Turning the Co-Production Corner: Methodological Reflections from an Action Research Project to Promote LGBT Inclusion in Care Homes for Older People

Evaluating Process and Outcomes of Public Involvement in Applied Health and Social Care Research: A Rapid Systematic Review

OBJECTIVE

Public Involvement (PI) in applied health and social care research has grown exponentially in the UK. This review aims to synthesise published UK evidence that evaluates the process and/or outcome(s) of PI in applied health and social care research to identify key contextual factors, effective strategies, outcomes and public partner experiences underpinning meaningful PI in research.

METHODS

Following a pre-registered protocol, we systematically searched four databases and two key journals for studies conducted within the UK between January 2006 and July 2024. A team of public partners and researchers carried out independent dual screening and data extraction. Included studies were narratively synthesised via Framework Synthesis.

RESULTS

Nineteen studies evaluated the PI process with a range of populations including National Health Service (NHS) users, carers, and low-income communities. No specific outcome evaluations were identified. Through their experience, public partners described important components of meaningful PI such as mutual respect and seeing and contributing to change, as well as some unintended harms of involvement. Harms related to 'experiencing negative attitudes', 'emotional burden of involvement', 'frustration and disappointment' and 'further marginalisation'. Meaningful PI was underpinned by structural, organisational, interpersonal and individual factors; as well as practical and principle-based strategies of involvement. Both public partners and researchers reflected on a range of outcomes of meaningful PI including changes to the research process and longer term impacts on organisations, researchers and public partners.

CONCLUSIONS

PI in research must be facilitated at multiple levels to reduce unintended harm and encourage meaningful and impactful outcomes. Findings are summarised within a model which gives an overview of priorities for individual researchers, organisations and funders to ensure best practice is achievable. From a methodological perspective, researchers should prioritise robust, transparent and co-produced approaches to evaluating PI to increase knowledge in the field.

PATIENT AND PUBLIC INVOLVEMENT

A regional public advisory network provided insight on the relevance and acceptability of the review concept. Our core research team included three public partners. Public partners contributed to the development of the initial review protocol, abstract and full-text screening, reviewing findings and their interpretation and writing the final report.

Participatory research approaches in long-term care facilities for older adults: a meta-ethnography

PURPOSE

There is growing interest in the potential of participatory research approaches to democratize research, empower participants and contribute to targeted health and social care. Participatory research approaches are emphasized in ethical and funding applications regarding patient and public involvement; however, less is known about their use in long-term care facilities for older adults. This meta-ethnography seeks to provide an increased understanding and novel conceptualization of participatory research approaches in long-term care facilities for older adults.

METHODS

A meta-ethnography was used to synthesize qualitative literature on participatory research approaches in long-term care facilities for older adults. In total, 1,736 articles were screened at title and abstract level, 35 studies were eligible for full-text review and 10 articles were included.

RESULTS

The following third-order constructs were identified as salient to the conceptualization and use of participatory research approaches in long-term care facilities for older adults: 1) participatory backdrops, 2) collaborative places, 3) seeking common ground and solidarity, 4) temporal considerations, and 5) empowerment, growth, and cultural and social change.

CONCLUSION

This meta-ethnography contributes a novel conceptualization and six recommendations to enhance the design and implementation of participatory research approaches as democratic spaces of exchange and collaboration for older adults.

Engaging Sexual and Gender Minority Older Adults to Elicit Concerns and Recommendations for Communicating Care Preferences in Long-Term Care: Focus Group Findings

OBJECTIVES

1) Describe sexual and gender minority (SGM) older adults' current practices and concerns for communicating end-of-life (EOL) and daily care preferences in long-term care (LTC); 2) Elicit ideas about adapting a video-based intervention to facilitate communication.

METHODS

After consulting a community advisory board, we conducted two focus groups with SGM older adults ≥55 years of age recruited from a community-based service organization (n = 4) and a continuing care retirement community (n = 9). We audio-recorded, transcribed, and coded data using directed content analysis methods and summarized results descriptively.

RESULTS

Most participants were cisgender (n = 12), female (n = 11), lesbian (n = 10), White and non-Hispanic (n = 13); mean age was 70.62. Participants' concerns included discrimination, autonomy, chosen family, and community; they linked daily care preferences with personhood and quality of life. They advocated for building intentional community-based support networks to help peers discuss preferences and produce videos before LTC transition and ensure compliance after.

