1
|
Marshall K. Exploring the Impacts of Heteronormative and Cisnormative Ideologies on Fertility Intentions and Family Planning Experiences Within the 2SLGBTQ Community: A Qualitative Case Study. J Holist Nurs 2024; 42:156-167. [PMID: 37545438 PMCID: PMC11131341 DOI: 10.1177/08980101231189653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023]
Abstract
Objectives: Normative beliefs around gender and sexuality place individuals in the Two Spirit, lesbian, gay, bisexual, trans, and queer (2SLGBTQ) community at risk for poorer health outcomes within the health care system compared with their heterosexual and cisgender counterparts, particularly within gendered areas of care including family planning and fertility intentions. The purpose of this research was to explore the effect that the normative beliefs of heteronormativity and cisnormativity had on the experiences of 2SLGBTQ people engaged in family planning, and to begin to understand how health care providers can provide appropriate, safe, and holistic care. Methods: We conducted a qualitative study using case study methodology and completing semi-structured interviews with 11 participants with diverse genders and sexualities. Findings: For members of the 2SLGBTQ community, family planning is greatly affected by ideals of normal, intersections of identities, health care systems, and community. They may face additional emotional labor and intentional decision-making when related to family planning. Heteronormativity and cisnormativity greatly impact the health care that is received. Conclusions: The findings contribute information in the limited field of research related to the 2SLGBTQ community and may support health care providers in providing holistic care.
Collapse
Affiliation(s)
- Kerry Marshall
- University of Saskatchewan, Saskatoon, Canada
- University of British Columbia, Vancouver, Canada
| |
Collapse
|
2
|
Primbas AD, Ogawa A. Medical Issues Affecting Older Lesbian and Bisexual Women. Clin Geriatr Med 2024; 40:251-260. [PMID: 38521596 DOI: 10.1016/j.cger.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
Lesbian and bisexual (LB) women are a growing and understudied population in the United States. LB women have unique histories and health experiences and encounter numerous resource and health care disparities that impact healthy aging. Despite LB population growth, little research has investigated the experiences of LB women separately from the broader lesbian, gay, bisexual, transgender, queer or questioning, or another diverse gender identity (LGBTQ+) community. The research that does exist largely focuses on the experiences of younger LB women. Nonetheless, there are unique care considerations providers can enact to improve clinical care and address lifetimes of disparities and discrimination.
Collapse
Affiliation(s)
- Angela D Primbas
- Division of Geriatrics, Department of Medicine, UCLA David Geffen School of Medicine, University of California, 200 Medical Plaza, Suite 365A, Los Angeles, CA 90024, USA.
| | - Al Ogawa
- Swedish Cherry Hill Family Medicine Residency
| |
Collapse
|
3
|
Campbell J, Nathoo A, Chard S, Messenger D, Walker M, Bartels SA. Lesbian, gay, bisexual, transgender and or queer patient experiences in Canadian primary care and emergency departments: a literature review. CULTURE, HEALTH & SEXUALITY 2023; 25:1707-1724. [PMID: 36794329 DOI: 10.1080/13691058.2023.2176548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
This literature review synthesises existing evidence and offers a thematic analysis of primary care and emergency department experiences of lesbian, gay, bisexual, transgender, queer and/or any other sexual or gender minority (LGBTQ+) individuals in Canada. Articles detailing first-person primary or emergency care experiences of LGBTQ + patients were included from EMBASE, MEDLINE, PsycINFO and CINHAL. Studies published before 2011, focused on the COVID-19 pandemic, unavailable in English, non-Canadian, specific to other healthcare settings, and/or only discussing healthcare provider experiences were excluded. Critical appraisal was performed following title/abstract screening and full-text review by three reviewers. Of sixteen articles, half were classified as general LGBTQ + experiences and half as trans-specific experiences. Three overarching themes were identified: discomfort/disclosure concerns, lack of positive space signalling, and lack of healthcare provider knowledge. Heteronormative assumptions were a key theme among general LGBTQ + experiences. Trans-specific themes included barriers to accessing care, the need for self-advocacy, care avoidance, and disrespectful communication. Only one study reported positive interactions. LGBTQ + patients continue to have negative experiences within Canadian primary and emergency care - at the provider level and due to system constraints. Increasing culturally competent care, healthcare provider knowledge, positive space signals, and decreasing barriers to care can improve LGBTQ + experiences.
