Mixed-Methods Evaluation of a Zine Promoting Healthier Chest-Binding Practices in Transgender and Gender-Diverse Populations

Chest-binding is a common practice among transgender and gender-diverse youth, yet there are few studies on health promotion tools about healthy chest-binding practices directed to this population. This study overviews the creation of <i>Breathe: Journeys to Healthy Binding</i> and the evaluation of its effectiveness for promoting informed decision-making around chest binding in transgender and gender-diverse (TGD) individuals. In this mixed-methods pilot evaluation, participants (<i>n</i>=25) aged 18+ took a pretest survey measuring their knowledge around healthy binding practices before reading <i>Breathe</i> (provided in an online format), then took a posttest survey, re-measuring knowledge and measuring the zine's acceptability. Finally, participants joined focus groups to discuss how the zine affected their attitudes and behaviors around binding. Quantitative findings suggest the zine significantly increased participant knowledge about healthy chest binding practices and exercises to reduce side effects caused by binding, as well as increasing scores on healthy binding self-efficacy measures. Thematic analysis of the focus groups identified key themes in participants' reactions to the zine, including its characters, perceived utility, and intentions to change behavior after reading the zine. This study demonstrates how zines may be effective in shifting knowledge, attitudes, and behaviors in participants, particularly as a culturally congruent method of health communication for the transgender community.