Lauren Catlett

Introduction Transgender and gender diverse (TGD) older adults in the United States (U.S.) face barriers to accessing health information and resources they need to make informed healthcare decisions. More resources are needed to promote their agency and preparedness to navigate an increasingly complex healthcare system and sociopolitical landscape. The purpose of this study was to develop a testable web-based resource to support informed healthcare decision-making for TGD older adults. Methods This multimethod co-design study integrated a human-centered design approach that centered the perspectives of TGD older adults in the research process. In the prototyping and testing phases of the study, TGD adults and multidisciplinary professionals from across the U.S. were enrolled to co-develop a web-based resource with the research team during individual and paired interviews. Participants also completed a demographic questionnaire and a website usability survey. Thematic analysis of qualitative data was used to identify design themes, which guided iterative prototyping of the web-based resource. Quantitative data were analyzed descriptively. Complementary data from the usability survey and participant interviews were integrated in a joint display. Results A total of 27 participants, of whom 14 (52%) were TGD older adults, enrolled in the prototyping and testing phases. Analysis of qualitative data across both phases yielded five design themes that structured the development of a functional web-based resource: (1) Facilitating healthcare decisions through information and resources; (2) Organizing complex content with clarity and inclusivity; (3) Maintaining security, accessibility, and navigability; (4) Phasing rollout to communities and organizations; and (5) Planning for leadership, stewardship, and partnership. In the prototyping phase, three low- and mid-fidelity prototypes of a health information and resources website for TGD older adults were developed. In the testing phase, participants trialed a mid-fidelity prototype of the website, and their recommendations for improvements were integrated into a high-fidelity prototype for dissemination. Conclusion This study is one of few studies using participatory methods to engage TGD older adults in public health research. Through the development of a health information and resources website, this study demonstrates an innovative and feasible community-based co-design approach to addressing barriers affecting healthcare decision-making for TGD older adults.