Transgender individuals represent one of the most marginalized and underserved populations in healthcare. Issues such as discrimination, lack of practitioner experience and knowledge, and a deficiency of services have contributed to the healthcare barriers experienced by transgender individuals. There is a lack of literature demonstrating how primary care services are delivered to transgender individuals and a need for research that helps advance our knowledge about the delivery and implementation of primary care services for this population. This thesis explores how primary care services are delivered and implemented from a perspective that acknowledges the complexities of the healthcare needs of the transgender population.
A multiple-case study design was used to explore the implementation and delivery of primary care for transgender individuals in Ontario within different delivery models of primary care and through diverse roles of primary care team members. Normalization Process Theory, an implementation theory and conceptual framework, was used in this study to understand and explain the dynamic processes that occur during implementation of interventions in healthcare, and guide data collection and analysis. Three cases representing different models of primary care delivery in Ontario were identified, all of which provide primary care services to transgender individuals. These models included a solo physician Fee-For-Service practice, a Family Health Team and a Community Health Centre. The multiple sources of data collection strategies used were interviews, a survey, documental evidence, and field notes. Participants included multiple members of the primary healthcare team, such as practitioners, clinical support staff and executive directors. This study helps to advance our knowledge of the delivery and implementation of primary care services for transgender individuals. Implications for nursing practice, including highlighting the need for curricula changes and understanding the nursing role, are discussed. / Thesis / Doctor of Philosophy (PhD) / Primary care, such as a family doctor, is where people get day-to-day healthcare. Worldwide, transgender individuals encounter barriers to appropriate healthcare, in particular access to practitioners who understand their health needs. This thesis aims to explore how primary care services are delivered to transgender individuals in Ontario, through a study that examined different ways services are provided, from a family doctor working alone in a clinic to a clinic with a team of practitioners (e.g., family doctors, nurse practitioners, nurses, counsellors). Interviews with practitioners, a survey, and clinic documents showed that primary care for transgender individuals is part of regular primary care services; whether delivered via a rapid access specialty clinic or embedded into regular primary care services, study participants were easily able to integrate primary care for transgender individuals into their routine work. However, evidence also highlighted the need for practitioners to obtain specialized knowledge of transgender needs.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/24479 |
| Date | January 2019 |
| Creators | Ziegler, Erin |
| Contributors | Valaitis, Ruta, Nursing |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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