This resource outlines the pathways to gender-affirming care in Nova Scotia. It intends to assist patients and providers navigate inequitable (approval) processes that makes it harder for trans and gender diverse populations in Nova Scotia to access the health services they need. It does not reflect recent changes to the approval process for gender-affirming surgeries.
DISCLAIMER: This is a guide for health service providers to assist them in navigating trans healthcare services in Nova Scotia. This resource was created independently and reflects our understanding of the current pathways to gender-affirming health services in Nova Scotia. While it refers to services, there is no affiliation between JK Health Equity and any service providers or organizations named in this document. Access to care is subject to change and depends on provider availability/wait times. This resource is based upon approval processes that were in place as of May 2022, which may change.
This study was designed to generate theory that works to further understandings of the processes and factors influencing the conditions under which primary care services are delivered to diverse 2SLGBTQ populations in Nova Scotia. This Constructivist Grounded Theory study employed Intersectional and Critical lenses, complicated the notion of identity in a broadly inclusive manner, and gained insight into socio-structural factors that influence access to health services in primary care settings across Nova Scotia. By conducting a preliminary literature review, stigma was identified as significant to the health outcomes of 2SLGBTQ populations, justifying its use as a starting point for the investigation. Upon REB approval, a diverse sample population was recruited; variation was maximized across categories of identity (sexual orientation, gender, race, (dis)ability, and citizenship), geographies, and professional scope of practice/role. Sampling purposively from historically underrepresented groups so they were overrepresented in the sample population created points of comparison for the purpose of enhancing data analysis and generation of a robust grounded theory. The sample population (n=30) was comprised of three subgroups: 2SLGBTQ health service users (HSUs) (n=10), 2SLGBTQ health service providers (HSPs) (n=10), and non-2SLGBTQ HSPs (n=10). Semi-structured interviews lasting up to 90 minutes were conducted with each participant using video-conferencing software. Participants confirmed that stigma was a meaningful construct; its significance was substantiated throughout the data collection process. Conceiving stigma as a socio-structural process that determines health outcomes allowed for an exploration of 2SLGBTQ stigmatization in health care by investigating the delivery of primary care services to 2SLGBTQ populations across a provincial health system. Data analysis started with its collection by way of constant comparison, and continued through coding methods, memo-writing, diagramming, and writing this dissertation. As such, the level of abstraction was raised and a substantive theory of Working Through Stigma was co-created. The main concern of participants was that stigma causes individuals to experience power relations differently and the experiences of those with relatively less power are often disproportionately negative. The theory depicts what participants are doing about their concerns and involves three interrelated processes: depending on context, resolving histories, and surviving the situation.