A multinational qualitative study examined the perspectives and experiences of women with a kidney transplant on access to healthcare.

Abstract

Women are less likely to receive a kidney transplant compared with men and may face specific barriers in accessing health care. Here, we describe the perspectives of women with a kidney transplant on access to transplantation and healthcare. We conducted semi-structured interviews with women with a kidney transplant, aged 18 years or over, from August 2022 to January 2024, in English, Spanish and Tamil languages. Transcripts were analyzed thematically. Forty women from 16 countries, aged 27 to 72 years, participated. Twenty-one individuals were from high, seven from upper-middle and 12 were from lower-middle income countries. We identified four themes: 1- frustrated by limitations of the health system (with subthemes of disempowered by lacking information, unresolved distress, exhausted from self-advocating and organizing logistics, and without continuity and cohesiveness of care); 2- stigma around gender-sensitive topics (unprepared for changing body image, loss of intimacy and femininity, shame of seeking mental health services, burdened by unexpected continence challenges, unforeseen menstrual changes, devastation of having human papillomavirus); 3- struggling to achieve motherhood (confronting irreversible consequences, grieving lost opportunities for parenthood, medicalization of the journey to motherhood, avoiding burdening children); and 4- social vulnerability exacerbating barriers (forced financial dependence, fear of relinquishing decision-making). Women with a kidney transplant face social, financial and cultural barriers to accessing health care. Providing gender-specific education, empowering women with the agency to self-advocate, addressing stigma, and financial resources for women requiring a kidney transplant may help to improve gender-sensitive and responsive care for better health and equity outcomes.