Yu Shi, Shijian Miao, Yang Fu, Chengjun Sun, Hongsheng Wang, Xiaowen Zhai
TeamSTEPPS improves patient safety
BMJ open quality
noncommunicable diseases ncds high priority list kerala government exploring extent transgender gender diverse tgd community members benefit services national programmes ncds provide valuable insights improving inclusivity health system moves towards universal health coverage study conducted explore prevalence ncd risk factors well facilitators barriers ncd management among tgd population kerala multiple methods study including crosssectional survey 120 selfidentifying tgd people included adaptation steps questionnaire well indepth interviews thirteen individuals conducted three districts kerala explore barriers facilitators ncd prevention management results presented using key dimensions emerging diederichsen framework range discrimination faced tgd people kerala traps situations low educational outcomes consequent disadvantages job market search livelihoods results large proportion sample living away families 69 percent finding precarious jobs including sex work 33 percent regular job aforementioned factors converging marginalise social position social position leads differential risk exposures increased exposure modifiable risk factors like alcohol 40 percent current alcohol users tobacco use 408 percent currently used tobacco ultimately metabolic risk factors 30 18 percent hypertensive diabetic respectively due differential vulnerabilities discrimination tgd people subjected 417 percent faced discrimination healthcare centre past one year higher exposure risk factors often find hard bring behavioural modifications often able access services require disadvantaged social position tgd people associated structural issues result exacerbated biological risks including ncds ignoring social determinants designing health programmes likely lead suboptimal outcomes