CONCLUSIONS

For SGM older adults, asserting and protecting their full personhood, through daily care preferences, is essential to quality of life in LTC.

CLINICAL IMPLICATIONS

Video-recorded statements of daily preferences, facilitated and supported by a peer network, could promote culturally competent, person- and community-centered care for SGM older adults in LTC settings.

Negotiating pace, focus and identities: Patient/public involvement/engagement in a palliative care study

Patient and public involvement and engagement (PPIE) is an increasingly important component of research conduct to enhance processes and potential for impact, yet is rarely critically interrogated. This paper draws on Foucauldian analysis to highlight the disciplinary powers and tensions arising in PPIE. The paper draws on a nested evaluation interview study with three PPIE members and eight academics, who had been involved in an implementation science study focused on palliative care. PPIE members were involved in the whole study and are co-authors of this article. Through shared values and commitments to the study, a team culture of equality was developed. Yet while power was dispersed and taken-up by all team members, in so doing a self-governance approach within the team was developed. The pace and focus of discussions was at times more subjugating than co-production. Identities and positions were porous; the simplistic division of 'academic' and 'PPIE' did not stand up to scrutiny, with an increasing blurring of boundaries as people's experiences and insights changed over time. Continual, subtle, negotiations of roles, inputs and identities were manifest throughout the project. PPIE in research involves subtle, complex and ongoing disciplinary practices enacted by all members of the team.

Using Palliative Care Needs Rounds in the UK for care home staff and residents: an implementation science study

Background

Care home residents often lack access to end-of-life care from specialist palliative care providers. Palliative Care Needs Rounds, developed and tested in Australia, is a novel approach to addressing this.

Objective

To co-design and implement a scalable UK model of Needs Rounds.

Design

A pragmatic implementation study using the integrated Promoting Action on Research Implementation in Health Services framework.

Setting

Implementation was conducted in six case study sites (England, n = 4, and Scotland, n = 2) encompassing specialist palliative care service working with three to six care homes each.

Participants

Phase 1: interviews (n = 28 care home staff, specialist palliative care staff, relatives, primary care, acute care and allied health practitioners) and four workshops (n = 43 care home staff, clinicians and managers from specialist palliative care teams and patient and public involvement and engagement representatives). Phase 2: interviews (n = 58 care home and specialist palliative care staff); family questionnaire (n = 13 relatives); staff questionnaire (n = 171 care home staff); quality of death/dying questionnaire (n = 81); patient and public involvement and engagement evaluation interviews (n = 11); fidelity assessment (n = 14 Needs Rounds recordings).

Interventions

(1) Monthly hour-long discussions of residents' physical, psychosocial and spiritual needs, alongside case-based learning, (2) clinical work and (3) relative/multidisciplinary team meetings.

Main outcome measures

A programme theory describing what works for whom under what circumstances with UK Needs Rounds. Secondary outcomes focus on health service use and cost effectiveness, quality of death and dying, care home staff confidence and capability, and the use of patient and public involvement and engagement.

Data sources

Semistructured interviews and workshops with key stakeholders from the six sites; capability of adopting a palliative approach, quality of death and dying index, and Canadian Health Care Evaluation Project Lite questionnaires; recordings of Needs Rounds; care home data on resident demographics/health service use; assessments and interventions triggered by Needs Rounds; semistructured interviews with academic and patient and public involvement and engagement members.

Results

The programme theory: while care home staff experience workforce challenges such as high turnover, variable skills and confidence, Needs Rounds can provide care home and specialist palliative care staff the opportunity to collaborate during a protected time, to plan for residents' last months of life. Needs Rounds build care home staff confidence and can strengthen relationships and trust, while harnessing services' complementary expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication. This can improve resident care, enabling residents to be cared for and die in their preferred place, and may benefit relatives by increasing their confidence in care quality.

Limitations

COVID-19 restricted intervention and data collection. Due to an insufficient sample size, it was not possible to conduct a cost-benefit analysis of Needs Rounds or calculate the treatment effect or family perceptions of care.

Conclusions

Our work suggests that Needs Rounds can improve the quality of life and death for care home residents, by enhancing staff skills and confidence, including symptom management, communications with general practitioners and relatives, and strengthen relationships between care home and specialist palliative care staff.

