Applying the Intersectional Model of Service Use to Understand Healthcare Utilization Among Transgender and Nonbinary People

Transgender and nonbinary people (TNB) experience significant barriers that impede their ability to access affirming healthcare, further exacerbating health inequities. Despite this, few theoretical models have been developed to specifically examine TNB healthcare access and service use. The Intersectional Model of Service Use (IMSU) is a newly developed healthcare utilization model to address this gap. This quantitative study applied the IMSU to a state-wide sample (n=388) of TNB people to identify factors related to health service use. Results indicated that the inclusion of TNB-specific factors significantly contributed to the IMSU’s ability predict healthcare use beyond traditional factors alone. Self-reporting a disability, being self-employed or a student, general social support, previously needing to educate healthcare providers, and having changed one’s gender marker was associated with increased odds of past-year healthcare use controlling for other factors. Longer wait times to see an affirming provider was significantly associated with lower odds of healthcare use. These findings provide preliminary support for the IMSU as a useful framework for understanding TNB healthcare utilization. Future researchers should continue to test the IMSU on larger, more diverse samples. • Transgender and nonbinary (TNB) people struggle to access healthcare • The Intersectional Model of Service Use (IMSU) is a model of TNB healthcare use • TNB-specific factors significantly added to the model’s ability to predict use