# Healthcare navigation services support access to gender-affirming care: A qualitative analysis of chat conversations

## TL;DR

This study shows how virtual healthcare navigators help transgender and gender diverse people access gender-affirming care by supporting them through complex healthcare and insurance systems.

## Contribution

The novel contribution is identifying how trained care coordinators in virtual navigation services support TGD individuals through three key themes: dignity, affirming relationships, and insurance navigation.

## Key findings

- Trained care coordinators help TGD individuals by providing dignified and affirming experiences.
- Navigators assist in connecting patients with vetted providers and understanding insurance policies.
- The service has impacts at individual, interpersonal, and structural levels, suggesting broader clinical and policy implications.

## Abstract

As transgender and gender diverse (TGD) people become increasingly visible, healthcare solutions in the United States have also expanded to meet their needs. As TGD people and their families pursue gender affirming care (GAC), they also seek support to navigate complex healthcare and insurance systems. With increased demand for GAC, virtual healthcare navigation services in the U.S. have developed tailored approaches to address gaps in systems for this population.

The purpose of this study was to qualitatively explore the role and influence of trained care coordinators (CCs) from a virtual navigation service in meeting commercially-insured TGD people’s GAC needs.

We examined and analyzed redacted chat conversations between CCs from a virtual healthcare navigation service in the U.S. and members seeking assistance. Reflexive thematic analysis of the data set involved multiple rounds of coding and reflexive analytic processes to develop themes.

We developed three intersecting themes: 1) Provide Dignified Experiences, 2) Promote Affirming Patient-Provider Relationships, and 3) Navigate Complex Insurance Systems. Sub-themes associated with each of the themes include: 1) Shared life experience; Exploring gender identity and GAC options in safe spaces; 2) Connections with vetted providers; 3) Access accurate information about insurance policies; Assistance with appeals process; and Obtaining letters of support.

Navigating U.S. healthcare and insurance systems presents unique challenges for TGD people. While challenges to accessing care are well documented, our findings suggest that healthcare navigation services supported by trained CCs substantively assist TGD patients overcome obstacles. Our findings revealed multiple levels at which the service provides benefits -- individual, interpersonal, and structural. These levels of influence have clinical and policy implications for improved care for TGD people. Interventions like tailored, virtual healthcare navigation services are scalable and should be evaluated for reach and magnitude of impact beyond commercially-insured populations.