Check the box that best describes you: reflexively managing theory and praxis in LGBTQ health communication research

Access to Healthcare and Unmet Needs in the Canadian Lesbian-Gay-Bisexual Population

Individuals who identify as a sexual minority, including those who are lesbian, gay, or bisexual (LGB), face barriers to healthcare as well as increased discrimination, stigmatization, and negative experiences during healthcare use. Further, few healthcare providers have education and training focused on the specific healthcare needs of individuals who are part of a sexual minority group. Given the limited research on Canadian healthcare access for sexual minorities, our purpose was to use data (n > 2,800) from the 2015-16 Canadian Community Health Survey (CCHS) to investigate the perceptions of healthcare access for LGB and non-LGB Canadians. Although non-LGB and LGB participants reported comparable access to a regular care provider and were equally likely to have consulted with a general practitioner in the past 12 months, LGB respondents were more likely to have seen a specialist and reported more unmet health needs. Although we expected the linear effects of both race and sex to vary by LGB status, this effect only occurred in one model. Current results have implications for addressing health inequalities for sexual minorities, including poorer health outcomes and greater discrimination.

Development of a multidimensional measure of health care access among LGBTQ midlife and older adults in the United States

Purpose

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) midlife and older adults are a health disparity population whose health and health care needs are distinguished by the intersection of gender, sexuality, and age. Research and measurement considering multidimensional factors influencing health care access among this population, however, remain limited. Theoretically cohesive indicators of health care access were combined to develop a comprehensive and reliable, yet parsimonious scale that assesses the unique health care access needs and experiences of LGBTQ midlife and older adults.

Methods

Data from the U.S.-based Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) were used, including 2322 LGBTQ participants from the 2015 wave of data collection. Twenty-four items were initially included in an assessment of scale reliability. The underlying factor structure of health care access was tested. Differences in mean health care access scores were examined across sexual identity, current gender, gender identity, and age cohort.

Results

Nineteen items remained in the final scale (α=0.90). Data supported health care access as multidimensional among NHAS participants. Heterogeneity in health care access scores was identified across participants. Bisexual, straight, and sexually diverse participants, women and gender diverse participants, and transgender participants faced more difficulties accessing care. Participants aged 66-80 and 81+ reported significantly higher health care access scores.

Conclusion

Final indicators represented the complex health care experiences of LGBTQ midlife and older adults. This scale can be utilized in future health equity research. Using NHAS longitudinal data, future research could assess changes in access over the life-course and as a predictor of health outcomes.

LGBTQ+ Peer Advocates' Health Communication Praxis for College Student Health Outreach and Intersectional Needs

The following essay examines health communication outreach for LGBTQ+ college students through analyzing both the design and exit evaluation of a federally funded United States public health program. SHARE-Pride was a three-year health intervention program that served LGBTQ+ students ages 18-24 at Southern University (SU)-a Hispanic and Minority Serving Institution. Because of structural barriers creating sexual health and drug and alcohol consumption risks, SHARE-Pride (SP) used a peer advocate model for students to develop mentoring relationships with LGBTQ+ peers to increase health knowledge. We first present health literature that informed SP's design and then examine research that shaped our exit study to understand advocates' intersectional identities and experiences as impacting their health communication outreach. We share rich findings from our interviews with 12 students, including communication approaches for LGBTQ+ health, increasing health communication inclusive of the full LGBTQ+ spectrum, and the role of intersectionality in LGBTQ+ health communication. We conclude with health communication praxis for future LGBTQ+ health programs and research.

"Asexual Healing Is Like the Sun Shining on Your Face in an Open Field": A Found Poetry Analysis of Asexual People of Color's Wellness and Dis/Ability

Despite growing research about asexuality in the field, there is a lack of asexual-centric health communication research. We leverage a communication lens in examining the lives of asexual-spectrum people of color and their experiences with wellness, dis/ability, and/or neurodivergence. Asexuality's fraught relationship with dis/ability provides a generative location to interrogate co-constitutive systems of oppression. Thus, this article uses poetic inquiry on 33 in-depth interviews with asexual-spectrum people of color. The poems explore the participants' emotive and experiential dimensions of their stories at the intersections of racism, ableism, and allonormativity and emphasize asexual people of color's individual and collective pursuits of wellness and healing. Ultimately and looking forward, we recognize allonormativity as a systemic barrier to health and wellness, and aim to instill a commitment to asexual people of color's wellness, healing, and hope.

