“…Some studies identified the impact that personal beliefs and attitudes had on staff behaviors, while some reported it did not affect their behavior, and others demonstrated a clear lack of awareness resulting in reduced quality of care and access to services (Byrd, 2020 ). Solutions such as the importance training and education can have on overcoming personal beliefs and attitudes, as well as organizational expectations helping to set clear requirements in quality of treatment (Brömdal et al., 2019 ; Brömdal et al., 2023 ; Matarese et al., 2023 ; Phillips et al., 2020 ; Redcay et al., 2020 ; Sevelius & Jenness, 2017 ; Tadros et al., 2020 ; Tarzwell, 2006 ; White Hughto et al., 2018 ) are reform-based attempts that seek “to improve the conditions inside of prisons or the people within them, but not to implement structural changes” (Lawston & Meiners, 2014 , p. 13). As such, findings from this study highlight the urgent need to address the underlying structural, systemic, and organizational factors that impact upon the knowledge, attitudes, and behaviors staff have and hold in correctional and other health and community settings to meaningfully and sustainably improve health, wellbeing and gender-affirming treatment and care for trans communities (Brömdal et al., 2019 ; Franks et al., 2022 ; McCauley et al., 2018 ; Mullens et al., 2017 ; Swan et al., 2023 ; Van Hout et al., 2020 ; Watson et al., 2023 ).…”