Introduction
Health inequities persist within transgender and gender diverse communities, necessitating research to provide insights into community experiences, needs, and solutions. Because the population is nonmonolithic, inclusive recruitment is imperative to illuminating unique subgroup needs. Researchers are often unsuccessful in recruiting Black and Latine trans/gender diverse individuals in studies (Cespedes et al., 2022; Cirrincione et al., 2023; Graham et al., 2012; LeBlanc et al., 2022; Schick et al., 2022), revealing a critical gap in recruitment strategies. This gap is especially pronounced as Black and Latine individuals form a larger proportion of the broader trans/gender diverse population than they do the overall US population (Herman et al., 2022). Researchers must adapt research practices to recruit Black and Latine trans/gender diverse individuals in studies and improve health outcomes.
Recognizing the strengths and resilience of trans/gender diverse individuals is indispensable to effective research and recruitment. Despite experiencing high rates of stigma, discrimination, harassment, physical and sexual abuse, unemployment, resource scarcity, and homelessness (Alpert et al., 2023; Meerwijk & Sevelius, 2017), trans/gender diverse communities are remarkably adaptive. Black and Latine trans/gender diverse individuals navigate societal and structural marginalization that interact with and amplify discrimination, such as racism, sexism, transphobia, classism, and ableism (Cole, 2009; Crenshaw, 2015). These distinct barriers to well-being increase the need for inclusive research (Alpert et al., 2023). Yet, researchers often miss opportunities to obtain valuable data that may improve well-being within Black and Latine trans/gender diverse communities (Cespedes et al., 2022; Cirrincione et al., 2023; Graham et al., 2012; LeBlanc et al., 2022; Schick et al., 2022).
Researchers’ success in recruitment may be contingent upon fostering community-researcher partnerships and uplifting community expertise. Failure by researchers to establish partnerships with trans/gender diverse communities may hinder community members’ decision to participate. As a result, research findings may not accurately embody the needs of this community, thus hampering the ability to create and implement interventions that effectively address health inequities (Castillo & Harris, 2021; LeBlanc et al., 2022). For example, without community insights, study enrollment forms may offer insufficient response items for gender identities, thereby inadequately and inaccurately capturing the experiences of trans/gender diverse participants. Further, misattuned questionnaires and enrollment forms may cast doubt on the responsiveness of the study in addressing community needs and alienate trans/gender diverse individuals from participating in studies (Suen et al., 2020).
Researchers must overcome barriers that impact trans/gender diverse people of color. Known barriers to research participation include the logistics of travel and financial costs of participation, emotional harm or lack of confidentiality of personal information, and lack of knowledge about research participation involvement (Cirrincione et al., 2023; Owen-Smith et al., 2016). Another crucial barrier to research participation is the historical mistreatment of people of color and those in trans/gender diverse communities. Additionally, the prevalence of social discrimination leads some trans/gender diverse persons to conceal their identity or avoid public spaces to mitigate transantagonism (Lewis et al., 2019; Meerwijk & Sevelius, 2017). Researchers who rely upon public places or social events as recruitment sites are unlikely to reach those who avoid such gatherings or do not wish to publicly disclose their gender identity. Thus, researchers must develop recruitment strategies and study procedures to reach these communities, offer safe and affirming recruitment sites, and overcome potential recruits’ mistrust of researchers and fear of exploitation (Asquith et al., 2021; Cespedes et al., 2022; Cirrincione et al., 2023; Owen-Smith et al., 2016).
Recognizing the challenges of recruiting trans/gender diverse people of color, researchers use snowball recruitment and outreach through online channels and venues (e.g., LGBTQIA+ social media groups, gender-affirming clinics, clubs, and Pride events) (Guillory et al., 2018; Parker et al., 2021). The predominance of mostly white LGBTQIA+ organizations hinders recruitment, as these organizations may not be inclusive of or welcoming to people of color (Parmenter et al., 2021). In addition, researchers may be less aware of spaces where trans/gender diverse people of color spend time together.
