The experiences of trans, gender-diverse, and non-binary students in school-based health and physical education: a scoping review and meta-synthesis of empirical literature

The experiences of trans, gender-diverse, and non-binary students in school-based health and physical education: a scoping review and meta-synthesis of empirical literature

Background and Aim
Current literature highlight the barriers trans, gender-diverse, and non-binary students experience to participation in Health and Physical Education (HPE) in school settings, however, the research meta-synthesizing the existing research is limited. This scoping review explores and synthesizes existing empirical literature identifying what is known about the experiences of trans, gender-diverse, and non-binary students in the school-based learning area of HPE.

Methods
In alignment with the PRISMA-ScR framework, the JBI manual for evidence synthesis, this scoping review drew on Arksey and O Malley’s five-stage framework. Six databases were used with literature search conducted on 9 June, 2025. Included empirical studies were written in English, peer-reviewed, full-text accessible online, with no restrictions to date or location, and relevant to the research question. Charted data was first meta-synthesized deductively using a modified three-level socio-ecological framework, and further meta-synthesized inductively using thematic analysis within the three levels.

Results
Ten studies were included in the final synthesis with four studies using qualitative methodologies, four cross-sectional, and two using mixed-methods approaches. Findings were meta-synthesized across three levels of barriers, with structural barriers included binary policies, limited curriculum inclusivity, and inconsistent application of supportive practices. Interpersonal barriers included peer bullying, misgendering, and lack of educator support, whilst individual barriers included emotional distress, gender dysphoria, and withdrawal from HPE participation. Collectively, these barriers were interconnected and reflect broader systematic issues of exclusion for trans, gender-diverse, and non-binary students.

Conclusions
The findings highlight how trans, gender-diverse, and non-binary students face multi-layered and ongoing challenges in accessing safe and inclusive HPE in schools in line with human rights obligations. These challenges are significantly informing the poor mental health of trans, gender-diverse, and non-binary students, including their long-term educational engagement and outcomes. Current inclusion practices are often reactive and inconsistent in nature, placing burden on already vulnerable students.