Participation of transgender and gender diverse people in the development of primary health care based on the free and informed consent model: A thematic synthesis of community resources

Anna Baleige, Mathilde Guernut, Frédéric Denis

Keywords: Transgender Persons; Health Services for Transgender Persons; Community Participation; Organization and Administration; Human Rights; Review

Developing primary care involves providing community-based services tailored to the population's needs. Among sexual minorities, transgender and gender-diverse people (TGD) form a heterogeneous and growing population, with a prevalence of up to 4.5% of adults and 8.4% of children and adolescents. International evidence points to systemic barriers in accessing care that justify transforming existing organizations. The free and informed consent model is widely promoted, both on health promotion and rights-based grounds, moving issues of access, assessment and coordination to family doctors. International examples have demonstrated the validity and effectiveness of such systems, but general practitioners remain under-trained to the needs and health issues of TGD people.

Research questions:
The aim of this participatory study is to establish an overview of the barriers and opportunities for promoting the health of TGD people. To do so, it relies on the expertise of NGOs and aims to produce a thematic synthesis that will support policy-making.

We conducted a literature review on health care systems' organizational transformations. We included publications in French and in English, relayed by TGD associations in Western contexts. Eligible articles were subjected to bibliometric and quality assessments before inclusion in the thematic synthesis.

We centralized the resources of 18 French and European organizations and included 25 eligible documents following a quality analysis. 3047 data were extracted and coded, then developed into 5 themes that allowed us to model the actions, obstacles and opportunities to improve care for the TGD population.

Health promotion of TGD people focuses on discrimination, care pathways, access to care, transmission of knowledge and research. The main obstacles are the role of medical specialists, pathologization, epistemic injustice and the low political priority of their health issues. The main opportunities will rely on ensuring that decision-making allows for the implementation of a pragmatic and collaborative health policy in this context.

Points for discussion:
The development of accessible primary health care services based on international examples

Knowledge transfer and the development of evidence-based and inclusive common knowledge

The prioritization of TGD people's needs within the needs of the population and the positive impact on the overall health care provision