Access Type

Open Access Dissertation

Date of Award

January 2016

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Social Work

First Advisor

Kim D. Jaffee

Second Advisor

Debra Patterson

Abstract

Transgender individuals report being denied healthcare services, but very little is known about primary care providers’ (PCP) willingness to deliver either routine or transition care to the transgender community. The purpose of this study is to examine PCP willingness to deliver routine care, continue a hormone therapy (HT) regimen initiated by another provider, and initiate HT for transgender patients using a theoretical framework informed by the Theory of Planned Behavior and Intergroup Contact Theory. The study sample was all family medicine, internal medicine, and women’s health providers in a large integrated Midwestern health system. Eligible participants were emailed a unique link to an online survey assessing clinical and personal exposure to transgender individuals, empathetic attitudes, transphobia, self-efficacy, willingness to deliver care, and socio-demographics. While the majority of providers were willing to provide routine care to transgender patients, only half (53%) were willing to continue HT and even fewer (22%) were willing to initiate HT. Factors that increased the odds of willingness to provide routine care included personal exposure to transgender individuals and feelings of capability. Being Christian or Jewish, personal and clinical exposure to transgender individuals, decreased transphobia, and familiarity with HT regimens increased the odds of willingness to continue HT. Familiarity with HT and reporting insurance barriers increased the odds of willingness to initiate HT. Both cultural and policy shifts and provisions of the ACA will increase access to care for transgender patients; in order for healthcare systems to adapt, both medical education and social work education should address cultural competence issues around transgender care.

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