Effectiveness of the i²TransHealth Interdisciplinary E-Health Service for Transgender and Gender Diverse People from Remote Regions: Preliminary Results

Introduction/Background *
Treatment-seeking transgender and gender diverse (TGD) people from rural areas are structurally disadvantaged by their place of residence. Barriers to accessing trans health care, such as lack of trans-informed health care providers or long travel distances, may be more pronounced in remote regions. E-health services appear to be potential useful complements to face-to-face treatments and require scientific evaluation in trans health care.

Specific Aim *
We are currently testing the e-health service i²TransHealth for its effectiveness in a randomized-controlled trial (RCT). i²TransHealth stands for an interdisciplinary, internet-based trans health care service, which is intended to provide TGD people from regions with no or low trans health care coverage with first-time access to university-based specialized trans health care. As part of the RCT, we will provide concomitant support to TGD study participants from northern Germany residing outside metropolitan areas up to and including Mai 2022. The e-health service is composed of digital (bi-weekly video consultations, 1:1 chat with a study therapist) and outpatient (crisis interventions close to home by a physician network) concepts.

Materials and Methods *
We compared an intervention group using i²TransHealth for 4 months with option to continue with a control group waiting 4 months and then starting i²TransHealth treatment. Quantitative data collection will occur before randomization (T0) and after 4 months of study participation (T1). The primary outcome is symptom burden (BSI-18), and secondary outcomes are quality of life (WHOQOL-BREF) and treatment satisfaction (mod. ZUF-8). N=175 TGD subjects were enrolled as service users in the RCT. In accordance with the study protocol, statistical analyses will be performed after completion of the intervention phase.

Results *
Compared to the waiting group, we expect that service users in the intervention group will report reduced symptom burden, increased quality of life, and treatment satisfaction after 4 months of study participation. Preliminary results are expected in summer 2022. Thus, we would like to present our preliminary results about the effectiveness, acceptability, and feasibility of i²TransHealth.

Conclusion *
The need to evaluate the effectiveness of e-health services for TGD people is immense. To our knowledge, the i²TransHealth e-health service is so far unique. For the first time, the combination of digital video consultations and chats with study therapists and outpatient treatments by a network of physicians can be studied in an RCT. For many TGD people from rural areas, this low-threshold access is the first link to an integrative care model that addresses their treatment concerns with professional expertise. Subject to a positive evaluation, we assume a high transfer potential of i²TransHealth into further care structures within and outside Germany. A particular characteristic of this clinical sample is the high proportion of rural-residing TGD people seeking treatment. The RCT results will be used to assess who could particularly benefit from e-health services and what needs to be paid special attention to when offering care to people from rural regions.