Readiness for Transition to Adult Care in Transgender and Gender Diverse Youth
Diana K. Bowen, M.D.1, Mona Ascha, M.D.2, Ilina Rosoklija, MPH1, Joshua Katz, MD2, Sumanas Jordan, MD PhD2, Raina Voss, MD MPH1.
1Ann & Robert H. Lurie Childrens Hospital of Chicago, Chicago, IL, USA, 2Northwestern Memorial Hospital, Chicago, IL, USA.
Background: The transition from pediatric to adult health care model for transgender and gender diverse (TGD) youth is a largely undefined process with significant barriers to care. The transition readiness assessment questionnaire (TRAQ) is a self-administered tool that has been validated and modified for use with many different conditions but has yet to be studied in TGD persons. The aim of our study was to assess readiness to transition and evaluate the fit of the TRAQ to our patient population including particular areas of concern with transition for the TGD population.
Methods: The TRAQ survey and a supplemental questionnaire were distributed to parents (if present) and patients age ≥16 years presenting to our multidisciplinary gender clinic. TRAQ assessed the following domains: Managing Medications, Appointment Keeping, Tracking Health Issues, Talking with Providers, and Managing Daily Activities. Each question was scored on a 5-point Likert scale with a score of 1=not transitioned at all, and 5=fully transitioned. Total TRAQ score was calculated as an average of each domain score (score range 1-5).The supplemental questionnaire queried domains such as fit of the TRAQ to this patient population, anticipated challenges to transition, planning for the future, and feedback on the clinic’s efforts toward improving transition readiness. Patient demographic and clinical characteristics were obtained from the medical record. Quantitative and qualitative analyses were carried out.
Results: Overall, 83 youths and 25 parents completed the TRAQ and 80 youths also completed the supplemental survey. Of the youths, mean age was 18.2 +/- 1.4 years, 51 (62%) were designated female at birth. [Table 1 demographics] TRAQ scores were higher in the "Talking to Providers" and "Managing Activities" groups and lowest in the "Appointment Keeping and "Tracking Health" domains. There was no significant difference between patients and parent TRAQ scores. Youth without parents present at the visit scored higher (4.0 +/- 0.6) than those with a parent (3.1 +/- 0.8; p< 0.001) [Table 2] On the supplemental questionnaire, respondents felt the TRAQ was a good fit and prompted discussion with their provider regarding this topic. Only 6 (7%) respondents had talked with their provider about transition prior to the survey. Eleven youth brought up the topic of surgery and all comments were in relation to insurance concerns.
ConclusionsThe TRAQ is reasonable to assess readiness for healthcare transition in the TGD population.
Table 1. Characteristics of Youth Cohort
| Patients, n | 82 |
| Mean Age, years ± SD | 18.2 ± 1.4 |
| Gender Identity, n (%) | |
| Female | 30 (36.6) |
| Male | 50 (61.0) |
| Non-binary | 2 ( 2.4) |
| Designated Sex at Birth, n (%) | |
| Female | 51 (62.2) |
| Male | 31 (37.8) |
| Race, n (%) | |
| African American | 7 (8.4) |
| Asian | 2 (2.4) |
| Caucasian | 33 (39.8 ) |
| Unknown | 5 (6.0) |
| Missing | 35 (42.2) |
Table 2. Comparison of patients with parents present at visit versus without.
| All Patients | No Parent Present | Patients with Parent Present | P-value*(Comparison of parent present vs no parent present) | |
| Patients, n (%) | 82 | 57 (70) | 25 (30) | |
| Mean age at TRAQ completion, age ± SD | 18.21 (1.38) | 18.6 ±1.4 | 17.4 ± 0.9 | <0.001 |
| Gender Identity, n (%) | 0.733 | |||
| Female | 30 (36.6) | 22 (38.6) | 8 (32.0) | |
| Male | 50 (61.0) | 34 (59.6) | 16 (64.0) | |
| Non-binary | 2 (2.4) | 1 (1.8) | 1 (4.0) | |
| Designated Sex at Birth, n (%) | 1.0 | |||
| Female | 51 (62.2) | 35 (61.4) | 16 (64.0) | |
| Male | 31 (37.8) | 22 (38.6) | 9 (36.0) | |
| TRAQ Domain Scores | ||||
| Managing Medications score, mean ± SD | 3.77 (0.80) | 4.0 ± 0.6 | 3.2 ± 0.8 | <0.001 |
| Appointment Keeping score, mean ± SD | 3.24 (1.07) | 3.6 ± 0.9 | 2.4 ± 1.0 | <0.001 |
| Tracking Health score, mean ± SD | 3.55 (0.99) | 3.8 ± 0.9 | 3.0 ± 1.0 | 0.001 |
| Talking to Providers score, mean ± SD | 4.83 (0.40) | 4.8 ± 0.4 | 4.8 ± 0.5 | 0.799 |
| Managing Activities score, mean ± SD | 4.32 (0.79) | 4.4 ± 0.7 | 4.1 ± 0.8 | 0.052 |
| Total TRAQ Score, mean ± SD | 3.77 (0.78) | 4.0 ± 0.6 | 3.2 ± 0.8 | <0.001 |
*T-test for continuous and Fisher’s exact for categorical comparisons
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