Lessons Learned in Transgender Peer Navigation: A Year of Reflective Journaling.

People who are trans and gender-diverse are underserved by the healthcare system; one way to improve healthcare access is with peer healthcare navigators. We piloted two trans peer health navigators from April 2021 to March 2022 in a small Canadian province. The purpose of this study was to explore how trans peer navigators experienced their work and work environment through reflective journalling. The navigators journalled roughly weekly. They were encouraged to interrogate their own biases and to think about what was omitted from conversations with others. Each journal was treated as a qualitative case study, anonymized and analyzed thematically using Interpretive Phenomenological Analysis. Six themes emerged: expected work, unexpected work, teamwork, lived experience, challenges, and systemic factors. These themes were complexly interwoven with a network of subthemes that frequently fell under multiple main themes and were highly emotionally charged, many both positively and negatively. The importance of navigators being transgender themselves was highlighted. The rewards came from being able to provide meaningful help to people in their community and the challenges came from not being respected by other healthcare providers and systemic barriers that prevented them from helping clients. The navigators successfully adapted their services to bridge some systemic barriers. This research has implications for improving both navigators' and clients' experiences.