Social Determinants of Health Influence on Trans and Gender-Diverse People: A Qualitative Photovoice Study

Abstract

Despite the introduction of inclusive and gender-affirming approaches in healthcare, transgender and non-binary people continue to show poorer physical, psychological, and social outcomes, shaped by social determinants within historically pathologizing and stigmatizing contexts. This study used qualitative participatory action research with photovoice among seven transgender individuals residing in Murcia, Spain; data were generated through semi-structured interviews and focus group dialogue, applying the SHOWED technique to the visual and discursive narratives of the participants, and analyzed with Atlas.ti v8. Educational, employment, and healthcare contexts significantly condition well-being. Well-being was determined by the circumstances and support in which gender identity is constructed, within sociocultural environments marked by gender stereotypes, exclusion from social spaces, and fears regarding the irreversibility of certain transition steps. Reported lifetime negative events, social barriers, exclusion, and persistent questioning of identity were associated with increased anxiety, depressive symptoms, and insomnia. At the same time, the relevance of resilience and support networks also emerged during the sessions. Replicating photovoice in diverse settings may help identify social and territorial inequities and inform improvements in clinical practice, healthcare education, public policies, and legislation for transgender and gender-nonconforming people.