Trans, Gender-diverse and Non-binary Individuals Experienced Safe and Positive Care Within a Gender-affirming Physiotherapy Service: A Qualitative Study

Abstract

Background: People who are transgender, gender-diverse or non-binary (TGDNB) face barriers to safe and affirming care, and experience disparate health outcomes. The broader lesbian, gay, bisexual, transgender, queer, intersex, asexual and other related identities (LGBTQIA+) community report negative experiences in physiotherapy due to cis/heteronormative assumptions, discomfort about touch, observation and undressing, and a lack of practitioner knowledge on TGDNB health. TGDNB individuals have reported positive experiences when accessing general physiotherapy that has inclusive environments, respectful and knowledgeable practitioners, and a collaborative biopsychosocial approach to care.

Methods: 20 TGDNB individuals aged 18–38 who accessed a gender-affirming physiotherapy service in Wellington, Aotearoa New Zealand participated in the study. Semi-structured interviews were conducted with participants via videoconferencing software. An inductive approach to reflexive thematic analysis was undertaken.

Results: Four key themes and five subthemes were formed in the analysis. Themes were: 1) ‘Binding and my health’; 2) ‘My choice in holistic and person-centered care’; 3) ‘Experiencing safe and inclusive care with knowledgeable physiotherapists’ through safe communication, practitioners having knowledge on TGDNB health and considering potential discomfort; and 4) ‘Inclusive environments help me feel safe’ via safe environments and safe and warm referrals.

Conclusion: TGDNB individuals valued gender-affirming physiotherapy from practitioners who were inclusive, knowledgeable, and emphasized holistic and person-centered approaches to care. Key components of gender-affirming physiotherapy included practitioners addressing binding-related health issues (where appropriate and relevant), having specific training in TGDNB health, promoting autonomy, using inclusive language and fostering welcoming environments.