Care coordination solutions for caregivers of transgender, nonbinary, and gender expansive youth: a qualitative study of redacted chat conversations

Introduction Transgender and gender diverse youth (TGDY) face significant health disparities due in part to barriers to respectful, competent care. Parents and caregivers play a crucial role in facilitating access to quality care. Evidence suggests that health navigation services and care coordinators (CCs) may provide important support. This study explored how TGDY caregivers used a virtual health navigation service and interacted with CCs to access care.Methods Using codebook thematic analysis informed by symbolic interaction, we analyzed redacted, deidentified chat conversations between caregivers and CCs from a U.S.-based health navigation service. Chats from July 1, 2022, and January 24, 2025, were reviewed for inclusion.Results We included 738 relevant chats from 51 unique caregivers. Three themes were constructed: (1) negotiating meanings of affirming care; (2) anticipated and unanticipated social support; and (3) relational care outcomes: going beyond transactional service. Across themes, interactions moved from transactional exchanges to relational processes that involved shared meaning-making, expanded social support, and sustained engagement over time.Discussion Findings support prior evidence that TGDY caregivers face challenges to navigating U.S. health and social care. Caregiver-CC interactions revealed co-constructed meanings of affirming care and provide multifaceted support. Tailored, virtual healthcare navigation services warrant further research on reach and potential impact.