Experiences of Transgender Participants in Emergency Departments: Findings from the OutLook Study

Daniel N Thompson-Blum; Todd A Coleman; Natalie E Phillips; Sean Richardson; Robb Travers; Simon Coulombe; Ciann Wilson; Michael Woodford; Ruth Cameron; Charlie Davis

doi:10.1089/trgh.2020.0112

Experiences of Transgender Participants in Emergency Departments: Findings from the OutLook Study

Transgend Health. 2021 Dec 2;6(6):358-368. doi: 10.1089/trgh.2020.0112. eCollection 2021 Dec.

Affiliations

¹ Department of Psychology and Wilfrid Laurier University, Waterloo, Canada.
² Department of Health Sciences, Wilfrid Laurier University, Waterloo, Canada.
³ Faculty of Social Work, Wilfrid Laurier University, Kitchener, Canada.

Abstract

Purpose: Even in cases of medical emergency, mistreatment and negative experiences in life or in medical settings can deter trans patients from seeking necessary care. The purpose of this study was to identify factors associated with trans persons' emergency department (ED) avoidance in the mixed urban-rural Region of Waterloo, Ontario, Canada. Methods: The OutLook Study was a community-based partnership that created an online, cross-sectional questionnaire for lesbian, gay, bisexual, transgender, and other sexual and gender minority community members. Participants in this analysis were 16 years of age or older, lived, worked, or attended school in Waterloo Region, and identified as trans (n=112). Binary logistic regression was used to test associations between sociodemographic, resilience, and risk variables, and ED avoidance. Sociodemographic variables statistically significant at p<0.05 at the bivariate level were included as controls to explore different combinations of resilience and risk factor in multivariable models. Results: Participants reporting complete or partially complete medical transitions were more likely to report ED avoidance, compared to those who had not initiated medical transition. Elevated transphobia was associated with greater likelihood of avoidance. However, increasing levels of social support decreased the likelihood of avoidance. In multivariable models, social support, support from a special person, and transphobia were always significant, regardless of controlled variables. Conclusion: Transphobia-enacted in the contexts of everyday life and health care-can deter patients from seeking care. Patient-centered care requires careful attention to trans identity and health needs, especially in emergency settings. In the absence of structural changes, providers can take steps to mitigate the erasure and discrimination trans patients experience and anticipate when accessing EDs.

Keywords: Canada; emergency department access; social support; transgender; transphobia.