Future work

Conduct analysis of costs-benefits and treatment effects. Engagement with commissioners and policy-makers could examine integration of Needs Rounds into care homes and primary care across the UK to ensure equitable access to specialist care.

Study registration

This study is registered as ISRCTN15863801.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128799) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 19. See the NIHR Funding and Awards website for further award information.

Postacute Care and Long-term Care for LGBTQ+ Older Adults

LGBTQ + older adults have a high likelihood of accessing nursing home care. This is due to several factors: limitations performing activities of daily living and instrumental activities of daily living, restricted support networks, social isolation, delay seeking assistance, limited economic resources, and dementia. Nursing home residents fear going in the closet, which can have adverse health effects. Cultivating an inclusive nursing home culture, including administration, staff, and residents, can help older LGBTQ + adults adjust and thrive in long-term care.

Experiences and Attitudes of the LGBTQ+ Community on Care/Nursing Homes

Recent research has found that older lesbian, gay, bisexual, transgender and queer (LGBTQ+) people have a negative attitude toward long term care services. To build upon this, we conducted a systematic review analyzing current research into the LGBTQ+ communities' perspectives and experiences of care/nursing homes. Additionally, we sought to explore the attitudes of care/nursing home staff toward providing care for LGBTQ+ residents. To conduct this study, we used the databases Embase, Medline and Web of Science, which identified 19 articles for review. From this, we were able to draw several conclusions, including that LGBTQ+ participants were concerned that they would have to conceal their identity and experience abuse. Most staff had a positive attitude toward LGBTQ+ residents, but there were exceptions to this. Despite their positive attitude, staff often lacked awareness of LGBTQ+ issues. The results of this review suggest that care/nursing homes are not welcoming environments for sexual and gender minorities, and that staff require more training to support this community. We end with innovative suggestions to tackle these issues, such as designing coproduced services with the support of LGBTQ+ communities.

Intersectional epistemic tensions associated with building knowledge with LGBTQ+ older adults of color

In gerontological research, lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) older adults of color are a hard-to-reach and underrepresented population. In this paper, we reflected upon the process of designing and implementing a Participatory Action Research (PAR) study by and for LGBTQ+ older adults of color committed to intersectionality. Data generted from fieldnotes and focus groups with five older Black lesbians were analyzed to uncover epistemic tensions associated with building intersectional knowledge for social justice. Study findings addressed the fraught nature of scientific knowledge production influenced by inequitable power structures and historically extractive research practices. Specifically, how cultural, political, and intergenerational tensions as well as the COVID-19 pandemic influenced the research process and were instrumental in learning about culturally responsive research. Putting PAR in dialogue with intersectionality opened an expansive paradigm that addressed the limitations of gerontological research. We end with implications for culturally responsive research with marginalized populations in aging studies, such as older LGBTQ+ adults of color.

Effective approaches to public involvement in care home research: a systematic review and narrative synthesis

BACKGROUND

Public involvement (often referred to as patient and public involvement or PPI) integrates the voices of the public in health and care research. However, groups such as care home residents are often excluded from involvement opportunities due to the complexities of involving people with additional care and communication needs. Despite a range of approaches being used, there is little understanding about how best to incorporate their experiences, and those of other care home stakeholders, into the design and conduct of research.

OBJECTIVE

A systematic review was conducted to identify PPI methods that better meet the specific needs of care home stakeholders. This was undertaken by (1) outlining effective PPI approaches used in care home research and the key stakeholders involved; (2) describing the role of PPI in different care home contexts and (3) identifying stakeholders' experiences and attitudes towards PPI in care homes.

METHODS

Databases CINAHL, Embase, MEDLINE, PsycINFO and Scopus were searched for English language papers from inception to November 2021. A narrative synthesis approach was utilised to organise the extracted data into five themes.

RESULTS

The search initially yielded 2314 articles (following de-duplication), with 27 meeting the inclusion criteria. Articles reported a range of input from stakeholders (including residents, staff, relatives and community stakeholders), with the impact of PPI varying according to the type of care establishment and research context. The experiences and reflections of stakeholders' about their involvement in care home research varied, with some studies offering first-hand accounts compared with summaries from researchers. Some articles explicitly evaluated the effectiveness of the PPI approach using specific outcome measures whilst others indirectly described the impact of their approach. Five themes were identified as characterising an effective PPI approach: (1) valuing stakeholders' perspectives, (2) awareness of the multi-faceted research context, (3) ensuring inclusivity and transparency, (4) maintaining flexibility and adaptability and (5) utilising resources and wider support.