To encourage trans/gender diverse participation in research, researchers have introduced online methodologies for focus group studies. Online focus groups are appealing because they avoid public identification of gender identity, offer anonymity in the study setting, geographically expand the scope of research (Macapagal et al., 2017; Reisner et al., 2018), and offer the benefit of building community connections among often isolated participants (Bigelow, 2023; Macapagal et al., 2017; Reisner et al., 2018). Several online asynchronous focus group studies conducted discussions through bulletin posts with moderated prompts for responses (Macapagal et al., 2017; Reisner et al., 2018). However, online focus groups forgo face-to-face personalized connections, thus limiting the moderator’s ability to probe, seek clarification, and engage participants. The spontaneity of responses may be dampened, comments may be shorter, and agreement may be expressed less (Macapagal et al., 2017; Reisner et al., 2018).
Despite the aforementioned recruitment efforts, Black and Latine trans/gender diverse persons are frequently underrepresented in findings. In unweighted demographic data, the 2015 National Transgender Survey reported that Black and Hispanic respondents constituted 2.9% and 5.3% of participants, respectively (Herman et al., 2022). Similarly, a national survey of trans/gender diverse adults recruited a population in which only 2.2% were Black and 2.9% were Hispanic (Guillory et al., 2018). In a statewide survey, only 6.4% of respondents were Black, and 3.8% were Latine (Kattari et al., 2020).
Study Objectives
We undertook this research initiative because of a prior study that inadequately recruited Black and Latine trans/gender diverse individuals (Lewis et al., 2019). This focus group initiative aimed to provide insight into how engagement of Black and Latine trans/gender diverse persons in research can meaningfully improve. The focus group investigated what facilitates Black and Latine participation in trans/gender diverse research. It explored insights about effective recruitment strategies, communication of research opportunities, incentives for research participation, barriers to engaging in research studies, and study design features that facilitate engagement.
Methods
We employed a community-led research methodology in which nonacademic trans/gender diverse researchers held decision-making authority on study objectives, methods, data analysis, interpretation, and dissemination (Figure 1). The interdisciplinary research team included community organizers, licensed social workers, public health professionals, and academic researchers. This study was funded through a university diversity, equity, and inclusion grant and was deemed exempt from Institutional Review Board review.
Study Participants
Study participants included adults who identified as trans/gender diverse and Black and/or Latine and who could access reliable internet with sufficient privacy. Those who did not identify as Black or Latine trans/gender diverse or who were younger than 18 years were excluded from participation. Participants were required to attend the focus group session in August 2021 and were compensated with a mailed $50 VISA gift card. For each participant, we verified how they wished to be addressed on envelopes to prevent unwanted disclosure of their identity.
Recruitment
Recruitment efforts included email listservs, social media posts, and ads (i.e., Facebook and Instagram ads), disseminated in English. Recruitment materials highlighted a photograph of a transgender person of color, a trans/gender diverse–led organization co-sponsor, and relevant colors (i.e., black, brown, pink, light blue, white) (Figure 2). The materials were created by a trans/gender diverse graphic designer. Messaging appealed to participants’ desire to influence trans/gender diverse studies and to foster Black and Latine inclusion in future studies (e.g., “Findings that reflect our community, support our community”). Interested participants confirmed their eligibility by completing a screening survey either online or by phone with a research team member.
Focus Group Design
In response to COVID-19 precautions, the study was adapted to a virtual setting (i.e., Zoom). Licensed social workers on the research team, experienced in delivering trauma-informed care to trans/gender diverse clients, facilitated the focus group. Facilitators either shared overlapping identities with the focus group members (i.e., biracial trans femme) or were extensively involved in the trans/gender diverse-led organization (i.e., white bisexual cisgender woman). We incorporated psychosocial safety measures and trauma-informed practices (Substance Abuse and Mental Health Services Administration, 2014) into the focus group design to increase the participants’ emotional comfort and cultivate a safe space. Table 1 lists these measures, informed by team members’ experiences in community organizing (BAM, LH) and providing care (LH, CAT).
The focus group discussion guide explored what motivates and hinders research study participation. Semi-structured questions investigated (1) effective recruitment strategies, (2) communicating opportunities to participate in research, (3) incentives for research participation, (4) barriers to engaging in research studies, and (5) study features that facilitate engagement. The guide included follow-up probing questions, such as “What information would increase your confidence that the study will be inclusive of your gender and racial identity?”
