Gender-Affirming Care Is Not Standard Care in Occupational Therapy: A Scoping Review

IMPORTANCE: The transgender and gender-diverse (TGD) community faces significant health care disparities, including elevated rates of mental health issues, poverty, and barriers to accessing affirming care. Occupational therapy practitioners are ethically obligated to provide gender-affirming care, yet there are no practice guidelines for such care. OBJECTIVE: To examine the landscape of gender-affirming care within occupational therapy practice, aiming to identify gaps for future research and guidelines. DATA SOURCES: Six databases (MEDLINE, EMBASE, Scopus, PsycINFO, CINAHL, Web of Science). Search dates ranged from database inception to September 19, 2023. STUDY SELECTION AND DATA COLLECTION: We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute guidelines for all methodologies. Studies were included if they described gender-affirming care, included language related to the transgender and gender-diverse community, and mentioned occupational therapy. Studies were excluded if they were not peer-reviewed or did not include an intervention. FINDINGS: A total of 614 studies were identified, and 17 were included. Of the included studies, the majority were qualitative (n = 9) and from the United States or Canada. Published research highlighted clinicians' need for more training in gender-affirming care and suggested diverse modalities to bridge gaps in working with TGD individuals. CONCLUSIONS AND RELEVANCE: This review underscores the urgent need for targeted research to address TGD individuals' specific needs in occupational therapy practice. Future efforts should focus on developing and evaluating gender-affirming care interventions, expanding training modalities, and promoting inclusive care within occupational therapy. Plain-Language Summary: The transgender and gender-diverse (TGD) community often encounters obstacles in accessing health care, including mental health issues and barriers to affirming care. Occupational therapy practitioners play a crucial role in providing gender-affirming care, yet there is a lack of clear guidelines for doing so. This study aimed to examine the current state of gender-affirming care in occupational therapy and identify areas for improvement, ultimately benefiting both practitioners and clients. Future research should focus on developing and evaluating gender-affirming care interventions, expanding training modalities, and promoting inclusive care within occupational therapy. Positionality Statement: The authorship team represents one individual who identifies as nonbinary and four who identify as cisgender. Most of the authors identify as White. Three authors identify as LGBTQ+. Two authors have prior experience writing scoping reviews.

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