Barriers to accessing and engaging in healthcare as potential modifiers in the association between polyvictimization and mental health among Black transgender women

• Type of Material: Article
• Authors: Athena Sherman, Emory University; Monique Balthazar, Emory University; Gaea Daniel, Emory University; Kalisha Johnson, Emory University; Meredith Klepper, Johns Hopkins School of Nursing, Baltimore; Kristen D Clark, University of California San Francisco; Glenda N Baguso, University of California San Francisco; Ethan Cicero, Emory University; Kisha Allure, Casa Ruby; Whitney Wharton, Emory University; Tonia Poteat, University of North Carolina
• Language: English
• Date: 2022-01-01
• Publisher: PUBLIC LIBRARY SCIENCE
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Sherman et al
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0269776
• Title of Journal or Parent Work: PLOS ONE
• Volume: 17
• Issue: 6
• Start Page: e0269776
• End Page: e0269776
• Grant/Funding Information: The original TransConnect study received partial funding from the following sources: the Robert Wood Johnson Foundation Future of Nursing Scholars (ADFS) and the Scholl Award from Johns Hopkins School of Nursing (ADFS). The original STROBE study received partial funding from the Johns Hopkins Center for AIDS Research (TP; https://hopkinscfar.org/). This secondary analysis was funded by the Nell Hodgson Woodruff School of Nursing, Emory University Postdoctoral Fellowship funds (ADFS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
• Keywords: RETENTION; TRANSPORTATION BARRIERS; Science & Technology - Other Topics; POPULATION; DISCRIMINATION; ENGAGEMENT; DEPRESSION; Multidisciplinary Sciences; CHALLENGES; Science & Technology; STIGMA; FINANCIAL BARRIERS; BALTIMORE
• Research Categories: Health Sciences, Nursing; Health Sciences, Public Health

Abstract

Background Black transgender women endure pervasive polyvictimization (experiencing multiple forms of violence throughout the lifespan). Polyvictimization is associated with poor mental health. Black transgender women also face barriers in access to healthcare, but the extent that such barriers modify the association between polyvictimization and poor mental health has not been described using convergent mixed-methods analysis. Methods This convergent mixed-methods secondary analysis employs an intersectional lens and integrates two inter-related datasets to describe barriers to healthcare and the extent that such barriers modify the association between polyvictimization and mental health among Black transgender women. Investigators used survey data (n = 151 participants) and qualitative interview data (n = 19 participants) collected from Black transgender women (age 18 years and older) in Baltimore, MD and Washington, DC between 2016 and 2018. Analyses include thematic content analysis, bivariate analysis, joint display, and multivariate linear regression analysis examining mediation and moderation. Results Joint display illuminated three domains to describe how barriers to healthcare present among Black transgender women–Affordability, Accessibility, and Rapport and Continuity. Independent t-tests revealed significantly higher polyvictimization, Post Traumatic Stress Disorder (PTSD), and depression scores among participants who reported at least one barrier to healthcare (BHI) compared to those who reported no barriers. BHI significantly moderated and partially mediated the association between polyvictimization and PTSD symptom severity and BHI fully mediated the association between polyvictimization and depressive symptom severity–when accounting for age and location. Discussion Findings highlight the importance of access to healthcare in modifying the association between polyvictimization and PTSD and depression symptom severity among Black transgender women. Findings call for immediate interventions aimed at reducing barriers to healthcare and improved training for clinical providers serving Black transgender women.