"If You Don't Lose Weight, the Government Will Take You Away": An Analysis of Memorable Messages and Eating Disorders in the LGBTQ+ Community

Family communication plays a key role in children's body image, disordered eating, and full-blown eating disorders;. However, much existing communication research on eating disorders has focused on general populations. As the LGBTQ+ community is disproportionately affected by eating disorders , more work is needed to better understand how family communication may be perceived as influencing eating disorders in the LGBTQ+ community. Thus, the current study aimed to further this understanding by examining familial memorable messages reported by LGBTQ+ individuals which they perceived to have influenced their eating disorders. In a Qualtrics survey, participants (n = 73) provided memorable messages received from family members and explained their significance. Results of a thematic analysis indicate five themes among the memorable messages: Problematic Body Size/Weight, Pathologized Eating, Emphasizing Appearance Ideals, Emotion Origins, and Other Focus. Findings support the theory of memorable messages and reveal the ways in which diet culture and LGBTQ+ identity stigma intersect within parent-child communication toward a perceived influence on LGBTQ+ eating disorders. Implications for future communication research on LGBTQ+ eating disorders, as well as practical applications, are discussed.

A scoping review of the structuring of questions about sexual orientation and gender identity

The purpose of this scoping review is to map the extent of the current research on how to best structure questions asking respondents to self-identify their sexual orientation and gender identity and to ascertain what further issues about measurement need to be explored. Using the Arksey and O'Malley framework for scoping reviews, 52 articles describing primary research about how to structure sexual orientation and gender identity (SOGI) questions, published in the years 2000-2021, were identified and analyzed. The domain of sexuality being asked about (e.g., self-label vs. behavior) needs to be clarified, and gender identity should be asked through a multipart item differentiating current identity from the sex assigned at birth. The terms used in the response options should be defined and may vary based on the study population or context. Contrary to expectations given the wide range of question formats currently being used in the field, there is considerable consensus around the basic tenets for structuring questions designed to assess SOGI dimensions.

LGBTQ+ Youth Homelessness in Delaware:: Building a Case for Targeted Surveillance and Assessment of LGBTQ+ Youth Needs and Experiences

Objective

In this article, we examine the issue of LGBTQ+ youth homelessness in Delaware, summarize current services available and prior research work that has been done, examining the number, needs, and experiences of unaccompanied unhoused LGBTQ+ youth.

Methods

We provide a literature review detailing risks associated with LGBTQ+ youth homelessness, resources available, and prior studies and surveys examining this population.

Results

LGBTQ+ youth experiencing homelessness are particularly vulnerable to physical and mental health challenges, abuse, and violence. The unique needs of this population necessitate specialized resources, yet there are a limited number of such resources available in Delaware and a dearth of information on youth homelessness in general, including LGBTQ+ youth. For example, administrative barriers exist for unaccompanied queer youth seeking shelter services, such as need for legal identification or being grouped in shelter populations based on sex assigned at birth rather than gender identity. Exposure to unsafe environments is a general problem for queer youth. This can make public spaces feel unsafe and increase risk of physical or mental harm, mistreatment, or abuse when seeking shelter outside of agency services and resources. In order to accurately identify and appropriately serve this population, additional research is necessary.

Conclusions

Evidence building is a critical first step in creating an effective study to examine the issue of LGBTQ+ youth homelessness in Delaware. With the evidence acquired in our literature review our next step to establish an informed methodology is to hold service provider and LGBTQ+ lived experience focus groups. Through a qualitative approach we aim to learn how to appropriately utilize the quantitative tools identified in our analysis and to assess what questions are missing to advance the needs of this population.

