Centering Resilience: A Methodological Framework for Studying Trans and Gender-Diverse Experiences of Waiting for Gender-Affirming Surgery in South Africa
1
School of Public Health, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A2715
ABSTRACT
INTRODUCTION:
South Africa has wait times exceeding 20 years for gender-affirming surgery at Groote Schuur Hospital (Shabalala and Campbell, 2023), one of two public healthcare facilities offering these services (Koch, McLachlan et al. 2019). Existing research predominantly employs deficit-based frameworks (Wilson, Newins et al. 2024), emphasising negative mental health outcomes and barriers to care. This approach risks pathologizing trans and gender-diverse (TGD) individuals and obscuring resilience, agency and coping strategies employed by communities navigating these delays (Turone, Petersen et al. 2025). This study addresses this gap by centering TGD resilience and strengths while at the same time examining how prolonged waiting affects wellbeing in resource-limited settings.
METHODS:
This qualitative study will employ semi-structured interviews with 12-15 TGD adults on the waiting list for gender-affirming surgery at Groote Schuur Hospital or deterred by wait times. Recruitment will occur through community organisations and TGD networks, with interviews conducted in English, Afrikaans, or isiXhosa to enhance inclusivity. The research framework will integrate resilience theory, decolonial methodologies, and community-engaged approaches. Data analysis will follow reflexive thematic analysis.
RESULTS:
: The presentation will focus on the methodological and ethical considerations for conducting strengths-based research with TGD populations in resource-limited settings. Key points will include ethical considerations, balancing researcher positionality with community engagement, and using resilience frameworks in qualitative health research.
CONCLUSIONS:
This research will contribute to global discussions on gender-affirming healthcare access by centering TGD voices and resilience rather than focusing solely on deficits. The methodological approach will possibly offer insights for researchers conducting ethical, decolonial, community-engaged public health research with marginalised communities in the Global South.
South Africa has wait times exceeding 20 years for gender-affirming surgery at Groote Schuur Hospital (Shabalala and Campbell, 2023), one of two public healthcare facilities offering these services (Koch, McLachlan et al. 2019). Existing research predominantly employs deficit-based frameworks (Wilson, Newins et al. 2024), emphasising negative mental health outcomes and barriers to care. This approach risks pathologizing trans and gender-diverse (TGD) individuals and obscuring resilience, agency and coping strategies employed by communities navigating these delays (Turone, Petersen et al. 2025). This study addresses this gap by centering TGD resilience and strengths while at the same time examining how prolonged waiting affects wellbeing in resource-limited settings.
METHODS:
This qualitative study will employ semi-structured interviews with 12-15 TGD adults on the waiting list for gender-affirming surgery at Groote Schuur Hospital or deterred by wait times. Recruitment will occur through community organisations and TGD networks, with interviews conducted in English, Afrikaans, or isiXhosa to enhance inclusivity. The research framework will integrate resilience theory, decolonial methodologies, and community-engaged approaches. Data analysis will follow reflexive thematic analysis.
RESULTS:
: The presentation will focus on the methodological and ethical considerations for conducting strengths-based research with TGD populations in resource-limited settings. Key points will include ethical considerations, balancing researcher positionality with community engagement, and using resilience frameworks in qualitative health research.
CONCLUSIONS:
This research will contribute to global discussions on gender-affirming healthcare access by centering TGD voices and resilience rather than focusing solely on deficits. The methodological approach will possibly offer insights for researchers conducting ethical, decolonial, community-engaged public health research with marginalised communities in the Global South.
| eISSN: | 2654-1459 |
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