Personal Healthcare Networks and Access to Care after Major Surgery

Compared to other adults, TGD individuals face substantial health concerns including increased depression, anxiety, substance use, suicidal thoughts and attempts, and chronic disease. TGD people live long and complex lives, but little is known about their needs and interactions with healthcare providers after surgery. Most previous research has focused on their challenges and needs prior to surgery. To fill this gap in knowledge, the proposed study seeks to identify challenges and facilitators to resilience after surgery. Access to care is a systems-level resilience factor with great potential to intervene upon the health of individuals across the life course. However, evidence indicates that TGD adults delay and avoid needed healthcare, in part due to negative experiences in healthcare settings. Moreover, current data about access to care in this population is insufficiently detailed. To capture the complex systems and interpersonal factors affecting access to healthcare, this study proposes a unique application of egocentric social network analysis to operationalize access to care as a multifaceted and relational process. By conceptualizing a “personal healthcare network” composed of the varied and multidisciplinary healthcare professionals that a person engages with when seeking healthcare, this research will quantitatively and qualitatively describe concepts that are often insufficiently measured using dichotomous variables. This study focuses on patients’ insider perspectives about their care network to provide essential insights that are not available in the current literature or with previously-used methods. The specific aims are to (1a) characterize the personal healthcare networks of TGD adults after surgery (N = 100), (1b) examine associations between network characteristics and participant outcomes in mental and physical health, and (2) qualitatively explore TGD people’s experiences of building and accessing a network of healthcare providers after major surgery (N = 24). These aims will be achieved by adding new quantitative items to data collection in an existing study of adults one year after major surgery, and then recruiting a qualitative subsample from this group for semi-structured interviews. These aims are aligned with NINR’s Research Lenses of Health Disparities and Systems and Models of Care. Through the proposed research and training plan, the applicant will receive top-tier mentorship in a research-intensive environment at Columbia University School of Nursing, setting them on the path to becoming an independent nurse investigator. This research will be a significant contribution to access to care methods and address the dearth of literature on their healthcare experiences after surgery.