Revisiting the Rainbow: Culturally Responsive Updates to a Standard Clinical Resource

PURPOSE

Cultural responsivity is essential for efficacious and affirming clinical relationships. This may be especially important with historically marginalized clients, such as transgender and gender-diverse (TGD) people seeking behaviorally based affirming communication services. We recommend modifications to standard tools for diagnostics and training that otherwise might undermine our efforts to create an inclusive and affirming environment.

METHOD

Modifications to the Rainbow Passage, a standardized paragraph utilized for eliciting speech samples in clinical settings, focused on nongendered terminology and the elimination of content with religious connotations.

RESULTS

The recommended edits to the Rainbow Passage maintain similar length, cadence, and phonetic balance while considering cultural and health care context for TGD people and other clients.

CONCLUSION

Simple linguistic changes to a standardized paragraph maintain clinical benefits and facilitate SLP efforts toward cultural responsivity, client engagement, and good clinical outcomes.

"Who's the Mom?": Heterosexism in Patient-Provider Interactions of Queer Pregnant Couples

Previous scholarship has discussed how queer individuals experience discrimination in healthcare settings. This study furthers this area of research by exploring how queer pregnant couples encountered heterosexism within patient-provider interactions. Heterosexism is being used as a framework for the study by looking at how healthcare acts as a power system to promote heterosexual identity. Through using a multiadic analysis, I interviewed 16 couples both together and separately, resulting in 46 total interviews. The analysis demonstrated that the couples experienced heterosexism by providers not understanding who the "mom" is, having to explain sexual identity to providers and providers reinforcing heterosexist expectations. The couples also provided advice for healthcare providers to improve their interactions with future queer pregnant couples.

A Pilot Study of Latinx Lesbian, Gay, and Bisexual Adolescent Patients' Goal Prioritizations in Patient-Provider Sexual Orientation and Health Disclosures

This pilot study provides a theoretically-driven explanation of the dilemmas young Latinx LGB patients may experience surrounding disclosure of personal sexual orientation and sexual health information to a health care provider (HCP). The research team conducted face-to-face semi-structured interviews with LGB Latinx individuals (N= 29) ages 18-22 about their experiences, concerns, and preferences regarding divulging this type of information to an HCP. Interviews were thematically analyzed to identify (a) participants' instrumental, identity, and relational goals during the potential and real disclosures and (b) patterns of how the participants prioritized their goals. Thematic analysis revealed four distinct goal prioritization patterns detailed in this study. Participants' goals were shaped by (a) cultural upbringing, (b) beliefs about human sexuality, (c) perception of data leakage risk, (d) individual personality, (e) medical situation, and (f) the geographic location of clinic.

Educational preparedness to care for transgender and gender diverse adults: Perspectives of mental health professionals

Ensuring that mental health professionals are appropriately trained to provide affirming and sensitive care to transgender and gender diverse (TGD) adults is one mechanism that may reduce the marginalization sometimes experienced by TGD adults in mental health contexts. In this study, mental health professionals (n=142) completed an online survey documenting the sources and types of training received to provide TGD-sensitive care; and, shared a self-assessment of their comfort, competence, and ability to provide TGD-sensitive care. Findings revealed that the majority of the mental health professionals in the study (approximately 81%) received specific training to work with TGD clients from a variety of sources. These mental health professionals also self-reported high levels of comfort, competence, and ability to offer TGD-sensitive care which were statistically significantly associated with the number of hours of TGD-specific training they had received.

Specialists in Name or Practice? The Inclusion of Transgender and Gender Diverse Identities in Online Materials of Gender Specialists

Recommendations for health care providers working with transgender and gender diverse (TGD) individuals emphasize affirming clients' identities, such as using correct pronouns and name, however it is unknown how often gender specialists adhere to such recommendations. Websites and intake forms of gender specialists were coded for use of affirming language, asking for pronouns and chosen name, and mention of TGD specialties and resources. Most websites identified the provider's specialty to work with TGD individuals, though much fewer provided additional resources concerning TGD issues and only half of intake forms included affirming language. Given previous research that has demonstrated providers working in states with legal protections for TGD individuals use affirming language more often than providers in locales without protections, association with state legal climate is also examined.