Collapse
Affiliation(s)
- Jenn Campbell
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Aisha Nathoo
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Sidonie Chard
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - David Messenger
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Melanie Walker
- School of Medicine, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Susan A Bartels
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| |
Collapse
|
4
|
Mitchell LA, Jacobs C, McEwen A. (In)visibility of LGBTQIA+ people and relationships in healthcare: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 114:107828. [PMID: 37301011 DOI: 10.1016/j.pec.2023.107828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/16/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To identify and map research into the visibility of LGBTQIA+ people and their relationships in healthcare, with the view to inform future research and practice. METHOD Five databases were systematically searched for published and grey literature. Primary research reporting on visibility of LGBTQIA+ people in healthcare was included. Two reviewers independently screened the studies until an acceptable level of agreement was reached. A narrative synthesis was conducted and findings mapped to a taxonomy of microaggressions involving three sub-categories: microinsults, microassaults and microinvalidations. RESULTS The microaggressions identified included Microinsults: 'Perception of health professionals' knowledge and comfort' and 'Disclosure'; Microassaults: 'Discrimination and stigma'; Microvalidations: 'Accessing and navigating through services', 'Encounters of assumptions and stereotypes', 'Validating identities and including relationships', and 'Reading the environment'. CONCLUSION Despite growing societal acceptance, microaggressions still exist within healthcare. Groups within LGBTQIA+ communities have varying levels of visibility in research and healthcare based on the studies included. PRACTICE IMPLICATIONS The limited visibility of LGBT and lack of visibility of QIA+ people and their relationships in healthcare highlight the need to include the views of all LGBTQIA+ communities in research, and to ensure health professionals and clinical services are equipped to address this (in)visibility gap.
Collapse
Affiliation(s)
- Lucas A Mitchell
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia; Clinical Translation and Engagement Platform, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Australia.
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| |
Collapse
|
5
|
Rabbitte M, Enriquez M. Factors that impact assigned female sexual minority individuals health care experiences: A qualitative descriptive study. AMERICAN JOURNAL OF SEXUALITY EDUCATION 2023; 19:97-120. [PMID: 38576876 PMCID: PMC10989845 DOI: 10.1080/15546128.2023.2187502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
This qualitative descriptive study identified factors that impact assigned female at birth (AFAB) cisgender and non-binary sexual minority individuals' decision to engage, or not engage, in health-seeking behaviors and receive preventative health care services. AFAB sexual minority individuals were asked to describe their health care experiences to determine modifiable factors that could improve their intention to seek care and improve their health care experiences. Purposive sampling was used to recruit AFAB sexual minority individuals between 18-30 years of age in the Chicago metropolitan area. Three main themes emerged from data acquired through individual interviews: (1) "ask the right questions"; main themes (2 lack of trust in health professionals; (3 the need for better sexual health education. An important finding was participants wanted to be asked about their sexual orientation, sexual behavior, and gender identity. Participants wanted to be able to share their sexual orientation and gender identity with health care professionals so they could receive appropriate care, accurate information, and feel comfortable sharing aspects about their life. Additionally, the results suggested that general and health sciences curricula should include content about diverse sexual and gender minority populations. Findings have important implications for health education and clinical practice.
