![]() Both misgendering and deadnaming can cause significant distress for many TNB people. When TNB people are able to access care, many report non-affirming practices such as being misgendered, being deadnamed (i.e., referring to a TNB person by their given or birth name as opposed to their chosen name), or having incorrect pronouns used. As such, this study examines barriers and facilitators to healthcare access and health literacy among a statewide sample of TNB individuals in Colorado. However, health literacy in TNB populations has been absent from the literature. Research on poor health outcomes in other marginalized populations suggests that increasing patient health literacy can help reduce barriers to healthcare and ultimately health disparities. For example, TNB people have higher rates of diabetes, heart disease, substance abuse, HIV, and self-harm than cisgender people. ![]() ![]() These healthcare access barriers exacerbate already significant health disparities TNB people experience as a result of the systemic and structural forces of transphobia and cisgenderism. TNB people experience substantial barriers accessing appropriate healthcare, including having doctors refuse to treat them due to their gender, experiencing non-affirming or discriminatory care, encountering difficulty getting insurance to cover medically necessary procedures, and needing to educate providers who have not received training on TNB health. Conversely, facilitators of enacted healthcare literacy included positive experiences with healthcare providers and staff, and inclusive forms and processes. Difficulty identifying and physically reaching care, insurance and out-of-pocket expenses, negative experiences with healthcare providers and staff, provider incompetence, discriminatory and oppressive practices, and exclusionary forms and processes emerged as barriers to enacted health literacy among participants. TNB participants consistently engaged in efforts to increase their own health literacy and that of their medical providers yet faced multiple barriers to improve care. In partnership with a statewide LGBTQ advocacy organization, we recruited 46 transgender and nonbinary individuals to participate in seven focus groups conducted in urban, suburban, and rural locations throughout Colorado. Moreover, most health literacy frameworks focus primarily on the capacities of individual patients to understand and use healthcare information, with little attention given to provider literacy and environmental factors. One factor associated with poor health outcomes in other marginalized populations is health literacy, yet no identified studies examine health literacy in TNB samples. Transgender and nonbinary (TNB) individuals face disparities in nearly every aspect of health.
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