"The doctors have more questions for us": Geographic differences in healthcare access and health literacy among transgender and nonbinary communities

Transgender and nonbinary (TNB) individuals experience a variety of systemic barriers that impact their ability to access healthcare, often leading to negative health outcomes. Previous research has suggested that improving health literacy among marginalized communities may help reduce existing health disparities. Yet few studies have examined health literacy among TNB people and how health literacy and healthcare access may differ by urbanicity. Using the capabilities theoretical approach, the current study uses data from six focus groups (N=40) from metropolitan, urban, and rural areas in Colorado to examine geographic differences in health literacy and healthcare access. Findings show that geographic differences in accessing healthcare include transportation issues, having to travel far distances to access care, finding a TNB-affirming and competent provider, and needing to educate providers and staff. These differences were more prevalent among TNB people living in non-metropolitan areas. Additionally, our findings suggest that TNB individuals have high levels of health literacy due to having to self-educate and exist within a healthcare system that was designed for cisgender people.