CONCLUSION

Effective PPI in care home research requires researchers to create person-centred opportunities to adequately involve groups with physical and cognitive impairments. The findings led to the creation of evidence-based practical recommendations to support future involvement opportunities and help researchers develop strategies for inclusive opportunities for involvement.

SYSTEMATIC REVIEW REGISTRATION

The review was prospectively registered on PROPSERO (CRD42021293353).

Approaches to co-production of research in care homes: a scoping review

BACKGROUND

Using the technique of co-production to develop research is considered good practice. Co-production involves the public, practitioners and academics working together as equals throughout a research project. Co-production may help develop alternative ways of delivering care for older adults that are acceptable to those who live and work in care homes. However, guidance about applying co-production approaches in this context is lacking. This scoping review aims to map co-production approaches used in care homes for older adults in previous research to support the inclusion of residents and care staff as equal collaborators in future studies.

METHODS

A scoping review was conducted using the Joanna Briggs Institute scoping review methodology. Seven electronic databases were searched for peer-reviewed primary studies using co-production approaches in care home settings for older adults. Studies were independently screened against eligibility criteria by two reviewers. Citation searching was completed. Data relating to study characteristics, co-production approaches used, including any barriers and facilitators, was charted by one reviewer and checked by another. Data was summarised using tables and diagrams with an accompanying narrative description. A collaborator group of care home and health service representatives were involved in the interpretation of the findings from their perspectives.

RESULTS

19 studies were selected for inclusion. A diverse range of approaches to co-production and engaging key stakeholders in care home settings were identified. 11 studies reported barriers and 13 reported facilitators affecting the co-production process. Barriers and facilitators to building relationships and achieving inclusive, equitable and reciprocal co-production were identified in alignment with the five NIHR principles. Practical considerations were also identified as potential barriers and facilitators.

CONCLUSION

The components of co-production approaches, barriers and facilitators identified should inform the design of future research using co-production approaches in care homes. Future studies should be explicit in reporting what is meant by co-production, the methods used to support co-production, and steps taken to enact the principles of co-production. Sharing of key learning is required to support this field to develop. Evaluation of co-production approaches, including participants' experiences of taking part in co-production processes, are areas for future research in care home settings.

Religious-based negative attitudes towards LGBTQ people among healthcare, social care and social work students and professionals: A review of the international literature

There is a dearth of research on how negative religious attitudes towards LGBTQ people inform professional practice. This paper reports on a scoping review of 70 selected studies from 25 different countries. It explores key issues and knowledge gaps regarding the delivery of services to LGBTQ adults by religious healthcare, social care and social work organisations and/or practitioners with faith-based objections to LGBTQ people and their lives. The review identified four main themes: (1) a close connection between religious affiliation and negative attitudes towards LGBTQ people, among both students and professionals; (2) a heightening effect of religiosity, particularly among Christian and Muslim practitioners/students; (3) educators' religious attitudes informing curriculum design and delivery, and some highly religious students resisting and/or feeling oppressed by LGBTQ-inclusivity, if present; (4) examples of practice concerns raised by professionals and lay LGBTQ people. The article considers the ethical, practical, educational and professional standards implications, highlighting the need for further research in this area.

A rapid review of end-of-life needs in the LGBTQ+ community and recommendations for clinicians

BACKGROUND

Lesbian, gay, bisexual, transgender, and queer plus (LGBTQ+) adults face challenges accessing end-of-life care. Understanding the experiences of LGBTQ+ persons within the end-of-life context is crucial in addressing their needs and supporting equity at end of life.

AIM

Review recent literature documenting the experiences of LGBTQ+ adults nearing end-of-life, identifying needs, barriers to care, and translating this into clinical recommendations.

DESIGN

A rapid review design was chosen for prompt results. The process was streamlined by limiting the literature search to peer-reviewed articles, dissertations, theses, by date and language. Data collection used a predetermined set of items based on Meyer's Minority Stress and Bronfenbrenner's Ecological Models including participants' voices, needs, and barriers. Thematic analysis of collected data was conducted and presented results in a narrative summary.

