Transgender and non-binary people’s preferences for virtual health care post-pandemic: A cross-sectional Canadian study (Preprint)

BACKGROUND Virtual health care use has dramatically increased in response to the COVID-19 pandemic, raising the question of its potential role post-pandemic. For transgender and non-binary (TNB) people, virtual care is promising because it may expand access to health care providers who are affirming and competent to address TNB health needs. However, emerging research indicates potential disparities in virtual care access related to sociodemographic, health, and social factors. There is a paucity of research on the factors affecting patient preferences for virtual versus in-person care, particularly in TNB communities. OBJECTIVE This study aims to identify sociodemographic, health, and social factors associated with post-pandemic virtual care preferences in TNB communities. METHODS The 2020 Trans PULSE Canada COVID Survey examined health, social, and economic impacts of the COVID-19 pandemic among 820 TNB participants who previously completed the prepandemic 2019 Trans PULSE Canada survey (n=2783). Data were weighted to the demographics of the 2019 sample. Chi-square tests were used to compare post-pandemic preferences for virtual versus in-person care across sociodemographic, health, and social characteristics. Participants provided open-text responses explaining their preferences, which were used to contextualize the quantitative findings. RESULTS Of 812 participants who indicated whether they would prefer virtual or in-person care post-pandemic, a weighted 32.7% (n=275) would prefer virtual care and 67.3% (n=537) would prefer in-person care. Preferences for in-person over virtual care were associated with being in the 14-19 (85.0%), 50-64 (80.0%), and 65+ (90.7%) age groups (P=.002). Preferences for virtual over in-person care were associated with having a chronic health condition (37.7% versus 29.9%; P=.03) and having probable anxiety (34.7% versus 25.7%; P=.04). Among participants with romantic partners, preferences varied based on the partner’s level of support for gender identity or expression (P=.004); participants with moderately supportive partners were more likely than participants with very supportive partners to prefer in-person care (85.1% versus 62.3%). Care preferences did not vary significantly based on indicators of socioeconomic status. Open-text responses showed that multiple factors often interacted to influence participant preferences, and that some factors such as having a chronic condition simultaneously led some participants to prefer virtual care and others to prefer in-person care. CONCLUSIONS TNB people may have differential interest in virtual care based on factors including age, chronic and mental health conditions, and gender-unsupportive home environments. Future research examining virtual care preferences would benefit from mixed-methods intersectional approaches across these factors, to explore complexity in barriers and facilitators to virtual care access and quality. These observed differences support flexibility with options to choose between in-person and virtual modalities of health care to meet TNB patients’ specific health needs.

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