{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:06:49Z","timestamp":1790809609499,"version":"4.1.0"},"reference-count":86,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T00:00:00Z","timestamp":1655337600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017035","name":"Johns Hopkins Center for AIDS Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100017035","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Robert Wood Johnson Foundation Future of Nursing Scholars"},{"name":"Scholl Award"},{"name":"Post-doctoral to Faculty Fellowship at Nell Hodgson Woodruff School of Nursing"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Black transgender women endure pervasive polyvictimization (experiencing multiple forms of violence throughout the lifespan). Polyvictimization is associated with poor mental health. Black transgender women also face barriers in access to healthcare, but the extent that such barriers modify the association between polyvictimization and poor mental health has not been described using convergent mixed-methods analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This convergent mixed-methods secondary analysis employs an intersectional lens and integrates two inter-related datasets to describe barriers to healthcare and the extent that such barriers modify the association between polyvictimization and mental health among Black transgender women. Investigators used survey data (n = 151 participants) and qualitative interview data (n = 19 participants) collected from Black transgender women (age 18 years and older) in Baltimore, MD and Washington, DC between 2016 and 2018. Analyses include thematic content analysis, bivariate analysis, joint display, and multivariate linear regression analysis examining mediation and moderation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Joint display illuminated three domains to describe how barriers to healthcare present among Black transgender women\u2013<jats:italic>Affordability<\/jats:italic>, <jats:italic>Accessibility<\/jats:italic>, and <jats:italic>Rapport and Continuity<\/jats:italic>. Independent t-tests revealed significantly higher polyvictimization, Post Traumatic Stress Disorder (PTSD), and depression scores among participants who reported at least one barrier to healthcare (BHI) compared to those who reported no barriers. BHI significantly moderated and partially mediated the association between polyvictimization and PTSD symptom severity and BHI fully mediated the association between polyvictimization and depressive symptom severity\u2013when accounting for age and location.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>Findings highlight the importance of access to healthcare in modifying the association between polyvictimization and PTSD and depression symptom severity among Black transgender women. Findings call for immediate interventions aimed at reducing barriers to healthcare and improved training for clinical providers serving Black transgender women.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0269776","type":"journal-article","created":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T17:35:09Z","timestamp":1655400909000},"page":"e0269776","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":35,"title":["Barriers to accessing and engaging in healthcare as potential modifiers in the association between polyvictimization and mental health among Black transgender women"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3652-1196","authenticated-orcid":true,"given":"Athena D. 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Dinno","year":"2017","journal-title":"Am J Public Health"},{"issue":"18","key":"pone.0269776.ref019","doi-asserted-by":"crossref","first-page":"3864","DOI":"10.1177\/0886260516672940","article-title":"The nature of bias crime injuries: A comparative analysis of physical and psychological victimization effects","volume":"34","author":"MD Fetzer","year":"2019","journal-title":"J Interpers Violence"},{"issue":"11","key":"pone.0269776.ref020","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.2105\/AJPH.2013.301545","article-title":"Gender abuse and major depression among transgender women: A prospective study of vulnerability and resilience","volume":"104","author":"L Nuttbrock","year":"2014","journal-title":"Am J Public Health"},{"issue":"5","key":"pone.0269776.ref021","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1037\/cou0000143","article-title":"Discriminatory experiences associated with posttraumatic stress disorder symptoms among transgender adults","volume":"63","author":"SL Reisner","year":"2016","journal-title":"J Couns Psychol"},{"issue":"2","key":"pone.0269776.ref022","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1080\/19359705.2019.1700865","article-title":"Supporting sexual and gender minority health: Research priorities from mental health professionals","volume":"24","author":"KD Clark","year":"2020","journal-title":"J Gay Lesbian Ment Health"},{"issue":"2","key":"pone.0269776.ref023","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/00981389.2018.1532941","article-title":"Profound health-care discrimination experienced by transgender people: rapid systematic review.","volume":"58","author":"L. 