title: Navigating the System: How Transgender Individuals Engage in Health Care Services.
abstract: OBJECTIVE
  Transgender individuals (TIs) experience a number of healthcare disparities that result in compromised access to health care, placing them at high risk for poor health outcomes. Despite their unique health concerns, there is little known about how they engage in health care. The purpose of this grounded theory study was to construct a theoretical framework that depicts the process by which transgender individuals engage in health care.
  
  
  METHODS
  In this grounded theory study, data from interviews with 25 individuals who self-identified as transgender were used to develop a theoretical framework that depicts the process by which TIs engage in health care. Data analysis included open coding, category formation, and theoretical coding. Constant comparative analysis was used to facilitate theory generation.
  
  
  CONCLUSIONS
  The central phenomenon of how TIs engage in health care was the core process of navigating the system. The core process involves four subprocesses: needing to move forward, doing due diligence, finding loopholes, and making it work.
  
  
  CONCLUSIONS
  The theoretical framework of navigating the system can provide healthcare providers with a way to understand how TIs engage in health care as they move through the subprocesses of moving forward, doing due diligence, finding loopholes, and making it work in order to get their healthcare needs met. With a better understanding of the healthcare journeys of TIs, healthcare providers can provide better care for this population and advocate for change in policies that contribute to the health disparities TIs experience.
authors.affiliation: Associate Professor of Nursing, American Nurses Foundation Scholar, Kent State University - College of Nursing, Kent, OH, USA.
authors.forename: Cyndi Gale
authors.initials: CG
authors.lastname: Roller
authors.affiliation: Professor of Nursing, Kent State University - College of Nursing, Kent, OH, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Sedlak
authors.affiliation: Professor of Nursing, Indiana University - School of Nursing, Indianapolis, IN, USA.
authors.forename: Claire Burke
authors.initials: CB
authors.lastname: Draucker
mesh_terms: D000328:Adult; D001294:Attitude to Health; D005260:Female; D005783:Gender Identity; D066296:Grounded Theory; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D036301:Qualitative Research; D063106:Transgender Persons
keywords: Access; health care; transgender