title: Healthcare experiences of gender diverse Australians: a mixed-methods, self-report survey.
abstract: BACKGROUND
  To date the healthcare experiences of gender diverse Australians have received little attention. Previous international research indicates a range of both negative and positive healthcare experiences amongst this diverse population, with negative experiences being those most frequently reported.
  
  
  METHODS
  An online survey was designed to examine the healthcare experiences of gender diverse Australians. The survey included Likert scales asking participants to rate their mental and physical health, and their experiences with psychiatrists, general practitioners and surgeons (in terms of perceived comfort, discrimination and information provision). Open-ended questions provided the opportunity for participants to further elaborate on their experiences. Data were collected between June 2012 and July 2013. Quantitative data analysis was conducted utilising SPSS 17.0, including ANCOVAs and correlations to examine the relationships between variables. Qualitative data were coded by the authors in terms of negative or positive responses and the validity of ratings were assessed utilising Cohen's kappa.
  
  
  RESULTS
  110 people assigned male at birth (MAAB) and 78 people assigned female at birth (FAAB) completed two separate surveys. All identified as gender diverse as defined in this paper. 70% of participants had accessed a psychiatrist. Participants MAAB rated their experiences with psychiatrists more highly than participants FAAB. 80% of participants had accessed a general practitioner. Comfort with, and respect from, general practitioners were both positively correlated with mental health, whilst discrimination was negatively correlated with mental health. 42.5% of participants had undertaken sex-affirming surgery. Those who had such surgery reported higher levels of physical and mental health than those who had not undertaken surgery. Participants MAAB reported more positive experiences of surgery than did participants FAAB.
  
  
  CONCLUSIONS
  Findings highlight the need for increased education of medical practitioners in regards to engaging with gender diverse clients.
authors.affiliation: School of Social and Policy Studies, Flinders University, GPO Box 2100, Adelaide 5001, Australia. damien.riggs@flinders.edu.au.
authors.forename: Damien W
authors.initials: DW
authors.lastname: Riggs
authors.forename: Katrina
authors.initials: K
authors.lastname: Coleman
authors.forename: Clemence
authors.initials: C
authors.lastname: Due
mesh_terms: D000328:Adult; D001315:Australia; D005260:Female; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D008297:Male; D057566:Self Report; D057830:Gender-Affirming Surgery / Q000706:statistics & numerical data; D063106:Transgender Persons