Associations between intersectional discrimination, self-efficacy to manage one's health, and health outcomes among Black transgender women.

BACKGROUND

Black transgender women are disproportionately exposed to discrimination and healthcare barriers associated with poor health and delayed treatment-seeking. Consequently, traditional treatment pathways may not be accessible. Thus, health self-management (HSM) may be critical in promoting health among Black transgender women.

PURPOSE: The purpose of this study is to examine the relationships among intersectional discrimination, self-efficacy for health management, and mental health outcomes (PTSD symptoms, depressive symptoms, and unhealthy days) among Black transgender women, and to determine whether self-efficacy modifies or explains the association between intersectional discrimination and these health outcomes.

METHODS

We analyzed quantitative survey data from a community-based United States sample of 154 Black transgender women to advance our understanding of the associations between intersectional discrimination, self-efficacy to manage one's health, and distal health outcomes. Analyses included Pearson's correlations, T-tests, and multiple linear regression.

RESULTS

Higher self-efficacy was associated with better mental health overall but did not consistently buffer the effects of intersectional discrimination, suggesting partial mediation rather than full mediation or moderation.

DISCUSSION: Among Black transgender women, racism and cisgenderism may be influencing other components in the pathway between context and health outcomes, contributing to higher self-reported self-efficacy or reducing the potential effect of self-efficacy on health outcomes.

CONCLUSION

Future research should further examine the historical and present-day prejudicial systems that affect one's self-efficacy to manage their health and take an anti-cisgenderist and anti-racist approach to discussing HSM with Black transgender women.