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Michel-Smith","year":"2018"},{"issue":"4","key":"pone.0269776.ref028","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1080\/19359705.2010.505844","article-title":"Healthcare needs of the transgender homeless population","volume":"14","author":"SS Spicer","year":"2010","journal-title":"J Gay Lesbian Ment Health"},{"issue":"3","key":"pone.0269776.ref029","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1023\/A:1009573800168","article-title":"Lesbian, gay, bisexual, and transgender health: Findings and concerns","volume":"4","author":"L Dean","year":"2000","journal-title":"J Gay Lesbian Med Assoc"},{"issue":"1","key":"pone.0269776.ref030","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s12160-013-9565-8","article-title":"Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus","volume":"47","author":"JM Sevelius","year":"2014","journal-title":"Ann Behav Med"},{"issue":"6","key":"pone.0269776.ref031","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1370\/afm.1865","article-title":"Integrating quantitative and qualitative results in health science mixed methods research through joint displays","volume":"13","author":"TC Guetterman","year":"2015","journal-title":"Ann Fam Med"},{"issue":"6","key":"pone.0269776.ref032","article-title":"Legal immigration status is associated with depressive symptoms among Latina transgender women in Washington","volume":"15","author":"T Yamanis","year":"2018","journal-title":"DC. Int J Environ Res Public Health"},{"issue":"2","key":"pone.0269776.ref033","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/QAI.0000000000002112","article-title":"A gap between willingness and uptake: Findings from mixed methods research on HIV prevention among Black and Latina transgender women","volume":"82","author":"T Poteat","year":"2019","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0269776.ref034","volume-title":"Designing and Conducting Mixed Methods Research","author":"JW Creswell","year":"2011","edition":"2"},{"issue":"11","key":"pone.0269776.ref035","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1097\/01.MLR.0000093487.78664.3C","article-title":"The Patient Health Questionnaire-2 validity of a two-Item depression screener","volume":"41","author":"K Kroenke","year":"2003","journal-title":"Med Care"},{"issue":"1","key":"pone.0269776.ref036","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1185\/135525703125002360","article-title":"The primary care PTSD screen (PC\u2013PTSD): Development and operating characteristics","volume":"9","author":"A Prins","year":"2004","journal-title":"Prim Care Psychiatry"},{"key":"pone.0269776.ref037","volume-title":"Released 2017. IBM SPSS Statistics for Windows, Version 25.0","author":"IBM Corp"},{"key":"pone.0269776.ref038","author":"A. F. Hayes","year":"2012","journal-title":"PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling [White paper]"},{"issue":"1","key":"pone.0269776.ref039","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3758\/BF03203630","article-title":"GPOWER: A general power analysis program","volume":"28","author":"E. Erdfelder","year":"1996","journal-title":"Behavior Research Methods, Instruments & Computers"},{"issue":"5","key":"pone.0269776.ref040","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1037\/a0015808","article-title":"An effect size primer: A guide for clinicians and researchers","volume":"40","author":"CJ Ferguson","year":"2009","journal-title":"Prof Psychol Res Pr"},{"issue":"1","key":"pone.0269776.ref041","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1037\/a0024338","article-title":"Effect size estimates: Current use, calculations, and interpretation","volume":"141","author":"CO Fritz","year":"2012","journal-title":"J Exp Psychol Gen"},{"key":"pone.0269776.ref042","doi-asserted-by":"crossref","first-page":"279","DOI":"10.4300\/JGME-D-12-00156.1","article-title":"Using Effect Size\u2014or Why the P Value Is Not Enough","volume":"4","author":"J. Cohen","year":"2012","journal-title":"J Grad Med Educ."},{"key":"pone.0269776.ref043","volume-title":"Qualitative Research & Evaluation Methods","author":"MQ Patton","year":"1990"},{"issue":"5\u20136","key":"pone.0269776.ref044","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1007\/s11199-008-9400-z","article-title":"When Black + lesbian + woman \u2260 Black lesbian woman: The methodological challenges of qualitative and quantitative intersectionality research","volume":"59","author":"L. Bowleg","year":"2008","journal-title":"Sex Roles"},{"issue":"7","key":"pone.0269776.ref045","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.2105\/AJPH.2012.300750","article-title":"The problem with the phrase women and minorities: Intersectionality-an important theoretical framework for public health","volume":"102","author":"L. Bowleg","year":"2012","journal-title":"Am J Public Health"},{"key":"pone.0269776.ref046","volume-title":"Narrative methods for the human sciences","author":"CK Riessman","year":"2008"},{"issue":"5","key":"pone.0269776.ref047","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1037\/a0029597","article-title":"A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model","volume":"43","author":"ML Hendricks","year":"2012","journal-title":"Prof Psychol Res Pr"},{"issue":"1","key":"pone.0269776.ref048","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1177\/1473325010368316","article-title":"Bracketing in qualitative research","volume":"11","author":"L Tufford","year":"2012","journal-title":"Qual Soc Work"},{"key":"pone.0269776.ref049","author":"World Health Organization","year":"2002","journal-title":"25\u200e\u200e\u200e\u200e\u200e Questions and Answers on Health and Human Rights."