Background : Launched to address gaps in the local evidence base to inform transgender and non-binary (TNB) health needs and priorities for the Baltimore metropolitan area, the Behavioral Surveillance Research Study (BESURE)’s Transgender Health Project, is a community-engaged research and practice initiative that aims to: identify the strengths and assets, and understand health, social, and service needs of TNB individuals living in and around Baltimore. Formative research was critical for informing development of a community-academic partnership for improving the health and wellbeing of TNB people in Baltimore.
Methods : Key informant (KIIs) interviews (n=15) were conducted with community leaders, allies, and health and social service providers well known to the local TNB community. Subsequently, six small group discussions (SGDs) were conducted with TNB individuals (n=21), recruited using a purposive sampling approach. Field guides addressed: (1) best practices for conducting research, (2) community challenges and needs, (3) opportunities for collaboration and mechanisms for data dissemination. KIIs and SGDs were audio-recorded and transcribed verbatim. Analysis included identification of key themes, debriefing with community advisory board members and co-investigators, and ongoing theoretical sampling to explore relationships among themes and inform next steps in research and program development.
Results : Participants described frustration with: researchers’ focus on HIV among transgender women; lack of attention to transgender men and non-binary individuals; and persistent focus on health problems instead of strengths and resiliency. Participants suggested broad inclusion of TNB communities, intentionality in development of research, and attention to TNB individuals’ immediate needs through direct linkage to resources, partnerships with trusted local organizations and community leaders, and, recognizing that TNB communities are supporting themselves when services are unavailable, filling gaps where useful. A need for continuous and strategic research dissemination was emphasized, including transparency, ongoing collaboration, and data sharing and training to maximize data utilization by community members and stakeholders to inform policy and practice. Participants felt strongly about the importance of TNB inclusion among project staff and decision makers for project success and sustainability, and particularly for engaging previously excluded TNB communities.
Conclusions : These findings highlight key recommendations for TNB health research and program development that centers community voices and goals. These recommendations have been integrated into the operational plan for the BeSuRe Transgender Health Project, which now includes a multidimensional research component, a direct service linkage and support component, and a mutual knowledge transfer component focused on community and systems level capacity building, dissemination, and communication.