The Development of an Interactive Decision Aid for Feminizing Genital Gender-Affirming Surgery: The GenderAid

Purpose: The decision to undergo feminizing genital gender-affirming surgery (gGAS) and which option to choose is complex. We aimed to develop a design-validated interactive decision aid (DA) for individuals contemplating feminizing gGAS. Methods: A series of focus groups (February 2019 to July 2022) with health care professionals (HCPs) and target population representatives was organized to inform DA development. Development consisted of four phases: (i) Defining the scope of the DA framework and content, (ii) Collecting DA content and prototyping, (iii) Validation of the DA content and framework, (iv) Usability testing and finalization of the GenderAid. Results: In total, 32 transgender women, 2 nonbinary individuals, and 15 HCPs participated in six focus groups. Three DA components were developed: (i) Information, (ii) Comparator, and (iii) Choice Compass. The DA focuses on four treatment options: no surgery (yet), orchiectomy, vulvoplasty, and vaginoplasty. The Information covers topics such as preparation for surgery, information on surgical options, aftercare, dilating and fertility. The Comparator presents arguments for and against each option, quoted directly from participants in the first person singular. The Choice Compass includes value clarification exercises (making trade-offs between treatment arguments). The DA renders a personalized summary that can guide discussions with HCPs. The concept version of the GenderAid was well received in the focus group organized to test its usability. Conclusions: The GenderAid was developed in collaboration with HCPs and community members. Early evaluation suggests that it is a promising tool to support individuals in making decisions about feminizing gGAS.