Challenging heteronormativity in the consultation: a focus group study among general practitioners

The provision of healthcare services to older LGBT adults in the Nordic countries: a scoping review

OBJECTIVES

Our objectives were to examine what is known about the provision of healthcare services to older LGBT adults in the Nordic countries, identify knowledge gaps, map implications of this research for the education of healthcare professionals and delivery of healthcare, and identify key future research priorities to advance policy and practice for older LGBT adults in this region.

DESIGN

We conducted searches in nine databases. Peer-reviewed articles and PhD theses published in and after 2002 written in English, Norwegian, Swedish or Danish languages were included. 41 studies met our inclusion criteria. However, only eight of these studies focused specifically on older LGBT adults. Therefore, to answer all research questions, five book chapters about older groups were also included.

RESULTS

There were few studies from countries other than Sweden and few quantitative studies. Bisexual people represented a neglected group in research. The studies included showed that healthcare personnel lack knowledge on LGBT issues, particularly about older LGBT adults and non-binary gender identification. Older LGBT adults frequently reported being met with cis- and heteronormative expectations in healthcare encounters. For transgender people, access to medical treatment has been managed by gatekeepers influenced by a binary understanding of gender.

CONCLUSIONS

Relevant measures to enhance practices are increased attention on LGBT issues in education; training of healthcare professionals; measures at the institutional level; and ensuring that transgender people identifying as non-binary receive the same quality of care as individuals identifying in a binary way.

Being (in)visible in the clinic: A qualitative study of queer, lesbian, and bisexual women's health care experiences in Eastern Canada

In this article, we examine the ways in which 18 queer, lesbian, and bisexual (QLB) women in Eastern Canada negotiated their visibility in interactions with primary care providers. QLB women patients used a number of strategies to determine risk and to be visible or invisible to their health care providers. We describe participants' disclosure decisions and strategies, and we argue that being visible and invisible requires work on the part of QLB patients in the context of institutionalized heteronormativity. Conceptualizing (in)visibility as work is required in efforts to account for and improve health care interactions across differences.

Gendered communicative construction of patients in consultation settings

This study aimed to explore the communication in consultations between patients and health care staff from a gender perspective. We used 23 tape-recorded consultations between patients with Atrial Fibrillation and 5 nurses and 5 physicians at cardiac outpatient clinics at 6 different hospitals in southern Sweden during autumn 2009 to explore the verbal gendered constructions of patients. Through critical discourse analysis, we revealed that the male patients tended to describe their ailments with performance-oriented statements, whereas the female patients usually used emotional-oriented statements. The staff downplayed the male patients' questions and statements, while they acknowledged concern toward the female patients. Both the patients and the staff made conclusions according to a mutual construction. Male patients were constructed as competent, and female patients as fragile through gender-stereotypical communication. Open-ended statements and questions enabled consultations to be less limited by gender stereotypes.

Lesbians on Medical Encounters: Tales of Heteronormativity, Deception, and Expectations

The experiences of lesbian women in medical encounters prove particularly relevant for understanding their difficulties in their relationship with professionals and health services. We carried out semistructured interviews with 30 women aged 21 to 63 years, who define themselves as lesbian. The analysis highlights the difficulties experienced in disclosure of sexuality in medical encounters, the tendency for doctors to come across as heteronormative, and also medical practices experienced as appropriate by interviewees. Analysis of participant experiences demonstrates the need for reflection and decision making to promote the recognition of the sexual citizenship of lesbian women and their empowerment.

Heterosexism and health care: a concept analysis

BACKGROUND

The concept of heterosexism is used in a variety of ways in healthcare literature. The lack of consensus of the term makes identifying when and how it impacts the health care of lesbian, gay, and bisexual people difficult. A lack of clarity of the concept could also hinder effectiveness of education, awareness, and research tool development efforts.

PURPOSE

The purpose of this concept analysis is to offer a synthesized definition of the term heterosexism, including its relation to and distinction from related concepts like homophobia and heteronormativity.