What and how: doing good research with young people, digital intimacies, and relationships and sex education

As part of a project funded by the Wellcome Trust, we held a one-day symposium, bringing together researchers, practitioners, and policymakers, to discuss priorities for research on relationships and sex education (RSE) in a world where young people increasingly live, experience, and augment their relationships (whether sexual or not) within digital spaces. The introduction of statutory RSE in schools in England highlights the need to focus on improving understandings of young people and digital intimacies for its own sake, and to inform the development of learning resources. We call for more research that puts young people at its centre; foregrounds inclusivity; and allows a nuanced discussion of pleasures, harms, risks, and rewards, which can be used by those working with young people and those developing policy. Generating such research is likely to be facilitated by participation, collaboration, and communication with beneficiaries, between disciplines and across sectors. Taking such an approach, academic researchers, practitioners, and policymakers agree that we need a better understanding of RSE's place in lifelong learning, which seeks to understand the needs of particular groups, is concerned with non-sexual relationships, and does not see digital intimacies as disconnected from offline everyday 'reality'.

PrEP and sexual well-being: a qualitative study on PrEP, sexuality of MSM, and patient-provider relationships

Most new diagnoses of HIV in the United States are among men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is a medication that mitigates risk of HIV acquisition and requires regular STI testing and prescription refills with PrEP providers. Because PrEP care monitors sexual behavior, there is a need to understand how PrEP providers approach sexual health care for MSM patients. In this study, semi-structured qualitative interviews were conducted with 20 MSM in Atlanta, Georgia with current or past prescriptions for PrEP. Data were analyzed with thematic analysis using four major steps: (1) code and codebook development, (2) assigning codes to segments of interviews, (3) code-based and comparative analysis methods, and (4) developing thematic findings. Findings from interviews about changes in sexuality while using PrEP include decreased anxiety surrounding sex, increased feelings of control over personal health, and experiencing less stigma towards sexual partners with HIV. Participants indicated needs for tailored health advice based on individual sexual preferences, sexual health care free from stereotypical assumptions, and improved access to PrEP providers identifying as gay men or who practice in LGBT-friendly settings. Study findings support a call for a gain-frame approach to sexual health in PrEP care for MSM.

In Pursuit of "queer-friendly" Healthcare: An Interview Study of How Queer Individuals Select Care Providers

LGBQ+ individuals experience worse health outcomes than do other individuals. Some communication research finds that LGBQ+ individuals report receiving poor care during the mid- to post-health care, but this research assumes that LGBQ+ individuals have already received care. Little research has examined the pre- to early encounter experience of LGBQ+ individuals. This study presents exploratory research into how LGBQ+ individuals seek "queer-friendly" health care during pre- and early encounter experiences. Using an interview methodology, we report the facilitators and barriers to seeking queer-friendly care reported by LGBQ+ individuals. We offer implications for how health care providers and systems can better promote queer-friendly healthcare.

Improving pathways to primary health care among LGBTQ populations and health care providers: key findings from Nova Scotia, Canada

Background

This study explores the perceived barriers to primary health care as identified among a sample of Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) identified individuals and health care providers in Nova Scotia, Canada. These findings, based on a province-wide anonymous online survey, suggest that additional efforts are needed to improve pathways to primary health among LGBTQ populations and in deepening our understanding of how to advance the unique primary health needs of these populations.

Methods

Data were collected from the LGBTQ community through an online, closed-ended anonymous survey. Inclusion criteria for participation were self-identifying as LGBTQ, offering primary health care to LGBTQ patients, being able to understand English, being 16 years of age or older, and having lived in Nova Scotia for at least one year. A total of 283 LGBTQ respondents completed the online survey which included sociodemographic questions, perceptions of respondents’ health status, and their primary health care experiences. In addition, a total of 109 health care providers completed the survey based on their experiences providing care in Nova Scotia, and in particular, their experiences and perceptions regarding LGBTQ access to primary health care and physician-patient interactions.

