Most participants in a nationwide online study of Family Health Strategy nurses reported gaps in training and service protocols for caring for transgender women. Fifty-two of the 94 nurses, or 55.3%, reported no specific training, while 75, or 79.8%, reported no transgender-care protocol. Because the sample was selected by convenience, these figures describe the study group, not a national estimate.
What the study asked
The study set out to explore the care nurses provided to transgender women in primary health care. It was a qualitative, descriptive study guided by COREQ and Leininger's Transcultural Care Theory. In practical terms, the researchers examined nurses' written accounts of their experiences and care practices.
The study was conducted online across Brazil with Family Health Strategy nurses from all regions, without selecting particular health units in advance. To take part, nurses needed at least six months of Family Health Strategy experience and prior nursing consultations with transgender women; those on leave or vacation were excluded. All 94 nurses who completed the open-ended questionnaire were included in the qualitative analysis. Convenience sampling meant that national representativeness was not intended.
Researchers organized the answers with thematic content analysis and IRaMuTeQ, a text-analysis program, using Descending Hierarchical Classification to sort recurring language into thematic classes. That process produced the themes that structure the findings: barriers, essential primary-care actions, inclusion and respect, and the role of professionals and community health workers.
Where nurses saw the barriers
In the barrier theme, nurses described prejudice, stigma, insufficient information and insufficient preparation. They also pointed to missing training and workflows, the routine steps that guide care, as obstacles. These accounts reflect nurses' perceptions and do not include transgender women's direct views.
What inclusive care involved
The care theme emphasized a welcoming approach, effective listening, building a bond and comprehensive care without distinction. The researchers recorded these as reported practices, not as independently observed care or measured patient outcomes.
The inclusion theme highlighted PrEP, PEP, specific material for HPV collection and ongoing professional training. The study did not measure whether these practices were taken up, how effective they were or whether they changed clinical outcomes. That makes the finding a description of what appeared in nurses' accounts, not a test of which approach works best.
Community health workers featured in another theme as bridges between people and the health unit. Nurses described them as helping identify people, bring them to the unit and support more humanized care. The researchers did not compare community-health-worker models or quantify their impact, so the study cannot show whether one model works better than another.
A responsibility shared across the service
The authors' interpretation placed responsibility at two levels. Cultural competence was framed as both an individual attribute and an organizational function, with barriers and regional differences linked to its deficiency. From that perspective, they recommend continuing education, inclusive protocols, community health worker mediation, leadership commitment, monitoring and the participation of transgender people in designing care. These are recommendations from the study's interpretation, not demonstrated effects of an intervention.
What remains unanswered
The study's reach also sets limits on the conclusions. The convenience sample was not designed to represent the country, and the findings capture the perceptions of primary health care and Family Health Strategy nurses. Transgender women were not asked directly about their care, and transgender men and non-binary people were not included. The anonymous online format did not include participant feedback on the researchers' interpretations.
Future research will need to ask transgender women how they evaluate the care and community mediation nurses described, and whether training and inclusive protocols change access, quality or safety. Separate work is also needed on the needs and barriers of transgender men and non-binary people. Until then, the study provides a picture of nurses' reported experiences and organizational gaps, not evidence that any one intervention improves outcomes.
Paper data and sources
Original title: Transcultural care provided by nurses to transgender women in primary health care: a qualitative study*
Authors: Vila Nova P, Silva G, Candido A et al.
Journal/Repository: Revista latino-americana de enfermagem
Status: Peer-reviewed
First online: 2026-10-19
DOI: Not available
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