METHODS

The authors use Walker and Avant's eight-step concept analysis method: select a concept, determine the aim of analysis, identify all uses of the concept, determine defining attributes, construct a model case, construct additional cases, identify antecedents and consequences, and define empirical referents.

CONCLUSION

The results of the analysis reveal focus areas for future research, tool development, and suggestions for improvements in nursing clinical practice.

Epidemiological research on marginalized groups implies major validity challenges; lesbian health as an example

OBJECTIVE

Several studies have suggested an increased risk of health problems among lesbian women. Evidence-based practice calls for knowledge about risks and prevalences of diseases deserving special awareness. However, research on marginalized groups raises ethical challenges from normative assumptions underlying analysis, because models are drawn from the cultural context where marginalization itself is created and recreated. Several methodological problems consequently appear.

STUDY DESIGN AND SETTING

In this article, we aim to explicate some challenges related to validity in epidemiological research on minority groups where members can conceal their identity -- lesbian health being our case. Our approach is a case study drawing on analytic induction.

RESULTS

We demonstrate challenges related to conceptual indistinctness, internal and external validity, confounders, cultural context, type II error, and the issue of small population subgroups. As women with a lesbian orientation constitute a relatively small fraction of the population, modest measurement problems can lead to serious errors in inference about health in "lesbians."

CONCLUSION

Generalization of the findings about health to "all lesbians," and comparison between "all lesbians" and "women in general," should be undertaken with great caution. Similar awareness should be exercised in studies on any minority group where members can conceal their identity.

Being lesbian--does the doctor need to know?

BACKGROUND

A lesbian woman will have to choose whether to disclose or not in every new encounter, including when consulting her general practitioner (GP). She may fear a negative reaction in the doctor, based on knowledge of marginalization and prejudice of homosexuals throughout history.

OBJECTIVES

To explore patients' experiences concerning disclosure of their lesbian orientation to general practitioners (GPs), focusing on why they find it important, and what GPs can do to promote disclosure.

METHODS

One group interview was conducted, audiotaped, and transcribed verbatim. Qualitative analysis was conducted by systematic text condensation inspired by Giorgi's phenomenological approach. Six women aged 28-59 years, who self-identified as lesbian, were recruited through a web-based, publicly accessible network for research on homosexuality. Main outcome measures. Accounts of experiences where the patient thought that information of a lesbian sexual orientation was of importance in the consultation with a GP.

RESULTS

Disclosure can imply information of medical relevance, explain circumstances, and generate a feeling of being seen as one's true self. The intentional use of common consultation techniques may facilitate disclosure.

CONCLUSION

Lesbian patients may want to disclose their sexual orientation to the general practitioner but they experience certain barriers. These can be overcome when the GP provides an open and permissive context. GPs can benefit from knowledge concerning sexual orientation in their work with lesbian patients.

Interviewing one's peers: methodological issues in a study of health professionals

OBJECTIVE

Although health professionals are increasingly undertaking qualitative interviews with professional peers, there is little literature regarding the methodological implications of this process. The aim of the study was to elicit from informants their views on being interviewed by a fellow health professional.

DESIGN

Semi-structured interviews with nine general practitioners (GPs), three rheumatologists, and three physical therapists, with a substantive focus on perceptions of osteoarthritis. The interviewer was a GP, and informants were asked for their reactions to being interviewed by a fellow professional. Data were analysed by hand, using a thematic approach.

SETTING

Primary care clinics and practices in the UK.

RESULTS

Although reassured to the contrary, many informants viewed the interview as a test of their professional knowledge. The interview was also seen by some GPs as serving an educational process, with the interviewer as an authoritative source of clinical information. There were some indications of professional vulnerability among informants in relation to possible scrutiny of their practice or knowledge, though none reported a negative experience of the interview. Notions of professional identity appeared central to many of the issues that emerged.

CONCLUSION

The nature of the relationship in interviews involving professional peers creates specific methodological issues, which have important implications for qualitative research in primary healthcare. There are both advantages and disadvantages to interviewing professional peers, which should be considered in the light of the objectives of a particular study.