Understanding the context of positive experiences of primary care for transgender and gender diverse adults: An email interview study in Aotearoa New Zealand.

Background: Past research has demonstrated that transgender and gender diverse (TGD) people often have negative experiences of healthcare. Exploratory research is needed to provide in-depth understanding of the healthcare experiences of TGD people. Primary care is a crucial element of healthcare, but past research has tended to overlook what contributes specifically to positive experiences of primary care for TGD adults. Aim: The aim of this study was to explore positive experiences of TGD adults when engaging with primary care in Aotearoa New Zealand. Methods: Semi-structured email interviews were conducted with 11 TGD adults aged 20- to 62-years-old, with a range of binary or non-binary genders living across Aotearoa New Zealand. The email interview method allowed nationwide recruitment and flexible interaction. All aspects of the study were led by a researcher who is part of the TGD community. Results: Three themes were formulated to explain TGD participants' positive experiences with primary care. In order to contextualize positive experiences, participants described past negative experiences of healthcare and low expectations (Theme 1: The Sad State of Care). Participants also described exerting autonomy, for example by carefully selecting a general practitioner (GP) or choosing when to disclose transgender status to their GP (Theme 2: The Sphere of Control). Three levels were evident in positive experiences (Theme 3: The Gradient of Positive Experiences): basic professionalism, more desirable experiences of trans-specific competencies, and GPs as advocates for systemic change. Discussion: TGD people experience positive interactions in primary care in a variety of ways, all of which are contextualized by the negative state of healthcare at present. TGD people create opportunity for autonomy while navigating healthcare, which requires a form of interacting that can be termed reactive self-determination. Training for health professionals could apply the gradient of positive experiences to scaffold appropriate primary care for TGD adults.