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Table 2 Overview of the relationship between research questions, themes, subthemes, and meaning units

From: Interdisciplinary clinicians’ attitudes, challenges, and success strategies in providing care to transgender people: a qualitative descriptive study

Research question

Themes

Subthemes

Meaning units

(1) Attained and utilized information

1. Knowledge Acquisition: Formal and Informal Pathways to Competency

Formal pathways to competency

Healthcare school/residency exposure

Organizational training

Informal pathways to competency

Mentor

Self-taught

Patient

(2) Perceived barriers and facilitators and

(3) Understood gaps in their professional training

2. Perceived Challenges and Barriers: “I didn’t know what I was doing”

“People don’t know how to treat”: Knowledge gaps in providing care

General knowledge gaps

Scientific knowledge gaps

Specific knowledge gaps

Knowledge gaps that harm

Knowledge gaps based on caseload

“She was not comfortable”: Establishing a patient-clinician relationship

Reciprocal distrust

Meeting patient expectations

(2) Perceived barriers and facilitators

3. Power to Deny: Prescriptive Authority and Gatekeeping

Gatekeeping: The stigma, discomfort and underlying denial of hormone therapy

Conditional access to hormone therapy

Discomfort providing care

Collegial and organizational pressure

Fear of malpractice

Fear of hormone permanency

Fear of hormone side effects

Fear of referrals

Exceptions to the gatekeeping rule

Continuation of hormone therapy

Initiation of hormone therapy

Recognition of power of prescribing

(2) Perceived barriers and facilitators

4. Stigma: “This is really strange, and I can’t really understand it”

Negative stereotypes: “They’re really homosexuals that are afraid to admit it”

“Risky sexual behaviors”

Homophobia

Difficult patients

Physical appearance: “It’s this obsession”

Physical appearance preoccupation

Passing prejudice

“This is really strange, and I can’t really understand it”

Discomfort

Disbelief

Discrimination

“Go all the way”

Goal of invisibility

(2) Perceived barriers and facilitators

5. Reflections: Strategies for Success, Rewards, and Personal Motivations

Becoming proficient: Strategies for success

Patient-centered care

Time/practice

Clinical environment

Confronting fears and biases

Mentorship from within

Why I provide care

Rewards and benefits

Doing my job

“Tikkun olam”