Trans And Gender Diverse People And General Practitioners’ Accounts Of Health Care In Aotearoa New Zealand: A Discursive Analysis.

Trans and gender diverse people in Aotearoa New Zealand encounter significant challenges accessing primary healthcare. Both the trans and gender diverse and general practitioner (GP) communities identify barriers hindering the provision and receipt of quality healthcare and affirming gender identity. Scarce research explores the experiences of trans and gender diverse people and GPs in gender-affirming healthcare in Aotearoa New Zealand. Our understanding of these barriers and necessary measures is limited, requiring more knowledge about effective practices. Specifically, insights into how trans and gender diverse people interpret their experiences with GPs and how GPs express their understanding, difficulties, competence, and willingness to offer healthcare services are crucial.

This research, grounded in a social constructionist perspective, comprised two qualitative studies. Using semi-structured interviews, I engaged with 30 trans and gender diverse people and 30 GPs from diverse Aotearoa New Zealand locations.

Two shared discourses were identified: the 'knowledge' discourse and the 'specialised care vs general healthcare' discourse. In the 'knowledge' discourse, both groups depicted GPs as knowledge deficient. Trans and gender diverse people described this deficiency as either a 'complete lack of knowledge' or 'insufficient knowledge.' In the 'specialised care vs general healthcare' discourse, both groups portrayed gender-affirming healthcare as both 'specialised care' and 'general healthcare.' The former depicted GPs as ill-equipped, while the latter positioned GPs as equipped with the necessary knowledge.

Two distinct discourses also were identified: the 'dismissiveness' discourse employed by trans and gender diverse people to describe barriers faced in accessing quality gender-affirming healthcare, and the 'systemic discourse' used by GPs to frame barriers as systemic, advocating for necessary reforms.

This research provides insight into how 'knowledge deficiency' impacts primary healthcare provision. GPs' perception of the trans and gender diverse population influences learning capacity, training engagement, and perception of safe practice in initiating hormone replacement therapy. The 'dismissiveness' discourse affects the comfort and safety of trans people in discussing health concerns with GPs. The 'systemic' discourse highlights challenges within Aotearoa New Zealand's healthcare system. The findings emphasise the need for targeted interventions to improve the experiences of trans and gender diverse people in primary healthcare settings.