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Document Type


Organizational Units

Graduate School of Social Work


Health literacy, Transgender and nonbinary health, Barriers to care, Facilitators to care, Healthcare


Transgender and nonbinary (TNB) individuals face disparities in nearly every aspect of health. One factor associated with poor health outcomes in other marginalized populations is health literacy, yet no identified studies examine health literacy in TNB samples. Moreover, most health literacy frameworks focus primarily on the capacities of individual patients to understand and use healthcare information, with little attention given to provider literacy and environmental factors. In partnership with a statewide LGBTQ advocacy organization, we recruited 46 transgender and nonbinary individuals to participate in seven focus groups conducted in urban, suburban, and rural locations throughout Colorado. TNB participants consistently engaged in efforts to increase their own health literacy and that of their medical providers yet faced multiple barriers to improve care. Difficulty identifying and physically reaching care, insurance and out-of-pocket expenses, negative experiences with healthcare providers and staff, provider incompetence, discriminatory and oppressive practices, and exclusionary forms and processes emerged as barriers to enacted health literacy among participants. Conversely, facilitators of enacted healthcare literacy included positive experiences with healthcare providers and staff, and inclusive forms and processes

Copyright Statement / License for Reuse

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Publication Statement

This article was originally published as:

Hostetter, C.R., Call, J., Gerke, D.R., Holloway, B.T., Walls, N.E., & Greenfield, J.C. (2022). “We are doing the absolute most that we can, and no one is listening”: Barriers and facilitators to health literacy within transgender and nonbinary communities. International Journal of Environmental Research and Public Health, 19(3), 1229. doi: 10.3390/ijerph19031229

Rights Holder

C. Riley Hostetter, Jarrod Call, Donald R. Gerke, Brendon T. Holloway, N. Eugene Walls, Jennifer C. Greenfield


Received from author

File Format



English (eng)


16 pgs

File Size

543 KB

Publication Title

International Journal of Environmental Research and Public Health



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