Abstract
Introduction: Gender minority (GM) people experience significant disparities across a range of health and wellbeing outcomes. They encounter increased barriers when seeking healthcare, and fear mistreatment which can lead to avoidance. There is an urgent need for a better understanding of how GM people experience primary healthcare (PHC) services in Aotearoa New Zealand (NZ) to ensure equitable health outcomes.
Research Aims: The aim of phase one was to examine the literature on how GM people experience PHC services in Australia and NZ (Australasia). The aim of phase two was to explore PHC nurses' perceptions of how GM people experience PHC services across NZ, and nurses' knowledge and capability with this patient group. Sub-aims across both phases were to identify barriers and enablers for planning culturally competent care for this group of patients.
Methodology: A qualitative descriptive approach has been applied to this research which utilised mixed-methods and occurred in two phases.
Phase one: comprised an integrative literature review (ILR), including literature from Australasia, years 2019 to 2021. The ILR framework by Whittemore and Knafl (2005) was initially followed but modified during data analysis. A literature search was undertaken, titles and abstracts were screened for relevance and then full texts against inclusion criteria. Nine studies were selected and synthesised using qualitative thematic analysis (TA) by applying the Braun and Clark (2022; 2006) TA approach.
Phase two: comprised an online survey utilising a mixed-methods design targeting PHC nurses around NZ. A questionnaire was developed as the data collection tool for the anonymous cross-sectional survey conducted in February 2023. The survey results were analysed using descriptive statistics and qualitative reflexive TA (Braun and Clarke, 2022; 2006).
Results phase one: Two main themes were identified, getting past the front door' and the patient experience'. Four subthemes were identified relating to personal factors, discriminatory systems, (non)therapeutic interactions, and level of healthcare provider (HCP) knowledge. Themes indicate GM people face a discriminatory healthcare system and often receive invalidating treatment to receive essential care. Healthcare providers lack knowledge and understanding of gender diversity. Minimal evidence on the role of PHC nurses with GM patients provided the basis for phase two.
Results phase two: Qualitative and quantitative data was obtained from 27 participants. Four themes and three sub-themes were identified, relating to the system: healthy or hostile', provision of validating care', bound by barriers: the challenge to upskill', and cultural insights'. The quantitative data mostly corroborates the qualitative findings. The questionnaire was found to have strengths and limitations as an MMR data collection instrument.
Conclusion: Gender minority individuals experience positive and negative aspects when seeking and utilising PHC in NZ. However, the current system discriminates, and this research highlights widespread challenges including systemic barriers, and lack of knowledge and respect from PHC providers. Findings from the PHC nurse survey support ILR findings and illustrate what is occurring within PHC services from the nurse perspective. Nurses respect diversity and want to improve their knowledge on GM healthcare. However, pressure on services creates barriers to professional development and other strategies to improve patient care. Nurses must challenge the status quo and seek support from primary health organisations (PHOs) and GM representative groups to develop and implement inclusive policy and practices to benefit the health of GM minorities seeking PHC in Aotearoa NZ.