Healthcare professionals’ advocacy strategies for trans-inclusive primary care: a qualitative analysis

Abstract

Abstract Introduction The trans community faces significant barriers in healthcare due to inadequate medical education and systemic discrimination. Healthcare providers often lack training to address trans individuals’ health needs, with advocacy playing a key role in overcoming these gaps. This research explored how healthcare providers employ an advocacy-centred approach when delivering care to their trans patients, using Israel’s primary care system as a case study. Method We applied an institutional ethnography framework to examine trans-inclusive primary care in Israel. Data collection included semi-structured interviews with healthcare professionals, trans activists, and community members (n = 39), analysis of public documents and social media posts (n = 305), and observations at medical conferences (n = 6). Data was analyzed using thematic analysis methods to identify patterns in healthcare delivery practices. Results Our study revealed significant gaps in trans-related content across all Israeli medical education and primary care systems. We developed the framework of “advocacy-driven healthcare” to describe how healthcare professionals filled these gaps through practices performed on individual and collaborative levels. These included acts such as turning to alternative knowledge sources, creation of inclusive environments, and establishment of collaborative networks with colleagues and trans organizations. Despite the potential for promoting trans-inclusive services, we found advocacy-driven healthcare to be dependent on individual providers’ resources and commitment, which paradoxically increased the risk of inconsistent patient care. Conclusions This study demonstrates the use of advocacy as a fundamental infrastructure for healthcare delivery rather than a supplementary activity, as a strategy for providing trans-inclusive care. Our findings indicate that advocacy-driven healthcare can both ameliorate and uphold health inequalities, highlighting the need for systematic changes in medical education and institutional policies to reduce reliance on individual initiative while maintaining the benefits of advocacy-based approaches.

Keywords

• Trans
• Advocacy
• Primary care
• Activism
• Medical education
• Healthcare professionals