DATA SOURCES

We searched six electronic databases (PubMed, Medline, ProQuest Dissertations and Theses A&I, ProQuest Dissertations and Theses, Open Access Theses and Dissertations, CINAHL, and Google Scholar) for articles published from 2016 to 2020.

RESULTS

We included and appraised for quality 33 articles. We uncovered three latent themes: systemic barriers, a lack of lived experience within the literature, and treatment of LGBTQ+ as one homogeneous group.

CONCLUSIONS

The hybrid Meyer's Minority Stress and Bronfenbrenner Ecological model elucidated how stressors and social contexts may impact LGBTQ+ adults when accessing end-of-life care. Incorporating LGBTQ+ cultural competence training into continuing education and ensuring that LGBTQ+ individuals participate in the development of end-of-life care programming may better attend to the needs of this population.

Supporting care home residents in the last year of life through 'Needs Rounds': Development of a pre-implementation programme theory through a rapid collaborative online approach

Background

Realist evaluation aims to address the knowledge to practice gap by explaining how an intervention is expected to work, as well as what is likely to impact upon the success of its implementation, by developing programme theories that link contexts, mechanisms and outcomes. Co-production approaches to the development of programme theories offer substantial benefits in addressing power relations, including and valuing different types of knowledge, and promoting buy-in from stakeholders while navigating the complex social systems in which innovations are embedded. This paper describes the co-production of an initial programme theory of how an evidence based intervention developed in Australia - called 'Palliative Care Needs Rounds' - might work in England and Scotland to support care home residents approaching their end of life.

Methods

Using realist evaluation and iPARIHS (integrated Promoting Action on Research Implementation in Health Services) we sought to determine how contexts and mechanisms of change might shape implementation outcomes. Pre-intervention online interviews (n = 28) were conducted (February-April 2021), followed by four co-design online workshops with 43 participants (April-June 2021). The online interviews and workshops included a range of stakeholders, including care home staff, specialist palliative care staff, paramedics, general practitioners, and relatives of people living in care homes.

Results

This methodology paper reports developments in realist evaluation and co-production methodologies, and how they were used to develop context, mechanisms, outcomes (CMOs) configurations, and chains of inference. The initial (pre-intervention) programme theory is used to illustrate this process. Two developments to iPARIHS are described. First, involving stakeholders in the collaborative co-design workshops created opportunities to commence facilitation. Second, we describe developing iPARIHS' innovation component, to include novel stakeholder interpretations, perceptions and anticipated use of the intervention as they participated in workshop discussions.

Conclusions

This rapid and robust co-production methodology draws on interactive collaborative research practices (interviews, workshop discussions of data, illustrative vignettes and visual methods). These innovative and engaging methods can be packaged for online processes to develop, describe and interrogate the CMOs in order to co-produce a programme theory. These approaches also commence facilitation and innovation, and can be adopted in other implementation science and realist studies.

Dog-assisted interventions in care homes: A qualitative exploration of the nature, meaning and impact of interactions for older people

Dog-assisted interventions (DAI) have been shown to have a wide-range of potential benefits for older adults living in care homes. Yet, there is a lack of published qualitative research which explores the experiences of care home residents, staff and dog-owner volunteers involved in DAI to fully understand its meaning, impact and value. This study aimed to explore the impact of a DAI on the social and emotional wellbeing of older residents living in care homes. The research employed a qualitative study design comprising overt, naturalistic researcher observation of weekly DAI sessions with 54 older adult residents across four participating care homes in the South East region of England over 3 months in 2018. Data were also collected through focus groups with 12 care home staff and 7 dog-owner volunteers. The data from the observations and focus groups was individually coded followed by thematic analysis across the three data sources. Findings demonstrated there were clear benefits for older people who engaged with DAI, as well as for dog-owners and to some extent for care home staff members. Benefits included sensory, emotional stimulation and opportunities for social interaction, reminiscence on early life experiences and these were supported by the development of some new social relationships. While there were some environmental challenges to implementing DAI, the findings confirm its value for care home residents, with minimal drawbacks from an organizational standpoint. As a low cost intervention, adoption of DAI in care home settings appeared to strengthen relationships between residents and staff and enable wider relationships with an external community resource.