Results

Our results indicate that, in several key areas, the primary health care needs of LGBTQ populations in Nova Scotia are not being met and this may in turn contribute to their poor health outcomes across the life course.

Conclusion

A framework of intersectionality and health equity was used to interpret and analyze the survey data. The key findings indicate the need to continue improving pathways to primary health care among LGBTQ populations, specifically in relation to additional training and related supports for health care providers who work with these populations.

Waiting for the doctor to ask: influencers of lesbian, gay, and bisexual identity disclosure to healthcare providers

Lesbian, gay, and bisexual (LGB) individuals encounter multiple barriers in healthcare, resulting in problematic care. Many LGB patients wrestle with whether to disclose their sexuality to healthcare providers. This article explored what influences LGB patients’ decision to disclose their sexuality to healthcare providers. Guided by Communication Privacy Management theory, the authors conducted in-depth interviews with 20 LGB patients. LGB patients heavily relied on boundary management when negotiating the disclosure of their sexuality. The findings suggest several factors influence LGB patients’ disclosure of sexuality: i) experience with family; ii) fear of gossip and connections; iii) concern for provider care refusal; iv) religion; v) age; and vi) level of trust with providers. Boundary turbulence can be created between patient and provider when there is uncertainty about if and when sexuality is considered private information. Additionally, a site of tension for LGB patients was their concern about providers sharing private information outside the clinic setting.

First Impressions Online: The Inclusion of Transgender and Gender Nonconforming Identities and Services in Mental Healthcare Providers' Online Materials in the USA

BACKGROUND

When accessing mental healthcare services, transgender and gender nonconforming (TGNC) individuals face systemic barriers to gender-affirmative care. Initial points of contact, like intake forms, may show limited consideration for the heterogeneity of TGNC identities and can lead to negative consequences prior to face-to-face interaction with providers.

AIMS

The first aim was to mimic a likely pathway a TGNC individual may follow to seek mental healthcare services in the USA and to describe the extent to which they may encounter enacted stigma or affirmative messages that may impede or facilitate access to care. The second aim was to determine if a positive State legal climate for TGNC people was associated with more affirmative provider materials.

METHODS

Content analysis was used to examine a national sample of websites and intake forms of mental healthcare providers who advertise online as working with TGNC clients. Intake forms were coded for usage of affirmative language in gender/sex questions and including questions for a client's pronouns and preferred name. Websites were coded for mentioning a variety of services or resources for TGNC clients.

RESULTS

While provider websites were found through Google searches for a "gender therapist," only 56.6% of websites stated a provider specialty to work with TGNC clients and 32.1% of websites had no mention of services or resources for TGNC people. Additionally, a significantly larger proportion of intake forms from States with legal protections for TGNC people used affirmative language in gender/sex questions and asked for a client's pronouns than intake forms from States without legal protections.

DISCUSSION

Barriers to affirmative healthcare for TGNC people within patient and provider interactions have been identified in previous research and these data show TGNC individuals may face enacted stigma even in their search for a provider, particularly those TGNC people living in States without legal protections.

Providing quality family planning services to LGBTQIA individuals: a systematic review

OBJECTIVE

Lesbian, gay, bisexual, transgender, queer/questioning, intersex and asexual (LGBTQIA) individuals have unique sexual and reproductive health needs; however, facilitators and barriers to optimal care are largely understudied. The objective of this study was to synthesize findings from a systematic review of the literature regarding the provision of quality family planning services to LGBTQIA clients to inform clinical and research strategies.

STUDY DESIGN

Sixteen electronic bibliographic databases (e.g., PubMed, PSYCinfo) were searched to identify articles published from January 1985 to April 2016 relevant to the analytic framework.

