Addressing Institutional Barriers in Trans Health: Evidence to Education in Greece (TRANSCARE)
M Anastasaki, A Angelaki, P Paganis, EO Christidi, N Papathanasiou, E Kokkali, EP Stoupa, E Karamagioli, E Pikoulis, C LionisAbstract
Globally, transgender populations face significant barriers in accessing equitable healthcare, often rooted in institutional practices, limited provider competence and systemic discrimination. In Greece, evidence on trans health and accessibility remains scarce. The TRANSCARE project aimed to map existing barriers and develop an educational intervention to enhance health system readiness and responsiveness to transgender health needs. A scoping review was conducted in PubMed, with studies published since 2015 that reported barriers to healthcare access or identified educational needs related to trans health (N = 64). Concurrently, findings from the review, expert consultations, field research and best practices informed the development of Greece’s first medical education program on trans health delivered as a Massive Open Online Course guided by the Chronic Care Model.
The review identified multi-level barriers affecting healthcare access, including discrimination by healthcare providers, lack of trained professionals, absence of inclusive and safe healthcare environments, insufficient insurance coverage for gender-affirming services and persistent stigmatizing attitudes within health systems. In response, the comprehensive educational program (4 modules, 16 courses, 76 lectures) addressed foundational concepts, healthcare accessibility, legal frameworks, inclusive clinical practices and specialized trans health services, incorporating intersectionality and patient-centered care. Improving healthcare access for trans individuals requires systemic interventions targeting both institutional structures and professional competencies. TRANSCARE demonstrates how evidence-based educational strategies can address identified gaps and support the development of inclusive, competent and responsive health systems. Such approaches are critical for mitigating institutional harm and advancing health equity for LGBTQI+ populations across Europe.