Focus Group Procedure
Facilitators verified participants as they joined the virtual session and welcomed them to add pronouns in their screen display names. The use of first names only or aliases in their display names offered anonymity to participants. The focus group was conducted in English. Facilitators reviewed the consent form with participants, and a technical moderator administered the digital consent forms. The sponsoring trans/gender diverse–led organization provided an introduction, acknowledged participants with gratitude, and shared study origins. Facilitators obtained input and consent to focus group norms to enhance participants’ sense of personal safety. Facilitators highlighted multiple avenues to contribute to the discussion to encourage engagement, reduce barriers, and increase participation. Participants were encouraged to share verbally, through the group chat, or by privately messaging facilitators. The group was made aware that their chat contributions would be incorporated into the discussion and included in the analysis. Participants were not required to turn their cameras on during the session to minimize discomfort and allow disengagement from personally sensitive topics as needed. Additionally, facilitators offered direct support during or after the focus group via virtual breakout rooms. As Table 1 shows, facilitators took actions to instill a sense of psychosocial safety. Facilitators led the discussion with open-ended questions, prompts, and examples. Contributions were voluntary, although facilitators probed participant responses to seek clarification and explore their experiences, perceptions, and preferences. Visual cues, such as previous trans/gender diverse study flyers, were screen-shared to solicit critique and stimulate conversation around recruitment methods. Supportive services, such as therapy referrals, were made available to interested participants after the discussion ended.
Analysis
We transcribed the focus group recording using Zoom, syncing and compositing chat messages within the transcription for analysis, as well as de-identifying participants. Our analysis explored group-level narratives, themes, recommendation consensus, and divergence. Four research team members (BAM, CT, PB, NJWL) individually reviewed the transcripts and videos and identified key themes using inductive thematic analysis (Naeem et al., 2023), organizing recurrent themes within thematic categories using a consensus process. Preliminary findings were shared electronically with focus group participants and a facilitator (LH) to corroborate the results. We conducted a follow-up interview with a Latine trans/gender diverse community leader who was not a focus group participant or research team member. Based on feedback and confirmation of themes, we re-coded the data via DeDoose (9.2.6) and finalized the evaluation of our results.
Results
Eight of the 11 individuals inquiring about study enrollment met the criteria and participated in the focus group. They ranged in age from 20 to 39 years. Four participants identified as Black, three as Latine (i.e., Puerto Rican, Dominican, and Mexican), and one as multiracial. One participant reported that they immigrated to the United States. All group members were fluent in English. Gender identities included: gender nonconforming, nonbinary, trans woman, transfemme, transman, and genderqueer. Three participants reported having a disability or neurodivergence. Participants lived in California, Michigan, Missouri, New York, North Carolina, and Rhode Island.
In addition to verbal comments, all participants contributed through chat messages, expressing agreement or ideas otherwise unspoken. The group shared recommendations for effective communication and outreach of research opportunities (Table 2). Notable among their recommendations was the appeal of community-engaged research study methodologies.
The Importance of Trustworthy Research Leadership
Participants shared that study sponsorship affected their willingness to engage in research. All participants agreed it was “important to know [the study] is run by a community organization and community are the folks asking the questions.” They believed trans/gender diverse leadership at the study design stage ensured that objectives aligned with community needs. Opinions differed regarding university involvement. One participant noted that “not all allies are good allies.” Some shared that it depends on the university’s history, quality of care, and reputation within the community, whereas others indicated indifference. Some expected that university researchers would leverage institutional connections to amplify the impact of research results, especially among cisgender audiences.
Preference for Online Modalities
Study methodology influenced enrollment decisions. One person mentioned the value and accessibility of online focus groups: “I tend to avoid in-person studies because, um, large group social anxiety, sharing things face-to-face tends to be a lot more [emotionally] charging for me, and so, it’s much easier for me to engage in this kind of study or research when it’s virtual and in this [focus group] format.” Though, “depending on how deep the questions go, I would still be uncomfortable sharing certain aspects of my lived experience that I would only be comfortable sharing in a one-on-one situation you know, so I think it’s contextual.” Other participants agreed with these comments.
Equitable and Commensurate Compensation
Focus group members emphasized that participation was influenced by the amount of financial compensation offered. Such compensation should recognize the emotional burden trans/gender diverse people of color may experience. Higher compensation should be given for participation that solicits information about traumatizing experiences. As noted by one participant: “When it comes down to like things where I have to go into my traumas, um, when I have to start going into other avenues, yeah, I think I should get compensated for that.” Considering systemic factors, one participant shared: “Me as a Black trans woman, I know that I am fortunate with certain things… but there’s plenty of women that I know, that you know, don’t have the luxury of life like that, so if anything, [compensation] is the least that can be done.”
