Experiences of sexually and gender-diverse women with community-based health promotion services in Canada

This study aimed to explore the experiences and perspectives of sexually and gender-diverse women regarding community agency-based health promotion, identify barriers and facilitators to healthcare access, and suggest improvements to inform inclusive and culturally competent strategies for enhancing service delivery and promoting health equity. A qualitative descriptive study using semi-structured interviews and thematic analysis. Community agency-based healthcare services in Canada, including urban, suburban, and rural locations across Ontario, Quebec, and Manitoba. Twenty sexually and gender-diverse women (ages 18–70+) who had accessed community agency services for health advice or support were recruited. Participants identified as transgender women, female, cisgender and non-binary. Identification of experiences, barriers, facilitators, and suggested strategies for improving community agency-based health promotion services were the key outcome measures. Four major themes were identified: healthcare experiences (including satisfaction and use of gender-affirming care and mental health resources), factors necessary for healthcare service provision (e.g., cultural competence, supportive environments, inclusive policies), barriers or challenges of using community agencies (including long wait times, financial and transportation barriers, limited provider knowledge, and discrimination), and strategies to improve care (offering flexible and virtual services, extending service hours, increasing provider diversity and training, and enhancing advocacy and publicity). Most participants reported positive relationships with providers, though some highlighted ongoing challenges related to cultural sensitivity. Community agencies are critical sources of culturally safe healthcare for sexually and gender-diverse women but they face barriers to access such as limited capacity, staffing shortages, and structural discrimination. Addressing these barriers through expanded service hours, enhanced provider training, greater diversity among staff, targeted advocacy, and improved information dissemination can result in more equitable healthcare outcomes for this population. Future research should further examine systemic changes to optimize culturally competent care delivery. Purposeful sampling and wide recruitment efforts enhanced the diversity of experiences captured among sexually and gender-diverse women. Rigorous thematic analysis was conducted using Braun and Clarke’s framework, with multiple researchers ensuring coding consistency. Findings provide valuable insights from a hard-to-reach population within community-based health promotion settings. Limited geographic (Ontario, Quebec, Manitoba) and linguistic (English-speaking) representation may affect transferability to other regions. Focus on transcripts from audio-recorded interviews may have led to the omission of important non-verbal data.