People who are gender minority (GM; people whose gender is incongruent with the sex that was assigned to them at birth) experience significantly higher rates of disability, chronic disease, and poor mental health as well as higher mortality than cisgender individuals (people whose gender is congruent with the sex they were assigned at birth). These health disparities have been linked to chronic stress associated with multiple stressors they encounter. There is evidence from qualitative studies that interactions with the health care environment may be a major source of stress that affects GM people?s willingness to seek care. However, little is known about the relationship between the stressors in health care and the symptoms of emotional distress or impaired physical functioning experienced by GM individuals or whether some gender identity groups may be more negatively affected by stressors in health care than others. In addition, few psychometrically sound measures are available to conduct such studies. The purpose of this study is to address these gaps in knowledge. Data from the 2015 United States Transgender Survey (USTS) will be analyzed to identify factors that may underlie stressors in health care interactions for GM people and whether survey items related to these stressors constitute a valid and reliable index for future use in GM research. These items have not been tested as a group for validity and reliability. Additionally, this research will examine relationships that may exist between stressors in health care interactions and symptoms of both emotional distress and impaired physical functioning among people who are GM. Emotional distress is measured with Kessler?s Psychological Distress Scale. Items to assess physical functioning are adapted from CDC?s Behavioral Risk Factor Surveillance System and the National Health Interview Survey. Symptom Management Theory will inform the study.
Aim 1 : Identify key factors that may underlie stressors in health care interactions, by evaluating USTS stressor items for factor structure and internal consistency.
Aim 2 : Determine the relationship between exposure to stressors in health care interactions and symptoms experienced by GM people (emotional distress and impaired physical functioning), after controlling for socioeconomic factors (e.g. age, income, education, race/ethnicity).
Aim 3 : Evaluate the potential role of gender identity as a moderator between health care stressors and symptoms of both emotional distress and impaired physical functioning. Evaluating a potential measure of GM health care stressors can enhance the quality of research in the field. Findings can also be used to inform interventions and policy guidelines that will improve health care for GM people by reducing the symptom burden experienced. The training and experience acquired to achieve these outcomes will provide a solid foundation for this investigator?s developing program of research.

Public Health Relevance

This study will identify the stressors experienced by under-served and often marginalized people when they seek health care and the relationship of these stressors to symptoms of potential health problems. By better understanding the types of stressors that occur in health care, changes can be made to how care is provided and how health care personnel are educated. Interventions to prevent and manage physical and emotional symptoms associated with these stressors can also be developed.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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University of California San Francisco
Other Health Professions
Schools of Nursing
San Francisco
United States
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