"It's just a general lack of awareness, that breeds a sense that there isn't space to talk about our needs": Barriers and facilitators experienced by transgender people accessing healthcare in Aotearoa/New Zealand.

Introduction: Transgender people face serious health disparities associated with underlying social determinants, such as unmet healthcare needs and negative experiences with healthcare providers. Healthcare accessibility dimensions include availability, approachability, acceptability, affordability, and appropriateness. This study aimed to identify the perceived barriers and facilitators that transgender people in Aotearoa/New Zealand experience within these dimensions, as few studies have explored multiple dimensions of healthcare access for transgender people using a large national sample. Method: Responses to an open-text question in the Counting Ourselves survey ( Results: In line with international research, some prominent barriers were the lack of trans-competent providers (availability/accommodation), experiences of mistreatment (acceptability/appropriateness), and gatekeeping practices (approachability). Facilitators included, among others, providers' willingness to educate themselves (availability/accommodation), an affirming attitude (acceptability/appropriateness), and competence in navigating services (approachability). Conclusions: Transgender people in Aotearoa/New Zealand see their healthcare experiences affected by barriers across all dimensions of healthcare access. This highlights a great degree of mismatch between their needs and the healthcare system's characteristics, thereby breaching their right to healthcare of adequate standards. We recommend that all healthcare practitioners and administrative staff receive training on transgender health, that there is increased accessibility to information on gender-affirming care services, and that collaborative referral procedures that respect patient decisions are implemented.