Collapse
|
6
|
Altman MR, Cragg K, van Winkle T, Julian Z, Obedin-Maliver J, Tarasoff LA, Eagen-Torkko MK, Ferrell BL, Rubashkin NA, Lusero I, Vedam S. Birth includes us: Development of a community-led survey to capture experiences of pregnancy care among LGBTQ2S+ families. Birth 2023; 50:109-119. [PMID: 36625538 PMCID: PMC10332260 DOI: 10.1111/birt.12704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/04/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Limited research captures the intersectional and nuanced experiences of lesbian, gay, bisexual, transgender, queer, two-spirit, and other sexual and gender-minoritized (LGBTQ2S+) people when accessing perinatal care services, including care for pregnancy, birth, abortion, and/or pregnancy loss. METHODS We describe the participatory research methods used to develop the Birth Includes Us survey, an online survey study to capture experiences of respectful perinatal care for LGBTQ2S+ individuals. From 2019 to 2021, our research team in collaboration with a multi-stakeholder Community Steering Council identified, adapted, and/or designed survey items which were reviewed and then content validated by community members with lived experience. RESULTS The final survey instrument spans the perinatal care experience, from preconception to early parenthood, and includes items to capture experiences of care across different pregnancy roles (eg, pregnant person, partner/co-parent, intended parent using surrogacy) and pregnancy outcomes (eg, live birth, stillbirth, miscarriage, and abortion). Three validated measures of respectful perinatal care are included, as well as measures to assess experiences of racism, discrimination, and bias across intersections of identity. DISCUSSION AND CONCLUSIONS By centering diverse perspectives in the review process, the Birth Includes Us instrument is the first survey to assess the range of experiences within LGBTQ2S+ communities. This instrument is ready for implementation in studies that seek to examine geographic and identity-based perinatal health outcomes and care experiences among LGBTQ2S+ people.
Collapse
Affiliation(s)
- Molly R. Altman
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Kase Cragg
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Teresa van Winkle
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Zoë Julian
- Department of Obstetrics and Gynecology, Wellstar Kennestone Regional Medical Center, Marietta, Georgia, USA
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Lesley A. Tarasoff
- Department of Health & Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Meghan K. Eagen-Torkko
- University of Washington Bothell School of Nursing & Health Studies, Bothell, Washington, USA
| | - Brittany L. Ferrell
- Washington University in St. Louis, Goldfarb School of Nursing, St. Louis, Missouri, USA
| | - Nicholas A. Rubashkin
- Division of Hospitalist Medicine, Department of Obstetrics, Gynecology& Reproductive Sciences, Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | | | - Saraswathi Vedam
- Birth Place Lab, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
7
|
Joy P, Thomas A, Aston M. Compassionate Discourses: A Qualitative Study Exploring How Compassion Can Transform Healthcare for 2SLGBTQ+ People. QUALITATIVE HEALTH RESEARCH 2022; 32:1514-1526. [PMID: 35739090 PMCID: PMC9411689 DOI: 10.1177/10497323221110701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Compassion can be seen as a necessary, but often lacking, concept and practice in healthcare. Due to the cis-heteronormative nature of societies, people who identify as Two-Spirit, lesbian, gay, bisexual, transgender, queer (2SLGBTQ+) often experience health disparities and disparities in accessing compassionate healthcare. We aimed to explore the meanings of compassion in healthcare for Canadian 2SLGBTQ+ people. Using a poststructuralist framework, 20 self-identifying 2SLGBTQ+ participants were interviewed. Data was analyzed through discourse analysis. Three main discursive considerations are discussed, including (1) meanings and expectations of compassion in healthcare, (2) compassionate healthcare is not guaranteed, and (3) prescription for care: self-compassion for healing and health. The results provide insights into how compassionate healthcare is framed for 2SLGBTQ+ participants and how compassion is often lacking for them due to discourses of cis-heteronormativity and healthism.
