Foregone Health Care: A Secondary Analysis of Survey Data on the Experiences of a Sample of Transgender and Nonbinary in Nova Scotians




Introduction: International research has identified that transgender and nonbinary populations experience high rates of discrimination, stigma, and negative health care experiences (Clark et al., 2018; Costa et al., 2018; Ercan Sahin et al., 2020). Collectively, these experiences can lead to forgone health care, defined as patients not accessing necessary health care due to many barriers, which can negatively impact health outcomes (House of Commons Canada, 2019). Objective: This study focuses on examining challenges in accessing gender-affirming health care among a sample of transgender and nonbinary Nova Scotians, and explores how these experiences may contribute to forgone health care. Methods: This research utilized secondary data analysis of a subset of data from an existing province-wide online survey of transgender and nonbinary Nova Scotians. The methodology of this study utilizes thematic analysis of closed-ended and open-ended survey response categories. The socio-ecological model was used as the conceptual framework to describe the various levels of influence contributing to transgender and nonbinary people forgoing health care. Results: Three main themes emerged from the data. Fear of discrimination leading to decreased quality of care, poor availability of transgender- and nonbinary-specific health services, and perceived or actual low levels of cultural competency among health care providers. Conclusion/Discussion: These factors contributed to forgone health care within this population, to which we respond with a number of recommendations to improve patient-provider interactions. Specifically, we recommend additional resources and training for health care providers and trainees to improve their cultural competency in providing gender-affirming care.

Author Biography

Jacqueline Gahagan, Dalhousie University

School of Health and Human Performance


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