE BELOW
Supplemental Appendix 1. Client Interview Questions
Supplemental Appendix 2. Healthcare Provider Interview Questions- Madill_Supp_App_1-2.pdf -
PDF file
- Madill_Supp_App_1-2.pdf -
VISUAL ABSTRACT IN PDF FILE BELOW
- Madill_visual_abstract.pdf -
PDF file
- Madill_visual_abstract.pdf -
PLAIN-LANGUAGE SUMMARY
Original Research
Peer Health Navigators Improve Access to Affirming Health Care for Transgender and Gender-Diverse Patients
Background and Goal:Transgender and gender-diverse individuals often experience additional difficulties navigating health care systems due to a variety of factors, including but not limited to a lack of knowledgeable and/or culturally competent practitioners, discrimination, and structural or socioeconomic barriers. This study examined the effectiveness of a peer health navigator pilot program in Saskatchewan, Canada. The program aimed to improve access to affirming health care for transgender and gender-diverse individuals by employing navigators with lived experience to provide guidance and support.
Study Approach: Two peer health navigators were recruited to pilot the program. The navigators were required to be transgender or gender diverse and have experience in health care or community-based organizations. They were trained informally by the research team and through mentorship with another Canadian navigator program. Navigators supported clients by providing information on gender transition and identities, connecting them to affirming health care professionals and community resources, booking appointments, advocating on their behalf, assisting with legal name and gender marker changes, and educating health care providers through individual and group sessions. Researchers conducted semi-structured interviews with clients and health care practitioners from May to July 2022 to explore their experiences with the navigators.
Main Results:
-
Navigators reduced structural barriers to affirming health care, improving access and alleviating stress for transgender and gender-diverse individuals.
-
Clients valued the navigators’ shared lived experience, which fostered trust and understanding.
-
Navigators provided tailored guidance, connected clients to affirming providers and resources, and supported health care practitioners with accurate information.
-
The program positively impacted clients’ mental health by filling gaps in psychosocial support and reducing stress while awaiting formal counseling.
Why It Matters: The study findings highlight the critical role of peer health navigators in improving access to affirming health care for transgender and gender-diverse individuals and suggest that making peer navigator roles a permanent part of the health care system may significantly benefit health care equity and patient well-being.
Interviews to Assess a Peer Health Navigator Service for People Who Are Transgender or Gender Diverse
Stéphanie J. Madill, PhD, et al
University of Saskatchewan, School of Rehabilitation Sciences, Saskatoon, Saskatchewan, Canada
Visual Abstract:
-
In this issue
Jump to section
Related Articles
Cited By...
- No citing articles found.