How Epistemic Stances Shape Quality of Life Through Healthcare Barriers in LGBTQ + populations: A Comparison between Cisgender and Transgender, Nonbinary, and Questioning Individuals

Abstract Introduction LGBTQ+ individuals, especially transgender, nonbinary, and questioning (TNBQ) individuals, experience significant health disparities due to discrimination, stigma, and barriers to care, which undermine their access to services and overall well-being. Epistemic stances—namely epistemic trust (ET), mistrust (EM), and credulity (EC)—have been proposed as key psychological dimensions that shape how individuals respond to interpersonal information, including in healthcare contexts. Methods This study compared ET, EM, EC, barriers to care, and quality of life between 219 LGB+ cisgender and 152 TNBQ individuals surveyed between 2024 and 2025. Also, the study explored the associations between epistemic stances and quality of life through perceptions of barriers to care within each group. Results TNBQ individuals reported higher barriers to care and lower quality of life, while no group differences emerged in epistemic stances. Age, education, and disability influenced all main study variables. Across both groups, higher EM and EC were associated with more perceived barriers and lower quality of life. However, mediation models revealed distinct paths of association between variables in the two groups. Conclusions Findings highlight the need for addressing the impact of healthcare barriers on quality of life through an intersectional lens and gender identity-sensitive interventions. Policy Implications These findings underscore the need for healthcare policies to prioritize inclusive training for providers that fosters ET and minimizes bias. Structural reforms aimed at reducing systemic barriers—such as improving provider cultural competency, expanding access to affirming care, and enforcing non-discrimination policies—are essential to enhance the well-being of LGBTQ+ populations.