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.

"They Don't Think Like Us": Exploring Attitudes of Non-Transgender Students Toward Transgender People Using Discourse Analysis

Literature concerned with attitudes toward transgender (TG) individuals has been found to be lacking. Predominant research is quantitative and the few qualitative studies either investigated TG experience or attitudes of those with personal experience of TG people.This study investigated this topic using a qualitative approach employing semi-structured interviews exploring beliefs, understanding, and experience of TG people. Foucauldian Discourse Analysis was used to analyze the language used to construct a "transgender" discourse. Participants were cisgender, heterosexual, female participants from Black and ethnic minority backgrounds (n = 6).Prevalent discourses were; "Heteronormativity as a Benchmark," "The Ease of Disclosure'" and "Actualising the Other." Participants consistently drew on discourse that constructed TG as "other." Findings indicate a need to attend to context, as well as content, when exploring attitudes and that covert forms of prejudice need to be addressed and could inform anti-prejudice interventions and the creation of future transphobia measurements.

Negotiating psychiatric cisgenderism-ableism in the transgender- autism nexus

Most of the literature on autism and gender is rooted in a medical deficiency model. This study aimed to critically examine the discursive position of mainstream clinicians-researchers and to explore how their position affects, and may be affected by, autistic transgender individuals. We analyzed nine psychiatric case studies depicting autistic transgender individuals, and five texts written by transgender Aspie (i.e. having Asperger’s syndrome) individuals in online blogs and forums. The critical discourse analysis revealed that within the case studies’ cisgenderist-ableist lens, co-occurring autism and transgender were considered co-morbidities. Aspie transgender individuals reported difficulties in receiving social recognition of their gender. We discussed their ambivalence toward the cisgenderist-ableist discourse in light of recent cultural negotiations over the normativity of transgenderism and autism which start broadening the intelligibility of neuroqueer positions.

“It was like I had to fit into a category”: Care-seekers’ experiences of gender regulation in the Swedish trans-specific healthcare

The few previous studies investigating regulation of gender in trans-specific healthcare are mainly based on text material and interviews with care-providers or consist solely of theoretical analyses. There is a lack of studies analysing how the regulation of gender is expressed in the care-seeker’s own experiences, especially in a Nordic context. The aim of this study is to analyse narratives of individuals with trans experiences (sometimes called transgender people) to examine how gender performances can be regulated in trans-specific care in Sweden. The conceptual framework is inspired by trans studies, a Foucauldian analysis of power, queer phenomenology and the concept of cisnormativity. Fourteen interviews with people with trans experiences are analysed with constructivist grounded theory. The participants’ experiences indicate that gender is constructed as norm-conforming, binary and stable in trans-specific healthcare. This gendered position is resisted, negotiated and embraced by the care-seekers. Norms and discourses both inside and outside trans-specific care contribute to the regulation and limit the room for action for care-users. We conclude that a trans-specific care that has a confirming approach to its care-users, instead of the current focus on gender norm conformity, has the potential to increase the self-determination of gender performance and increase the quality of care.