RESULTS

The search parameters identified 7193 abstracts; 19 descriptive studies met inclusion criteria. No studies assessed the impact of an intervention serving LGBTQIA clients on client experience, behavior or health outcomes. Two included studies focused on the perspectives of health care providers towards LGBTQIA clients. Of the 17 studies that documented client perspectives, 12 elucidated factors facilitating a client's ability to enter into care, and 13 examined client experience during care. Facilitators to care included access to a welcoming environment, clinicians knowledgeable about LGBTQIA needs and medical confidentiality.

CONCLUSIONS

This systematic review found a paucity of evidence on provision of quality family planning services to LGBTQIA clients. However, multiple contextual facilitators and barriers to family planning service provision were identified. Further research is needed to assess interventions designed to assist LGBTQIA clients in clinical settings, and to gain a better understanding of effective education for providers, needs of specific subgroups (e.g., asexual individuals) and the role of the client's partner during receipt of care.

A Culture-Centered Approach to Improving Healthy Trans-Patient-Practitioner Communication: Recommendations for Practitioners Communicating withTrans Individuals

The following manuscript explores trans individuals' lived experiences with practitioners and the types of advice they suggested be provided to practitioners treating trans patients to improve the trans-patient-practitioner relationship. Thirteen semi-structured qualitative interviews were conducted with individuals who self-identified as trans. Interviews were analyzed using thematic analysis (Braun & Clarke, 2006; Owen, 1984). Data analysis revealed that changes in practitioner's communication behavior during office visits as well as modifications to office logistics and e-health particulars would contribute to a healthy communication environment. Interviewees explained that these variations may potentially improve trans-patient-practitioner communication. We conclude by offering practical and theoretical implications as well as areas of future research for trans health communication.

Stress, Socializing, and Other Motivations for Smoking Among the Lesbian, Gay, Bisexual, Transgender, and Queer Community in New York City

PURPOSE

This study contributes to the emerging literature on lesbian, gay, bisexual, transgendered, and queer (LGBTQ) health disparities and tobacco use by examining the motivations for smoking among the New York City (NYC) LGBTQ population.

APPROACH

We used grounded theory and blended methods from 3 grounded theorists-Strauss, Corbin, and Charmaz-for data collection, coding, and analysis.

SETTING

NYC has extensive legislation to prevent smoking; however, the current smoking prevalence of homosexuals is double that of heterosexuals.

PARTICIPANTS

Study participants were leaders from 23 NYC LGBTQ organizations. Leaders were chosen to establish a relationship with community and to ensure cultural sensitivity. Eligibility criteria required holding a leadership position in an organization serving the NYC LGBTQ community.

METHODS

Interviews were transcribed verbatim and uploaded into Dedoose for analysis. An initial code list was developed from the interview guide. Key themes were identified as the themes with the most number of quotes.

RESULTS

Three key themes emerged from our interviews: image, socializing, and stress. Smoking was reported to be a socialization aid and a maladaptive coping technique for stress arising from interactions of conflicting identities.

CONCLUSION

Future smoking cessation interventions among the LGBTQ community should equip smokers with healthy coping mechanisms that address the stressors that arise from the intersections of smokers' many identities.

"I feel like I am surviving the health care system": understanding LGBTQ health in Nova Scotia, Canada

Background

Currently, there is a dearth of baseline data on the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations in the province of Nova Scotia, Canada. Historically, LGBTQ health research has tended to focus on individual-level health risks associated with poor health outcomes among these populations, which has served to obscure the ways in which they maintain their own health and wellness across the life course. As such, there is an urgent need to shift the focus of LGBTQ health research towards strengths-based perspectives that explore the complex and resilient ways in which LGBTQ populations promote their health.

Methods

This paper discusses the findings of our recent scoping review as well as the qualitative data to emerge from community consultations aimed at developing strengths-based approaches to understanding and advancing LGBTQ pathways to health across Nova Scotia.

