Abstract
For transgender and gender-diverse (TGD) persons, encounters with health practitioners can be harmful and can compromise medical outcomes. Harm against TGD people is not always overt and direct; it can also be unintentional and subtle, and these are known as microaggressions. A key text in TGD microaggression literature is Nadal, Skolnik, and Wong’s (2012) taxonomy. Aim: The aim of this study was to explore these occurrences of harm experienced by TGD people when they interact with health practitioners (HPs). Methods: An interview study using combined deductive and inductive procedures was conducted. Six online unstructured interviews were conducted with TGD participants who had experienced harm in healthcare settings in South Africa. The deductive component used Nadal, Skolnik, and Wong’s (2012) taxonomy as a codebook. Unlike the deductive analysis which was theory-driven, the study also used inductive analysis that was data-driven. The inductive procedures included tools from grounded theory, such as diagramming. This procedure was not linear but was reflexive and iterative. Findings: The deductive content analysis revealed that eight of the 12 themes from the transgender taxonomy were present in the dataset. Inductive analysis revealed five other themes, namely: Patients’ Avoidance of Care, HP’s Lack of TGD Education, HP’s Change of Behaviour When Being Observed, HP’s Lack of Seriousness, and Compromised Bioethics. Compromised Bioethics consisted of four subthemes: Turning Away, Blocking, Redirection and Substandard Care. Conclusions: Two inductive themes stood out: Compromised Bioethics and HP’s Lack of TGD Education. The former is a consequence of the latter. The original contribution in this study is presented in the form of a model of microaggressions that can be situated in a victim- vs perpetrator-focused framework. Diversity training or cultural competence should be taught alongside TGD-related medical training.
Keywords: compromised healthcare, critical health psychology, microaggressions, South Africa, transgender and gender-diverse