Collapse
Affiliation(s)
- Phillip Joy
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Andrew Thomas
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Megan Aston
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
8
|
Newman CE, Prankumar SK, Cover R, Rasmussen ML, Marshall D, Aggleton P. Inclusive health care for LGBTQ+ youth: support, belonging, and inclusivity labour. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1725443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Christy E. Newman
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | | | - Rob Cover
- School of Social Sciences, The University of Western Australia, Perth, Australia
| | - Mary Lou Rasmussen
- School of Sociology, The Australian National University, Canberra, Australia
| | - Daniel Marshall
- School of Communication and Creative Arts, Deakin University, Melbourne, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
- School of Sociology, The Australian National University, Canberra, Australia
| |
Collapse
|
9
|
LaVaccare S, Diamant AL, Friedman J, Singh KT, Baker JA, Rodriguez TA, Cohen SR, Dary FY, Pregler J. Healthcare Experiences of Underrepresented Lesbian and Bisexual Women: A Focus Group Qualitative Study. Health Equity 2018; 2:131-138. [PMID: 30283859 PMCID: PMC6071790 DOI: 10.1089/heq.2017.0041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: To understand the complex healthcare experiences of women identifying as lesbian or bisexual. who are also women of color, veterans, and/or 65 years of age and older. Methods: Inclusion criteria were age 25 or older, Los Angeles County resident, self-identification as a lesbian or bisexual woman, and as an African American, Latina, Asian-Pacific Islander, and/or a veteran. For the age 65 years and older group, participants were eligible regardless of their veteran status or race/ethnicity. Five focus groups were conducted (n=35) and the same questions were asked addressing their comfort interacting with healthcare providers, the provider knowing their sexual orientation, characteristics of a perfect provider, and barriers to care. Structured qualitative analyses were performed. Results: Participants identified concerns that providers often hold to heterosexual cultural norms. Participants varied on preferences for providers of the same race/ethnicity as themselves. Lesbians who are 65 years and older identified legal barriers as major concerns. All groups identified incorrect provider assumptions about sexual orientation and sexual practices as frequently compromising their care. Participants supported the idea of certification for providers skilled in lesbian, gay, bisexual, transgender, and queer (LGBTQ) health, but expressed skepticism that such programs would necessarily result in better care. Conclusion: Healthcare provider trainings need to address the specific concerns and experiences of underrepresented lesbian and bisexual women. Healthcare environments must be transformed to effectively address their needs. More research is needed on the separate healthcare experiences of specific marginalized populations related to their sexual orientation and/or gender identity.
Collapse
Affiliation(s)
- Sue LaVaccare
- Los Angeles County Lesbian and Bisexual Women's Health Collaborative, Los Angeles, California
| | - Allison L. Diamant
- Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Julie Friedman
- Iris Cantor-UCLA Women's Health Education and Research Center, Los Angeles, California
| | - Karen T. Singh
- Iris Cantor-UCLA Women's Health Education and Research Center, Los Angeles, California
| | - Jessica A. Baker
- Iris Cantor-UCLA Women's Health Education and Research Center, Los Angeles, California
| | - Tayler A. Rodriguez
- Iris Cantor-UCLA Women's Health Education and Research Center, Los Angeles, California
| | - Susan R. Cohen
- Department of Health Sciences, California State University, Northridge, Northridge, California
| | - Farina Y. Dary
- Project RENEW, Pathways by Molina, Costa Mesa, California
| | - Janet Pregler
- Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Iris Cantor-UCLA Women's Health Center, Los Angeles, California
| |
Collapse
|
10
|
Müller A. Beyond 'invisibility': queer intelligibility and symbolic annihilation in healthcare. CULTURE, HEALTH & SEXUALITY 2018; 20:14-27. [PMID: 28508701 DOI: 10.1080/13691058.2017.1322715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Sexual minority health is increasingly receiving attention by health sciences education and healthcare, with the core argument being that health can be improved by challenging sexual minority invisibility. Invisibility as a concept, however, does not allow for a deeper theoretical engagement with the reasons and consequences of the lack of representation of queerness in healthcare. Drawing on empirical research with queer healthcare users in South Africa, I argue that 'invisibility' actually encompasses two distinct, though related, concepts: queer symbolic annihilation as the reason for the exclusion of queer identities in health professions education and, by consequence, in healthcare; and queer (un)intelligibility as the consequence of this systemic erasure. By simply attributing discriminatory healthcare experiences of queer people to 'invisibility' we are missing opportunities to address underlying issues of queer symbolic annihilation and unintelligibility.
Collapse
Affiliation(s)
- Alex Müller
- a Gender, Health and Justice Research Unit , University of Cape Town , Cape Town , South Africa
| |
Collapse
|