Improving the healthcare experiences of transgender and gender-diverse youths: A mixed-methods systematic review of interventions.

Introduction: Health disparities are commonly identified within the transgender and gender-diverse community. Gender minority stress theory expands the existing minority stress theory to identify the unique stressors of this community. The outcomes of these stressors and disparities are recurring negative experiences among transgender and gender-diverse youths and subsequent care avoidance. This mixed-methods systematic review aims to identify and critically analyze the effect of interventions to improve the healthcare experiences of transgender and gender-diverse youths. Methods: Studies published from inception until April 2023 were sought from CINAHL Plus with Full Text, PubMed, Academic Search Complete, PsycArticles, PsycInfo, ERIC, SocIndex, target journals, trial registries, and countries with significant transgender and gender-diverse academic outputs. Studies were double screened for eligibility. The included studies were critically appraised and assessed for risk of bias. Data were extracted and convergent segregated synthesis was conducted to synthesize evidence from various research designs. Results: In total, 4487 records were identified. Of those, nine studies were included, and three narratives were identified: components of intervention design, impact of the intervention on transgender and gender-diverse youths, and impact of the intervention on healthcare providers. Interventions were predominantly education-based, in-person, targeted healthcare providers and assessed knowledge, beliefs, confidence, and understanding of transgender healthcare. Transgender and gender-diverse focused education interventions demonstrated more significant differences in outcomes when compared with LGBT + focused interventions. Interventions that included social contact with transgender and gender-diverse individuals demonstrated more significant outcomes in both beliefs and knowledge. Conclusion: A targeted approach to the development and delivery of interventions is needed to improve outcomes, including the co-production of interventions, specific content, and the application of social contact with youths.