Intersectional Model of Service Use: Understanding Transgender and Nonbinary Healthcare Access

Abstract

Transgender and nonbinary (TNB) people often have difficulty accessing healthcare services because of the systemic forces of transphobia and cisgenderism. Despite this, there is little theory specifically designed to examine healthcare access among TNB people. We conducted a literature review to identify studies examining TNB healthcare access. We screened a total of 2,050 unique articles for inclusion, resulting in a final sample of 46 articles that met the review criteria. Theories used and key findings were coded to inform the development of the Intersectional Model of Service Use (IMSU) for TNB people. The IMSU builds upon current theoretical frameworks including the Behavioral Model for Vulnerable Populations (BMVP), which proposes that predisposing, enabling, and need factors drive healthcare utilization among vulnerable populations. The IMSU combines the predisposing, enabling, and need factors of the BMVP with TNB-specific healthcare access factors identified through this integrative review. The findings from this review suggest its effectiveness in informing research and interventions aimed at improving healthcare access among TNB people.