Overcoming Negative Research Experiences
The content and delivery of questions affect overall research engagement. Specifically, members shared that negative experiences with previous research can linger as a barrier to participation. One participant stated: “Oftentimes, yeah, keep in mind that we’re subjected, even in surveys, to racism and oppression. Sometimes, the questions that are asked are like, are you kidding me?” Another participant shared: “I felt like I was being exploited in a way, and my gender was, you know, being dissected in a very, very harmful way.” These experiences were likened to opening a “Pandora’s box.” “Here’s all this PTSD and trauma and depression, and then what? And for people of color who do not have access to therapists—not so great.” Another participant shared, “We need to be reassured that these spaces are safe for us, and I mean that in an emotional way.”
Community-Engaged Research Methods
Community engagement in the study design can prevent these harms and promote perceptions of safety as one participant stated, “So just making sure that [trans/gender diverse individuals] are included in the process to begin with, because they’re going to go back to folks and say, ‘Hey, I was a part of this, trust me, this is safe, this is going to be okay.’” Community members can inform mindfully delving into sensitive topic areas by addressing the question, “what is the least harmful way that we can go into it?”
Weighing Personal Burden Against Community Benefits
Participants weighed anticipated personal emotional burdens against community benefits. Participants concurred that research objectives must address issues important to the trans/gender diverse community to merit participation. They wanted to participate in research that would be effective, reach broad audiences, and transform dominant attitudes: “I sometimes I do feel like a lab rat, and I’m constantly being asked to be, you know, to take myself back to these traumatic experiences to you know, help people understand I guess, I mean that’s the ultimate goal.” Several participants agreed that not knowing how research would benefit their lives or their community hindered research participation. Studies unlikely to yield data or beneficial outcomes were of low interest, especially given the commitment, costs, and burdens of participating.
Discussion
In 2011, The National Academies called for research methods to yield data informing decisions about transgender-specific health (Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities, 2011). While transgender research has expanded, the relative paucity of data on trans/gender diverse people of color hides the characteristics, needs, and strengths of these subgroups, thus hindering progress toward health equity (Schick et al., 2022). Our findings indicate that researchers must take specific, additional steps to engage these communities throughout the research process to gather that data. Assuring participants of their personal safety may entail protections beyond those required by institutional review boards (Meerwijk & Sevelius, 2017), such as intentionally creating safe spaces and protecting participant identity in mailings.
Promoting participation requires study processes to overcome systemic barriers affecting trans/gender diverse people of color. Study materials should communicate sensitivity to participation barriers, such as lack of transportation or employment, transient housing, concerns for safety, and the worry of discrimination (Cespedes et al., 2022; Owen-Smith et al., 2016; Parker et al., 2021). Study features may help to surmount some barriers; for instance, virtual focus groups facilitate participation for those who lack reliable transportation, have challenging work schedules, and wish to avoid the personal stress of participating onsite. One participant recounted, “Why should I participate if I am already exhausted?”
Compensation directly influenced willingness to participate and was perceived as material support and gratitude for participants’ lived expertise. Participants’ comments indicated that compensation should be clearly described in recruitment materials, including the amount and method of payment. Inclusive compensation processes require distinct considerations. For instance, if compensation is given via bank checks, then attention is needed to ensure that the name on the check matches the identification documents required for check cashing. While digital gift cards circumvent name concerns, they may be limited to select stores. Given the sensitivity surrounding these issues, participants were provided with activated VISA gift cards. Awareness of safety concerns for participants who were not “out” or had unsafe housing circumstances (Kattari et al., 2022) led to precautions in addressing participant mailings. For those with accessibility needs, offering easy ways to support or accommodate participant needs and using “shame-free” language may increase research engagement and access (Levitis et al., 2021). Although not discussed by our participants, additional features such as screen-reader–compatible materials and American Sign Language interpreters would foster further inclusion.