},{"key":"pone.0269776.ref050","author":"A. Bourns","year":"2019","journal-title":"Guidelines for gender affirming primary care with Trans and Non-binary patients."},{"issue":"1","key":"pone.0269776.ref051","doi-asserted-by":"crossref","first-page":"41","DOI":"10.3109\/13561820.2014.937481","article-title":"When students from different professions are co-located: The importance of interprofessional rapport for learning to work together","volume":"29","author":"A Croker","year":"2015","journal-title":"J Interprof Care"},{"key":"pone.0269776.ref052","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.healthplace.2015.03.009","article-title":"The role of neighborhoods in shaping perceived norms: An exploration of neighborhood disorder and norms among injection drug users in Baltimore, MD","volume":"33","author":"MA Davey-Rothwell","year":"2015","journal-title":"Health Place"},{"issue":"2","key":"pone.0269776.ref053","doi-asserted-by":"crossref","DOI":"10.1097\/MED.0000000000000227","article-title":"Barriers to healthcare for transgender individuals","volume":"23","author":"JD Safer","year":"2016","journal-title":"Curr Opin Endocrinol Diabetes Obes"},{"issue":"0","key":"pone.0269776.ref054","first-page":"1","article-title":"Common barriers to healthcare for transgender people in the U.S. Southeast","volume":"0","author":"AH Johnson","year":"2019","journal-title":"Int J Transgenderism"},{"issue":"12","key":"pone.0269776.ref055","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.1377\/hlthaff.2017.1048","article-title":"Older Americans were sicker and faced more financial barriers to health care than counterparts in other countries","volume":"36","author":"R Osborn","year":"2017","journal-title":"Health Aff"},{"key":"pone.0269776.ref056","author":"SC Coleman","year":"2003","journal-title":"Hidden Costs, Value Lost: Uninsurance in America. Washington, DC"},{"issue":"6","key":"pone.0269776.ref057","doi-asserted-by":"crossref","first-page":"815","DOI":"10.2105\/AJPH.2020.305579","article-title":"Transportation barriers to health care in the United States: Findings from the National Health Interview Survey, 1997\u20132017","volume":"110","author":"MK Wolfe","year":"2020","journal-title":"Am J Public Health."},{"issue":"5","key":"pone.0269776.ref058","first-page":"1","article-title":"Race, neighborhood economic status, income inequality and mortality","volume":"11","author":"NA Mode","year":"2016","journal-title":"PLoS One"},{"key":"pone.0269776.ref059","article-title":"Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care","author":"B Smedley","year":"2003","journal-title":"Unequal treatment: Confronting racial and ethnic disparities in health care"},{"issue":"10","key":"pone.0269776.ref060","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.1377\/hlthaff.2011.0640","article-title":"Place, not race: Disparities in Southwest Baltimore when Blacks and Whites live under the same conditions","volume":"30","author":"T LaVeist","year":"2011","journal-title":"Health Aff."},{"key":"pone.0269776.ref061","first-page":"139","article-title":"Demarginalizing the intersection of race and sex: A Black femenist critique of antidiscrimination doctrine, feminist theory and antiracist politics","author":"K. Crenshaw","year":"1989","journal-title":"Univ Chic Leg Forum."},{"key":"pone.0269776.ref062","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.2307\/1229039","article-title":"Mapping the margins: Intersectionality, identity politics, and violence against women of color","volume":"43","author":"K. Crenshaw","year":"1991","journal-title":"Stanford Law Rev"},{"issue":"4","key":"pone.0269776.ref063","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1300\/J155v07n04_06","article-title":"Triple jeopardy and beyond: multiple minority stress and resilience among black lesbians","volume":"7","author":"L Bowleg","year":"2003","journal-title":"J Lesbian Stud"},{"issue":"3","key":"pone.0269776.ref064","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1089\/lgbt.2016.0151","article-title":"Mental health concerns and insurance denials among transgender adolescents","volume":"4","author":"L. Nahata","year":"2017","journal-title":"LGBT health"},{"issue":"4","key":"pone.0269776.ref065","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1007\/s11606-015-3529-6","article-title":"Societal implications of health insurance coverage for medically necessary services in the U.S. transgender population: A cost-effectiveness analysis","volume":"31","author":"V Padula W","year":"2016","journal-title":"J Gen Intern Med"},{"issue":"3","key":"pone.0269776.ref066","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1377\/hlthaff.2019.01448","article-title":"Did The ACA lower Americans\u2019 financial barriers to health care? A review of evidence to determine whether the Affordable Care Act was effective in lowering cost barriers to health insurance coverage and health care","volume":"39","author":"SA Glied","year":"2020","journal-title":"Health Aff"},{"issue":"2","key":"pone.0269776.ref067","first-page":"6","article-title":"The dying black transgender woman: Sight unseen #saytheirnames","volume":"42","author":"P. Halliwell","year":"2020","journal-title":"Thomas