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Staras, CO 
ORCID: https://orcid.org/0000-0002-8155-8107,
2025.
Improving healthcare for trans and gender diverse people: exploring the feasibility of social prescribing pathways.
PhD, Nottingham Trent University.
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Abstract
Trans and gender diverse people experience significantly poorer health outcomes in comparison to their cisgender counterparts, with trans and gender diverse young people (TGDYP) at increased risk due to their vulnerable developmental stage. Social determinants (e.g., loneliness, hostile social and political climates, minority stress) contribute to these disparities, and are compounded by the clinical focus of, and challenges accessing, gender affirming care (GAC). Responsively, the National Healthcare Service (NHS) in England has publicised calls for holistic approaches to GAC that address the social determinants of health. Social support has been identified as a key protective factor, with Social Prescribing (SP) offering a formalised route to such support. Thus, this thesis explored the acceptability and feasibility of embedding SP within gender-identity clinics (GICs) to improve health outcomes for TGDYP. Given the existing evidence for SP is inconsistent and theoretically underdeveloped, the Social Identity Approach to Health (SIAH) was applied to theoretically ground SP and its adaptations for TGDYP.
Three studies were conducted in this thesis. Study One systematically reviewed SP literature through a SIAH lens, finding SP most effective when it fosters meaningful social connections anchored in shared group identity, with link workers playing a critical role. Study Two, a two-part qualitative investigation, identified meaningful group memberships for TGDYP and practical SP implementation strategies. Developing and utilising our novel Qualitative Triangulation Framework to integrate multi-stakeholder perspectives, the study revealed that TGDYP-specific social support is vital for wellbeing and participants articulated enthusiasm at GIC-integrated SP. However, preferences varied by transition stage: early-stage TGDYP preferred support-focused groups, while later-stage individuals favoured activity based spaces. Concerns were raised about GICs’ capacity to deliver SP that provisions these varied spaces and whether GIC-facilitated support would be perceived as genuine or conditional, especially amid the Cass Review’s staged care model. Responsively, Study Three evaluated a gender clinic integrating social support into their care pathways. Findings indicated that integrated social support was symbolically affirming of diverse TGDYP needs, especially when support was delivered by those with lived experience, fostering trust and perceived authenticity. However, implementation was limited by late offering and systemic barriers.
Collectively, the findings presented in this thesis suggest that SP has significant potential to enhance TGDYP health, but only if it is well resourced, sensitive to transition-stage identity needs, and delivered by identity-aligned link workers. Thus, we propose a model that involves outsourcing SP delivery to established SP providers with the infrastructure for access, while retaining care coordination within identity-relevant roles such as trained link workers or care navigators with lived experience. Future research should build on our qualitative, cross-sectional insights by quantitatively validating the proposed SP model through longitudinal designs that capture how social support and identity needs evolve over time. Implementation studies are also needed to explore how SP can be delivered in partnership with trusted providers to effectively support TGDYP.
| Item Type: | Thesis |
|---|---|
| Creators: | Staras, C.O. |
| Contributors: | Name Role NTU ID ORCID |
| Date: | September 2025 |
| Rights: | © Chase Oscar Staras, 2025. The copyright in this work is held by the author. You may copy up to 5% of this work for private study, or personal, non-commercial research. Any re-use of the information contained within this document should be fully referenced, quoting the author, title, university, degree level and pagination. Queries or requests for any other use, or if a more substantial copy is required, should be directed to the author. |
| Divisions: | Schools > School of Social Sciences |
| Record created by: | Laura Borcherds |
| Date Added: | 09 Apr 2026 15:46 |
| Last Modified: | 09 Apr 2026 15:46 |
| URI: | https://irep.ntu.ac.uk/id/eprint/55530 |
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