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. 2022 Jul 31;21(1):104.
doi: 10.1186/s12939-022-01702-8.

Community engagement to improve access to healthcare: a comparative case study to advance implementation science for transgender health equity

Hale M Thompson  1 , Allison M Clement  2 , Reyna Ortiz  3 , Toni Marie Preston  4 , Ava L Wells Quantrell  4 , Michelle Enfield  5 , A J King  6 , Lee Klosinski  7 , Cathy J Reback  8 , Alison Hamilton  9 , Norweeta Milburn  2
Affiliations

Community engagement to improve access to healthcare: a comparative case study to advance implementation science for transgender health equity

Hale M Thompson et al. Int J Equity Health. .

Abstract

Background: Recent calls to action have been made for Implementation Science to attend to health inequities at the intersections of race, gender, and social injustice in the United States. Transgender people, particularly Black and Latina transgender women, experience a range of health inequities and social injustices. In this study, we compared two processes of transgender community engagement in Los Angeles and in Chicago as an implementation strategy to address inequitable access to care; we adapted and extended the Exploration Planning Implementation and Sustainment (EPIS) framework for transgender health equity.

Methods: A comparative case method and the EPIS framework were used to examine parallel implementation strategies of transgender community engagement to expand access to care. To foster conceptual development and adaptation of EPIS for trans health equity, the comparative case method required detailed description, exploration, and analyses of the community-engagement processes that led to different interventions to expand access. In both cities, the unit of analysis was a steering committee made up of local transgender and cisgender stakeholders.

Results: Both steering committees initiated their exploration processes with World Café-style, transgender community-engaged events in order to assess community needs and structural barriers to healthcare. The steering committees curated activities that amplified the voices of transgender community members among stakeholders, encouraging more effective and collaborative ways to advance transgender health equity. Based on analysis and findings from the Los Angeles town hall, the steering committee worked with a local medical school, extending the transgender medicine curriculum, and incorporating elements of transgender community-engagement. The Chicago steering committee determined from their findings that the most impactful intervention on structural racism and barriers to healthcare access would be to design and pilot an employment program for Black and Latina transgender women.

Conclusion: In Los Angeles and Chicago, transgender community engagement guided implementation processes and led to critical insights regarding specific, local barriers to healthcare. The steering committee itself represented an important vehicle for individual-, organizational-, and community-level relationship and capacity building. This comparative case study highlights key adaptations of EPIS toward the formation of an implementation science framework for transgender health equity.

Keywords: Community engagement; Comparative case study; EPIS framework; Health equity; Human-centered design; Transgender; World Café model.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The UCLA CFAR steering committee logic model to develop a trans-affirming medical curriculum
Fig. 2
Fig. 2
Trans Accountability Project (TAP) logic model as a multi-level employment intervention, including the group-level TAP Employment Program
Fig. 3
Fig. 3
An adaptation of the EPIS framework for community-engagement and trans health equity; implementation of the UCLA CFAR Trans Health Project (2016–2021)
Fig. 4
Fig. 4
An adaptation of the EPIS framework for community-engagement and trans health equity; implementation of the Trans Accountability Project and the TAP Employment Pilot (2019–2021)
See this image and copyright information in PMC

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