People who identify as trans, non-binary or gender diverse can experience inclusive, culturally sensitive physical therapy while attending a gender-affirming clinic: qualitative study

Abstract

ABSTRACTObjectiveTo explore physical therapy experiences and identify barriers and facilitators of access to physical therapy for people who identify as trans, non-binary, or gender diverse (TGD).MethodsA qualitative descriptive design was employed using semi-structured interviews conducted in New Zealand. Participants were individuals aged 12 years or older, who self-identified as TGD, and had accessed physical therapy at a New Zealand clinic that provided a gender-affirming service. Participants were recruited via email invitation to the clinic database. Interview data were analysed using reflexive thematic analysis.Demographics are reported descriptively.ResultsSeventeen individuals participated. Four themes identified during analysis. Barriers to and facilitators of care were identified at policy, environmental, clinic and therapist levels. All participants reported physical therapy experiences relating to one or more of the following themes:challenging cisnormativityat policy, environmental, clinic and therapist levels;safety and trustthroughout the clinical experience-including clinic credibility for being a safe provider, clinic displays of TGD-inclusivity, implementation of safe clinic processes, and respectful therapist interactions;inclusive experiencesin a clinic which provided affordable care and took active steps to understand and affirm TGD identities, and physical therapists with a high level of knowledge of TGD-specific health issues and a biopsychosocial approach to care; and sensitivity tobody discomfort or dysphoriatriggers.ConclusionsPeople who identify as TGD face challenges to accessing safe and culturally sensitive physical therapy. However, there are achievable areas for improvement at policy, environmental, clinic and physical therapist level to gain trust and engagement in care for the TGD-community.Impact StatementThis study provides nuanced exploration of TGD physical therapy experiences and identifies specific areas of improvement for TGD physical therapy care to provide clinicians and physical therapy clinics insights into the provision of safe and culturally sensitive physical therapy.