Navigating healthcare realities: exploring access and engagement for transgender and non-binary individuals in England

Purpose
Engaging transgender, non-binary and gender-diverse (TNBiGD) individuals in healthcare beyond transition-related care is necessary for improving health outcomes. Because of a lack of legislative protections in the UK, this population faces substantial barriers to accessing healthcare, characterised by negative experiences and discrimination. This study aims to explore the healthcare experiences of TNBiGD individuals in England, focusing on access and engagement within primary and secondary care services.

Design/methodology/approach
Adopting a participatory research approach, this study involved 17 TNBiGD individuals in England through online focus groups and semi-structured interviews, conducted in three phases. Ethical clearance was obtained, and participants were recruited via snowball sampling from LGBTQIA+ networks. Thematic analysis was used to interpret the data, with a focus on healthcare engagement and barriers to access.

Findings
Participants highlighted the necessity of equitable healthcare access as a fundamental human right, often hindered by discrimination, restricted access to gender-affirming care and a lack of provider knowledge. Systemic exclusions and identity erasure were identified as major barriers, with participants experiencing misgendering, incorrect use of gender markers and diagnostic overshadowing. Positive healthcare experiences were noted when gender identity was respected and integrated into care.

Originality/value
This study underscores the significant healthcare barriers faced by TNBiGD individuals in England, highlighting the need for systemic changes to ensure accessible, respectful and inclusive care. Recommendations focus on education, policy changes and further research to address these challenges and improve healthcare outcomes for the transgender and non-binary community