Navigating access to gender care: a multi-method study on the experiences of gender-diverse youth in Ireland

Background: Gender-affirming healthcare has been well-established as a critical component in addressing dysphoria and distress among gender-diverse individuals. However, access to this healthcare remains complex and varies greatly worldwide. This thesis aims to explore healthcare navigation among gender-diverse youth and will focus largely on the Irish landscape. Methods: In an effort to answer the research questions and address the objectives of the thesis, I have adopted a multi-method approach. This has resulted in the completion of a series of investigations pertaining to gender-affirming healthcare, including: a qualitative systematic review of healthcare access needs, a quantitative scoping review of instruments used in assessing access, a clinical audit of demographics, referrals, and comorbidities, a multi-stakeholder qualitative study exploring access to gender care in Ireland, a qualitative examination of healthcare provider perspectives in providing care, and lastly, the implementation and evaluation of a nurse-led initiative on surgical information education. Results: Both reviews conducted comprehensive examinations of barriers and enablers to healthcare access, simultaneously exploring these through established healthcare access theories, thereby contributing significantly to the existing literature. The clinical audit provided a snapshot of the clinical landscape for young adults in Ireland, identifying specific needs related to waiting times and the pursuit of surgery overseas. The first qualitative study explored three distinct perspectives (youth, parents and healthcare workers) and their perceptions of barriers associated with accessing gender-affirming care. Notably, the lack of services for those under eighteen was evident across all groups. In addition, conflicting views of the models of care used arose, and all groups emphasised the importance of family and peer support. The second qualitative study exploring the experiences of healthcare workers in providing gender care offered a clinical perspective and rationale for multidisciplinary work in this area. The results delved into the processes of assessing risk and benefit, addressing clinical complexity, exploring clinical decision-making processes, and highlighting perceived political challenges of working in this field. Lastly, the final study demonstrated the effectiveness of nurse-led surgical information initiative in enhancing the knowledge and confidence of gender-diverse patients considering genital surgery. Conclusion: The findings of this thesis strongly suggest a need for increased resource investment in gender services in Ireland, specifically targeting paediatric and surgical services. The research offers recommendations and insights into assessment processes, as well as providers' perspectives on the significance of assessment and multidisciplinary care. Neurodiversity emerges as a prominent theme, prompting recommendations for healthcare providers to enhance their skills and integrate support systems. Future empirical longitudinal research is crucial for evaluating long-term outcomes, especially within the context of youth and at the intersections of autism and gender diversity.