Results

Our scoping review findings demonstrated the lack of strengths-based research on LGBTQ health in Nova Scotia. Specifically, the studies examined in our scoping review identified a number of health-promoting factors and a wide variety of measurement tools, some of which may prove useful for future strengths-based health research with LGBTQ populations. In addition, our community consultations revealed that many participants had negative experiences with health care systems and services in Nova Scotia. However, participants also shared a number of factors that contribute to LGBTQ health and suggestions for how LGBTQ pathways to health in Nova Scotia can be improved.

Conclusions

There is an urgent need to conduct research on the health needs, lived experiences, and outcomes of LGBTQ populations in Nova Scotia to address gaps in our knowledge of their unique health needs. In moving forward, it is important that future health research take an intersectional, strengths-based perspective in an effort to highlight the factors that promote LGBTQ health and wellness across the life course, while taking into account the social determinants of health.

"I am yet to encounter any survey that actually reflects my life": a qualitative study of inclusivity in sexual health research

BACKGROUND

Heteronormativity describes a set of norms and assumptions pertaining to heterosexual identities and binary gender. In 2015, we conducted our annual Sex, Drugs and Rock'n'Roll study, an online health survey of over 1000 Victorians aged 15-29 years. Feedback from participants suggested that our survey contained heteronormative language. In response to this, we aimed to make inclusive changes to our survey via consultation with young gender and sexually diverse (GSD) people.

METHODS

We conducted two semi-structured focus groups in Melbourne with a total of 16 participants (age range: 21-28 years). Participants were mostly cisgender women, and there were two transgender participants and one non-binary participant. Participants also had a range of sexual identities including lesbian, queer, bisexual, pansexual, and asexual. Focus group discussions were transcribed verbatim and analysed thematically.

RESULTS

Most participants indicated heteronormativity affects their lives in multiple ways, noting its impacts on access to sexual healthcare, invalidating sexual experiences and miscommunication in forms and surveys. Overall, participants emphasised the need for sexual health research to avoid assumptions about behaviour, to be clear and eliminate question ambiguity and avoiding treating gender as binary. Participants also discussed how the Sex, Drugs and Rock'n'Roll survey could address a range of sexual behaviours and experiences, rather than focusing on penetrative sex, which many participants found invalidating.

CONCLUSIONS

Our findings have important implications for future health surveys aimed at general populations. We present recommendations that encourage research to be more inclusive to ensure data collection from GSD participants is respectful and rigorous.

The utility of resilience as a conceptual framework for understanding and measuring LGBTQ health

BACKGROUND

Historically, lesbian, gay, bisexual, transgender and queer (LGBTQ) health research has focused heavily on the risks for poor health outcomes, obscuring the ways in which LGBTQ populations maintain and improve their health across the life course. In this paper we argue that informing culturally competent health policy and systems requires shifting the LGBTQ health research evidence base away from deficit-focused approaches toward strengths-based approaches to understanding and measuring LGBTQ health.

METHODS

We recently conducted a scoping review with the aim of exploring strengths-based approaches to LGBTQ health research. Our team found that the concept of resilience emerged as a key conceptual framework. This paper discusses a subset of our scoping review findings on the utility of resilience as a conceptual framework in understanding and measuring LGBTQ health.

RESULTS

The findings of our scoping review suggest that the ways in which resilience is defined and measured in relation to LGBTQ populations remains contested. Given that LGBTQ populations have unique lived experiences of adversity and discrimination, and may also have unique factors that contribute to their resilience, the utility of heteronormative and cis-normative models of resilience is questionable. Our findings suggest that there is a need to consider further exploration and development of LGBTQ-specific models and measures of resilience that take into account structural, social, and individual determinants of health and incorporate an intersectional lens.

CONCLUSIONS

While we fully acknowledge that the resilience of LGBTQ populations is central to advancing LGBTQ health, there remains much work to be done before the concept of resilience can be truly useful in measuring LGBTQ health.