Given hesitation regarding the psychosocial safety of research, participants suggested recruitment materials that include supplementary background information, distilled in an accessible, easy-to-read manner. Detailed information about the study’s purpose, methodology, participant requirements, and individuals involved should be listed in the study advertisement, ranging from the sponsoring organizations to specific research team members. The researchers’ connection and history with trans/gender diverse communities were of key importance. One participant noted, “I need to know who I am sharing my traumas with,” and another shared, “Knowing who is behind the research helps establish trust.”
Incorporating trauma-informed practices may garner participant trust and be critical for future study participation. Community-engaged research methods have been likened to trauma-informed approaches for communities facing multiple intersections of oppression and stigmatization (Johnson-Lawrence et al., 2024). Such approaches foster safe and affirming spaces, while protecting against exacerbating trauma-related harms, distrust, and research disengagement. Our focus group echoed the views of others who found that study enrollment will likely be enhanced if researchers build trust within communities, nourish community strengths, and treat participants as invaluable experts rather than research beneficiaries (Cespedes et al., 2022; Venkateswaran et al., 2023). To develop these relationships, researchers must be gender-affirming and cognizant of the systemic factors that affect the complexity of participants’ lives. Researchers working collaboratively with trans/gender diverse communities create safe, affirming spaces while reducing the potential of causing unintended emotional harm. Others have highlighted the transformative power of equitably engaging communities in research (Venkateswaran et al., 2023). The potential momentum from community engagement is evident in that the impetus for this focus group study came from the findings of a previous study, led by the same trans/gender diverse organization (Lewis et al., 2019). Both studies illustrate that communities have the capacity to critically evaluate, improve, and apply research. Researchers can empower this capability through community-centered partnerships.
Limitations
Several study limitations must be considered. Due to funding limitations, we did not provide recruitment materials in Spanish or offer interpretation for the focus group discussion, thereby constraining the sample to those with English fluency. The perspectives of older trans/gender diverse adults were not gathered, nor was the full spectrum of experiences among trans/gender diverse people of color. Although we found consistent consensus on key topics, more nuanced or different findings may be produced if more focus groups were held. Additionally, participant responses were related to survey and qualitative research and may not apply to other study types. Further research is recommended to explore effective clinical and interventional study engagement methods.
Conclusions
Our findings are a road map to increase the meaningful engagement of Black and Latine trans/gender diverse persons in research studies. Negative experiences with prior research were substantial barriers to future enrollment, as participants expressed apprehension of re-encountering oppression and feelings of exploitation. Participants weighed these anticipated feelings against the degree to which the study addressed community needs. Recruitment information detailing the potential benefits for trans/gender diverse people of color enhanced enrollment likelihood, as did adequate participant compensation. Community leadership, trusted researchers and research sponsors, trauma-informed practices that cultivate psychosocial safety, and overcoming socioeconomic barriers to participation were paramount. Central to engaging trans/gender diverse communities of color in research effectively are equitable partnerships and co-collaboration. Given participants’ desires for specific information and study features, these findings offer practical advice for researchers who intend to gather data from trans/gender diverse individuals.
Funding
The University of Michigan Institute for Social Research Diversity, Equity, and Inclusion Committee funded the study.
Conflicts of Interest/Competing Interests
No conflict-of-interest disclosures have been reported by the authors of this paper.
Data Availability
Data supporting this study are not publicly available due to the sensitive nature of the focus group session. We received participant consent for recording the focus group session; however, the obtained consent did not include sharing the focus group transcript beyond the research team.
Author Contributions
Misiolek, B. A.: Conceptualization (lead), analysis (support), funding acquisition (support), methodology (equal), project administration (equal), writing original draft (lead), review and editing (lead), focus group facilitation (support)
Batra, P.: Conceptualization (support), analysis (lead), funding acquisition (lead), methodology (equal), project administration (equal), writing original draft (support), review and editing (lead)
Hicks, L.: Analysis (support), methodology (support), writing review and editing (support), focus group facilitation (equal)
Tupper, C. A.: Conceptualization (support), analysis (support), funding acquisition (support), methodology (support), writing review and editing (support), focus group facilitation (equal)
Lewis, N. J. W.: Conceptualization(support), analysis (support), funding acquisition (support), methodology (support), writing, original document (support), review and editing (support)
Acknowledgments
Thank you to the transgender and gender diverse community for supporting and participating in Your Voice Matters. Your insights drive us forward.
Thank you to Cecil McGhee for their thoughtful review during manuscript development.
RTI Press Associate Editor: Nitya Venkateswaran