Barriers to Care and Root Cause Analysis of LGBTQ+ Patients’ Experiences

Nair, Julie McCulloh; Waad, Alex; Byam, Stacey; Maher, Madeline

doi:10.1097/nnr.0000000000000541

Cited by 6 publications

(7 citation statements)

References 23 publications

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“…36 Once in practice, all clinicians and clinic staff should routinely receive training on the care of the LGBTQIA2+ population. 37,38 Th is is especially important for NPs who practice in rural and suburban areas, as there is less access to LGBTQIA2+specifi c clinics in these areas. 37 Organizations such as the Fenway Institute have LGBTQIA2+-specifi c educational modules that have been accredited and could be used to provide inclusive training (Box 1).…”

Section: (Continued)mentioning

confidence: 99%

“…10,42 Efforts to develop more dedicated LGBTQIA2+ clinics and recruit clinicians who identify as members of this population are also cited by the LGBTQIA2+ population as initiatives that would improve their access to care. 3,38,43 Cancer screening guidelines. NPs must ensure that they are knowledgeable about screening recommendations for all members of the LGBTQIA2+ community, including transgender patients and/or those who have undergone gender-affi rming surgeries, such as top or bottom surgeries.…”

Section: (Continued)mentioning

confidence: 99%

“…Many health professional programs are beginning to provide supplemental experiences to increase awareness and competency of new graduates in LGBTQIA2+ health 36. Once in practice, all clinicians and clinic staff should routinely receive training on the care of the LGBTQIA2+ population 37,38. This is especially important for NPs who practice in rural and suburban areas, as there is less access to LGBTQIA2+-specific clinics in these areas 37.…”

Section: Addressing the Problemmentioning

confidence: 99%

“…Advocating at the community level for access to affordable housing, mental health services, and transportation is critical, as is partnering with schools and parents to provide inclusive sexual education 10,42. Efforts to develop more dedicated LGBTQIA2+ clinics and recruit clinicians who identify as members of this population are also cited by the LGBTQIA2+ population as initiatives that would improve their access to care 3,38,43…”

Section: Addressing the Problemmentioning

confidence: 99%

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Evidence-based sexual healthcare for the LGBTQIA2+ patient across the lifespan

Shihabuddin,

Lee,

Casler

2023

The Nurse Practitioner

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People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, two-spirit, or other minority sexual and gender identities (LGBTQIA2+) often avoid seeking healthcare due to social discrimination and stigma. Clinical education in LGBTQIA2+-affirming care is essential but often lacking across disciplines. Provider acceptance, awareness of personal biases, and understanding of microaggressions affecting LGBTQIA2+ people can improve access, outcomes, and survival for this population. Expertise in caring for LGBTQIA2+ people in rural and suburban communities, for people who are transgender, and for people who have undergone or are in the process of undergoing gender-affirming surgeries is essential to offer best-practice healthcare.

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Section: (Continued)mentioning

confidence: 99%

Section: (Continued)mentioning

confidence: 99%

Section: Addressing the Problemmentioning

confidence: 99%

Section: Addressing the Problemmentioning

confidence: 99%

See 2 more Smart Citations

Evidence-based sexual healthcare for the LGBTQIA2+ patient across the lifespan

Shihabuddin,

Lee,

Casler

2023

The Nurse Practitioner

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“…In addition to the broader socio-structural causes of health inequities among LGBTQ + people, barriers to high quality healthcare remain. LGBTQ + people commonly report experiences of discrimination and gatekeeping in healthcare settings (18)(19)(20)(21). Most transgender individuals have encountered harassment, gatekeeping, misgendering or deadnaming (using a former or "birth" name after a person has transitioned and changed their name), belittlement or ridicule, or denial of care (18,22,23).…”

Section: Introductionmentioning

confidence: 99%

Using the Community Readiness Model and Stakeholder Engagement to Assess a Health System’s Readiness to Provide LGBTQ+ Healthcare: A Pilot Study

