The Debilitating Impact of Transphobia on Health Care Services: The Moderated Mediation Model of Transphobia, Minority Stress, Social Exclusion, and Access to Health Care among People Who Are Transgender

Drawing on the perspective of minority stress theory, an elaboration of social stress theory, and the Social Exclusion Knowledge Network model, this study's aim is to develop and test the feasibility of a moderated mediation model in the context of Pakistan. This model investigates the roles that transphobia, minority stress, and social exclusion play in the transgender population's access to health care services by the individual's communities in Pakistan. By applying a time-lagged research design and collecting multisource data from public sector hospitals in the capital city of Pakistan, alongside conducting a single-source survey over 30 consecutive working days (N = 206), we explore these relationships in depth. The results reveal that transphobia is negatively related to health care access, with minority stress mediating this negative relationship. Furthermore, social exclusion not only moderates the connection between transphobia and minority stress but also amplifies the indirect association between leader transphobia and health care access via minority stress. This moderated mediation framework underscores the critical impact of transphobia on health care access and highlights the amplifying role of social exclusion. The findings from this study offer invaluable insights for future researchers and practitioners focused on mitigating transphobia's impact on health care access within transgender contexts.