Understanding and Measuring LGBTQ Pathways to Health: A Scoping Review of Strengths-Based Health Promotion Approaches in LGBTQ Health Research

Health research traditionally has focused on the health risks and deficits of lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations, obscuring the determinants that can promote health across the life course. Recognizing, appropriately measuring, and rendering visible these determinants of health is paramount to informing appropriate and engaging health policies, services, and systems for LGBTQ populations. The overarching purpose of this article is to provide an overview of the findings of a scoping review aimed at exploring strengths-based health promotion approaches to understanding and measuring LGBTQ health. Specifically, this scoping review examined peer-reviewed, published academic literature to determine (a) existing methodological frameworks for studying LGBTQ health from a strengths-based health promotion approach, and (b) suggestions for future methodological approaches for studying LGBTQ health from a strengths-based health promotion approach. The findings of this scoping review will be used to inform the development of a study aimed at assessing the health of and improving pathways to health services among LGBTQ populations in Nova Scotia, Canada.

Heteronormativity and practitioner-patient interaction

Heteronormativity is the presumption of heterosexuality as the default sexual orientation and can result in discrimination against the lesbian, gay, and bisexual (LGB) population. This study serves as one of the first experimental studies to examine heteronormative perceptions in communication and their effects on practitioner-patient relationships. LGB participants were randomly assigned to read either heteronormative or non-heteronormative vignettes of a doctor-patient interaction. They then indicated how much health-relevant information they would disclose to the doctor in the vignette and their level of trust in the doctor. In the heteronormative condition, participants were less likely to disclose health-relevant information to the doctor in the vignette and were less trustful of the doctor as compared to those in the non-heteronormative condition. These results have important health implications, as lack of disclosure and trust may prevent people from getting needed care and prevent doctors from giving the best health advice possible. The results of this study provide further evidence that there is a need for more education for all health care professionals to feel comfortable while respectfully communicating with and treating patients who do not identify as heterosexual in order to ensure the best health care experience.

Negotiating sexuality in home care settings: older lesbians and bisexual women's experiences

There is evidence that lesbians and bisexual women often face prejudice and stigma when accessing routine primary healthcare services. However, limited research to date has examined their experiences outside of primary healthcare contexts or the perspectives of older healthcare users. This paper presents findings from a qualitative study of older lesbians and bisexual women in Ontario who accessed publicly-funded home care services. In qualitative in-depth interviews, 16 women responded to questions about their decision making around disclosure of their sexuality, home care workers' reactions to disclosure and their experiences of receiving care. The thematic analysis of participants' responses demonstrated that they experienced isolation and ongoing anxiety, as well overt and subtle examples of heterosexism and discrimination. However, there was also evidence of participants' resilience and resistance to heteronormativity and sexual minority stress. These findings have implications for our understanding of lesbians' and bisexual women's healthcare experiences and for policy recommendations.

Enhancing benefits or increasing harms: community responses for HIV among men who have sex with men, transgender women, female sex workers, and people who inject drugs

Studies completed over the past 15 years have consistently demonstrated the importance of community-level determinants in potentiating or mitigating risks for the acquisition and transmission of HIV. Structural determinants are especially important in mediating HIV risk among key populations, including men who have sex with men, people who inject drugs, sex workers of all genders, and transgender women. The objective of this systematic review was to synthesize the evidence characterizing the community-level determinants that potentiate or mitigate HIV-related outcomes for key populations. The results of the review suggest that although health communication programs represent community-level strategies that have demonstrated the effectiveness in increasing the uptake of HIV testing and decreasing the experienced stigma among people living with HIV, there are limited studies focused on key populations in low- and middle-income settings. Moreover, interpretation from the 22 studies that met inclusion and exclusion criteria reinforce the importance of the continued measurement of community-level determinants of HIV risks and of the innovation in tools to effectively address these risks as components of the next generation of the HIV response. Consequently, the next generation of effective HIV prevention science research must improve our understanding of the multiple levels of HIV risk factors, while programming for key populations must address each of these risk levels. Failure to do so will cost lives, harm communities, and undermine the gains of the HIV response.