Psychosocial Factors Inhibiting Timely COVID-19 Vaccination and Booster Receipt Among Transgender and Gender Diverse Adults

Purpose: The goal of this study was to assess possible psychosocial contributors to delayed coronavirus disease 2019 (COVID-19) vaccination within a sample of transgender and gender diverse (TGD) individuals.

Methods: TGD participants (N=385) were recruited from Prolific.co. Survey items assessed COVID-19 vaccination status, experiences of discrimination in health care settings, medical mistrust, COVID-19 mistrust, and perceived barriers to vaccination. Logistic regressions were conducted using SPSS version 27 to assess whether demographic variables, medical mistrust, experiences of discrimination in health care, and COVID-19 mistrust predicted vaccination behaviors. A PATH model was developed using AMOS 21.0 to assess the relationship among experiences of discrimination, general medical mistrust, COVID-19 mistrust, and barriers to vaccination in predicting receipt of a booster at the time of the study.

Results: Results from the logistic regressions indicated a binary TGD identity and higher COVID-19 mistrust predicted experiencing a delayed first dose of a COVID-19 vaccination and receipt of a booster at the time of the study over and above racial identity, experiences of discrimination, and general medical mistrust. Results from a PATH model indicated an association among experiences of discrimination in health care, medical mistrust, COVID-19 mistrust, barriers to vaccination, and having not received a booster at the time of the study.

Conclusion: These findings support prior research demonstrating that vaccination rates among TGD individuals do not differ from other groups. However, TGD individuals with a binary gender may have experienced or anticipated experiencing barriers to COVID-19 vaccination and/or receipt of a booster. Public health and clinical implications for these findings are discussed.