Background: Transgender people face numerous barriers to accessing care, particularly in rural settings. Transportation, travel time, a lack of providers offering transgender care, and discrimination all contribute to these barriers. The Gender Wellness Center was established in New York State, USA, to fill a gap in rural transgender care and was subsequently awarded a Robert Wood Johnson Foundation grant to establish a Center of Excellence. This study examined the implementation of the Center of Excellence, a complex intervention, to assess barriers and facilitators to implementation over 18 months. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to develop baseline and follow-up surveys. These were distributed to members of the core implementation team at the Gender Wellness Center at the midpoint and conclusion of the Robert Wood Johnson Foundation grant. Responses were largely open-ended and analyzed qualitatively. Results: Results are presented in terms of CFIR domains and constructs, as well as the relative outlook (positive or negative) of implementation. Overall, there were improvements over time, with more encouraging feedback and examples of success at follow-up. Though true, organizational culture and individual beliefs about the provision of transgender care challenged implementation of the Center of Excellence throughout the project. Conclusions: This study highlights the importance of organizational culture on implementation efforts, as well as the need for complex, multifaceted interventions to overcome such challenges in order to improve care for marginalized populations.

中文翻译：

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纵向使用实施研究综合框架评估建立农村跨性别健康卓越中心的情况

背景：跨性别者在获得医疗服务方面面临许多障碍，尤其是在农村地区。交通，旅行时间，缺乏提供跨性别护理的提供者以及歧视都是造成这些障碍的原因。性别健康中心成立于美国纽约州，以填补农村跨性别护理方面的空白，随后获得罗伯特·伍德·约翰逊基金会的赠款，以建立卓越中心。这项研究检查了卓越中心的实施情况，这是一项复杂的干预措施，旨在评估18个月内实施的障碍和促进因素。方法：实施研究综合框架（CFIR）用于制定基线和后续调查。这些资料在罗伯特·伍德·约翰逊基金会赠款的中点和结束时分发给了性别健康中心的核心实施团队成员。回答很大程度上是开放性的，并进行了定性分析。结果：结果以CFIR域和结构以及实施的相对前景（正面或负面）表示。总体而言，随着时间的推移，情况有所改善，反馈更加令人鼓舞，并在后续行动中取得了成功。尽管确实如此，但组织文化和个人对提供跨性别照料的信念对整个项目中卓越中心的实施提出了挑战。结论：这项研究强调了组织文化对实施工作的重要性以及对复杂，