We examined health care experiences of transmasculine young adults to clarify factors contributing to mistrust in the health care system and identify tangible and modifiable means to address health disparities through improved patient-provider interactions. Thematic analysis highlights patterns within historical relationships between medical models and transmasculine embodiment, and provides guidance for health care clinicians, researchers, and policy makers to deliver competent services for transgender and gender diverse (TGD) individuals. Methods: The study team used qualitative methodology guided by interpretive phenomenological analysis. Semistructured interviews with 12 participants who self-identified as transmasculine were conducted, transcribed, and coded thematically. Results: Participants were a community sample of 12 young adults 18-35 years of age (M = 23, standard deviation = 3.74), who self-identified as transmasculine. Three participants identified as a racial/ethnic minority. Participants were highly educated, with most completing at least some college. The superordinate thematic domain Perspectives on Health Care emerged, under which three subthemes were nested: (1) an essentialist, binary medical model is inaccurate and oppressive, (2) consequences of medicalizing gender (i.e., gender as a diagnosis), and (3) recommendations to improve health care. Conclusions: Qualitative analysis revealed specific ways in which the relationship between transmasculine individuals and current health care systems are fraught with difficulties, including the impact of stigma, gatekeeping, and inaccuracies, in current diagnostic criteria. Participants shared lived experiences and offered innovative ideas to improve health care delivery, such as challenging socialized biases, increased education, and immersion in TGD communities to advocate for change in research, practice, and policy.

Objective Existing psychosocial research offers little information on the unique challenges and strengths of children adopted from China with cleft lip and/or palate (CL/P). The present study aimed to understand biopsychosocial factors that support positive self-concept in this population. Design Qualitative, semistructured interviews were conducted with children and their parents. Interpretive phenomenological analysis of transcribed interviews was utilized for data analysis. Setting Participants were recruited in an outpatient, pediatric multidisciplinary cleft clinic during a standard team visit. Patients, Participants Participants were ages 8 to 12 years with a diagnosis of isolated cleft lip-palate who were internationally adopted from China before the age of 2 years and English-speaking. Participants also included English-speaking parents. Results Themes reflecting data from the child and parent subsamples include: (1) child's characteristics, (2) family strengths, (3) adoption identity, (4) cultural identity, (5) coping with a cleft, and (6) social factors. Additional 2 to 3 subthemes were identified for the parent and child subsamples within each broader theme. Conclusions Findings from this sample suggested factors supporting positive self-concept included pride and self-efficacy in activities, family support, instilment of family values, strategies for coping with a cleft, family belonging, cultural exposure, and normalization of differences. Medical providers can support patients and families by providing education on surgeries, CL/P sequelae and outcomes, and pediatric medical stress. Mental health providers can screen for social and emotional challenges and provide psychoeducation on racial/ethnic socialization, identity development, and coping.

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The purpose of the current project was to distill guidance for psychology researchers regarding ethical challenges that may arise in the conduct of qualitative research aimed to improve pediatric clinical care. Method: 6 pediatric psychologists with relevant research experience participated in semistructured interviews. Data were analyzed using inductive methods of general thematic analysis and then emerging ethical issues were interpreted within the framework of the American Psychological Association (APA) Ethics Code. Results: 6 broad areas of ethical considerations were derived: Establish competence and ensure research rigor; clearly distinguish research and clinical roles; consider the potential for sample selection bias and demand characteristics; protect research participants, especially minors; attend to common and unique privacy and confidentiality concerns; and respect provider stakeholders and the clinical setting. Researchers consistently identified proactive, rather than reactive approaches, in addressing potential ethical concerns. Some of the themes and subthemes represent typical considerations of psychology research while others speak to the unique elements of qualitative methodologies, pediatric populations, and clinical care improvement. Conclusions: Researchers' identified ethical considerations aligned with the APA Ethics Code, specifically sections 2 (competence), 3 (human relations), 4 (privacy and confidentiality), and 8 (research and publication). Recommendations were derived to aid in study planning and reflect the importance of considering competencies within the research team, dual relationships, privacy and confidentiality, and the context of clinical qualitative research. Overwhelmingly, researchers encouraged others to conduct qualitative pediatric clinical care research and emphasized the invaluable nature of the rich, in-depth information gained from such research.