Greene

Herrmann²,

Trimberger

2023

Preprint

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Background: Despite broad social and policy changes over the past several decades, many LGBTQ+ people face barriers to healthcare and report mistreatment and disrespect in healthcare settings. Few health systems level interventions have been shown to improve sexuality- and gender-related health disparities. Using the Community Readiness Model, we developed and implemented a rigorous assessment and priority-setting intervention at one mid-sized health system in the midwestern US. We evaluated the system’s readiness to provide LGBTQ+ healthcare and developed immediate action steps that are responsive to local context. We engaged diverse stakeholder groups throughout the process. Methods: Led by the Community Readiness Model, we identified key groups within the health system and conductedstructured interviews with 4-6 key informants from each group. Two trained scorers external to the study team individually scored each interview on a numerical scale ranging from 1 (no awareness of the problem) to 9 (community ownership of the problem) and discussed and reconciled scores. Group scores were averaged for each dimension of readiness and overall readiness, and then triangulated with stakeholders to ensure they reflected lived experiences. Finally, specific recommendations were generated to match the needs of the system and move them towards higher levels of readiness. Results: We convened an advisory committee of LGBTQ+ patients of the health system and a panel of local experts on LGBTQ+ wellness. Both groups contributed significantly to research processes. 28 interviews across 6 staff subcommunities indicated readiness levels ranging from “3: Vague Awareness” of the issue, and the “4: Preplanning” stage. Discrepancies across staff groups and dimensions of readiness suggested areas of focus for the health system. The evaluation process led to immediately actionable recommendations for the health system. Conclusions: This pilot study demonstrates the potential impact of the Community Readiness Model on improving health systems’ readiness to provide LGBTQ+ healthcare. This model combines strengths from community-based research and implementation science approaches to form an intervention that can be widely disseminated and maintain the flexibility and agility to meet local needs. Future research will evaluate changes in readiness at the same health system and test the process in additional health systems.

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Lack of Informed and Affirming Healthcare for Sexual Minority Men: A Call for Patient-Centered Care

Hascher,

Jaiswal,

LoSchiavo

et al. 2024

J GEN INTERN MED

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Background Sexual minority men (SMM) face severe health inequities alongside negative experiences that drive avoidance of medical care. Understanding how SMM experience healthcare is paramount to improving this population’s health. Patient-centered care, which emphasizes mutual respect and collaboration between patients and providers, may alleviate the disparaging effects of the homophobia that SMM face in healthcare settings. Objective To explore how SMM perceive their experiences with healthcare providers and how care can most effectively meet their needs. Design Semi-structured qualitative interviews focused on healthcare experiences, pre-exposure prophylaxis (PrEP), and HIV-related beliefs were conducted between July and November 2018. Participants The study included a sample of 43 young adult SMM (ages 25–27), representing diverse socioeconomic, racial, and ethnic backgrounds, in New York City. Approach Researchers utilized a multiphase, systematic coding method to identify salient themes in the interview transcripts. Key Results Analyses revealed three main themes: (1) SMM perceived that their clinicians often lack adequate skills and knowledge required to provide care that considers participants’ identities and behaviors; (2) SMM desired patient-centered care as a way to regain agency and actively participate in making decisions about their health; and (3) SMM felt that patient-centered care was more common with providers who were LGBTQ-affirming, including many who felt that this was especially true for LGBTQ-identified providers. Conclusions SMM expressed a clear and strong desire for patient-centered approaches to care, often informed by experiences with healthcare providers who were unable to adequately meet their needs. However, widespread adoption of patient-centered care will require improving education and training for clinicians, with a focus on LGBTQ-specific clinical care and cultural humility. Through centering patients’ preferences and experiences in the construction of care, patient-centered care can reduce health inequities among SMM and empower healthcare utilization in a population burdened by historic and ongoing stigmatization.

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Barriers to Care and Root Cause Analysis of LGBTQ+ Patients’ Experiences

Cited by 6 publications

References 23 publications

Evidence-based sexual healthcare for the LGBTQIA2+ patient across the lifespan

Evidence-based sexual healthcare for the LGBTQIA2+ patient across the lifespan

Using the Community Readiness Model and Stakeholder Engagement to Assess a Health System’s Readiness to Provide LGBTQ+ Healthcare: A Pilot Study

Lack of Informed and Affirming Healthcare for Sexual Minority Men: A Call for Patient-Centered Care

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