Jefferson Law Rev"},{"key":"pone.0269776.ref068","article-title":"Health insurance coverage in the United States: 2017","author":"ER Berchick","year":"2018","journal-title":"Current Population Reports. Washington DC"},{"key":"pone.0269776.ref069","first-page":"2","article-title":"Strong Patient-Provider Relationships Drive Healthier Outcomes","author":"EE Sullivan","year":"2015","journal-title":"Harvard Bus Rev Digit Artic"},{"issue":"5","key":"pone.0269776.ref070","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1007\/s10900-013-9681-1","article-title":"Traveling towards disease: Transportation barriers to health care access","volume":"38","author":"ST Syed","year":"2013","journal-title":"J Community Health"},{"issue":"1924","key":"pone.0269776.ref071","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1177\/0361198105192400110","article-title":"Access to health care and nonemergency medical transportation: Two missing links","author":"R Wallace","year":"2005","journal-title":"Transp Res Rec."},{"key":"pone.0269776.ref072","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1472-6963-7-40","article-title":"Effects of residence and race on burden of travel for care: Cross sectional analysis of the 2001 US National Household Travel Survey","volume":"7","author":"JC Probst","year":"2007","journal-title":"BMC Health Serv Res"},{"key":"pone.0269776.ref073","first-page":"0","article-title":"Black Mobility Matters: An Exploratory Study of Uber, Hacking, and the Commons in Baltimore","author":"R. Malcolm","year":"2016","journal-title":"Architecture_MPS"},{"issue":"1","key":"pone.0269776.ref074","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5038\/2375-0901.22.1.1","article-title":"COVID-19 and public transportation: Current assessment, prospects, and research needs","volume":"22","author":"A Tirachini","year":"2020","journal-title":"J Public Transp"},{"issue":"April 2019","key":"pone.0269776.ref075","doi-asserted-by":"crossref","first-page":"102601","DOI":"10.1016\/j.jtrangeo.2019.102601","article-title":"Transforming mobility justice: Gendered harassment and violence on transit","volume":"82","author":"A Lubitow","year":"2020","journal-title":"J Transp Geogr."},{"issue":"3\u20134","key":"pone.0269776.ref076","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1080\/10911359.2015.1129256","article-title":"From \u201cbrute\u201d to \u201cthug:\u201d The demonization and criminalization of unarmed Black male victims in America","volume":"26","author":"CJ Smiley","year":"2016","journal-title":"J Hum Behav Soc Environ"},{"key":"pone.0269776.ref077","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s12111-001-1016-0","article-title":"Criminal incarceration dividing the ties that bind: Black men and their families","author":"SL Browning","year":"2001","journal-title":"J African Am Men"},{"issue":"2","key":"pone.0269776.ref078","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1177\/073401689301800203","article-title":"Income Inequality, and Violent Crime: A meta-analysis of recent aggregate data studies","volume":"18","author":"C-C Hsieh","year":"1993","journal-title":"Crim Justice Rev"},{"issue":"4","key":"pone.0269776.ref079","doi-asserted-by":"crossref","first-page":"713","DOI":"10.2105\/AJPH.2007.132035","article-title":"Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City","volume":"99","author":"NF Sanchez","year":"2009","journal-title":"Am J Public Health"},{"issue":"1","key":"pone.0269776.ref080","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1089\/apc.2019.0067","article-title":"Engagement and retention in HIV Care for transgender women: Perspectives of medical and social service providers in New York City","volume":"34","author":"W Bockting","year":"2020","journal-title":"AIDS Patient Care STDS"},{"key":"pone.0269776.ref081","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.socscimed.2013.02.019","article-title":"Managing uncertainty: A grounded theory of stigma in transgender health care encounters","volume":"84","author":"T Poteat","year":"2013","journal-title":"Soc Sci Med"},{"key":"pone.0269776.ref082","doi-asserted-by":"crossref","first-page":"377","DOI":"10.2147\/AMEP.S147183","article-title":"Transgender health care: improving medical students\u2019; and residents\u2019training and awareness","volume":"9","author":"SN Dubin","year":"2018","journal-title":"Adv Med Educ Pract"},{"issue":"3","key":"pone.0269776.ref083","doi-asserted-by":"crossref","first-page":"144","DOI":"10.5480\/14-1355","article-title":"A national survey of faculty knowledge, experience, and readiness for teaching lesbian, gay, bisexual, and transgender health in baccalaureate nursing programs","volume":"36","author":"F Lim","year":"2015","journal-title":"Nurs Educ Perspect"},{"issue":"4","key":"pone.0269776.ref084","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1097\/JNC.0000000000000111","article-title":"Health care experiences of Black transgender women and men who have sex with men: A qualitative study","volume":"31","author":"JP Salerno","year":"2020","journal-title":"J Assoc Nurses AIDS Care"},{"issue":"3","key":"pone.0269776.ref085","doi-asserted-by":"crossref","DOI":"10.2105\/AJPH.2013.301789","article-title":"The state of transgender health care: Policy, law, and medical frameworks","volume":"104","author":"D. 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