Research as usual in humanitarian settings? Equalising power in academic-NGO research partnerships through co-production

Background

Research partnerships in conflict-affected and humanitarian settings can reveal complex power hierarchies between academics and NGOs. During the process of research, decision-making may skew in favour of more powerful actors, who often direct the scope of the research, hold the budget and lead the analysis. Co-production is increasingly emerging as a helpful approach that attempts to equalise power dynamics during research. The aim of this paper is to draw attention to the main challenges associated with a “research as usual” approach to research partnerships in humanitarian settings, as power hierarchies may be particularly magnified in these settings.

Methods

This paper is based on a comprehensive literature review and 32 semi-structured interviews with academics and practitioners from non-government organisations. Participants were selected purposively based on their experience in co-producing research or working within research partnerships. Some participants had worked in humanitarian settings while others had experience co-producing research in non-humanitarian contexts. We used Nvivo to thematically code data.

Results

This paper documents the problems with “research as usual” partnerships in humanitarian settings, specifically: the burden on communities as merely sources of data, certain forms of knowledge being valued over others, lack of reflection on the power hierarchies structuring research partnerships, top-down decision-making and lack of transparency, one-way “capacity-building”, lack of mutual benefit, and rigid research processes and timeframes.

Conclusion

This paper highlights key challenges with standard research practices in humanitarian settings and identifies seven key principles of co-production that can be helpful in attempting to equalise power dynamics within research partnerships, specifically in conflict-affected and humanitarian settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13031-021-00399-w.

Health care for LGBTI+ elders living in Nursing Homes

OBJECTIVE

to describe and analyze the scientific production on health care for Lesbians, Gays, Bisexuals, Transvestites, Transsexuals, Transgenders, Intersex (LGBTI+) and other variations of gender or sexual orientation living in Nursing Homes (NHs).

METHODS

a scoping review, in which PubMed, Web of Science, Scopus and Virtual Health Library databases were analyzed and studies from other sources were added. After assessment by two independent reviewers, 19 publications were selected to compose the sample.

RESULTS

the studies were grouped into two categories.

FINAL CONSIDERATIONS

NHs are configured as spaces that are not very inclusive, where LGBTI+ elders' demands are not considered due to the cis-heteronormativity in force in these places. Training and awareness of health professionals on the LGBTI+ theme is a tool that can make such spaces more inclusive for this population.

Reluctant educators and self-advocates: Older trans adults' experiences of health-care services and practitioners in seeking gender-affirming services

Background

Trans‐identifying individuals experience unique barriers and challenges in negotiating health‐care systems due to the cisnormative attitudes and practices which obstruct the receipt of trans‐inclusive care. To date, there has been little exploration of older trans consumers’ experiences of contemporary health‐care services when seeking to transition medically in later life.

Objectives

Qualitative findings are presented from a study of trans ageing and trans‐related health and social care needs in Wales, UK (2016‐18). The objectives are to (1) examine supportive and obstructive points of interaction with health‐care professionals, and (2) identify key learning messages for improving trans‐related health care from the perspectives of trans‐identifying adults in later life.

Design

Trans‐identifying participants self‐selected to take part in two interviews—a life‐history interview and a semi‐structured interview. Interview data were analysed thematically using the framework method approach.

Setting and participants

This paper focuses on the accounts of 19 participants (50‐74 years of age) who identified as trans and were seeking to transition medically in mid‐ to later life.

Results

Findings indicate how older trans patients are positioned as reluctant educators for GPs in primary care settings and illustrate the transphobic practices and cisnormative assumptions encountered across health‐care interactions and systems that impede their journey of transitioning in later life.

Discussion and conclusions

Messages from this study speak to the importance of improving professionals’ knowledge of gender identity diversity across the life course and making changes at a systemic level in redressing cisnormative assumptions and systems that reinforce inequities on the basis of gender identity.

A Systematic Review of UK Educational and Training Materials Aimed at Health and Social Care Staff about Providing Appropriate Services for LGBT+ People

Background: There is greater dissatisfaction with health services by LGBT people compared to heterosexual and cisgender people and some of this is from lack of equality and diversity training for health professionals. Core training standards in sexual orientation for health professionals have been available since 2006. The purpose of this project is to systematically review educational materials for health and social care professionals in lesbian, gay, bisexual, and transgender (LGBT) issues. Methods: A protocol was developed and searches conducted in six databases. Selection criteria: any studies reporting delivery or evaluation of UK education of health and/or social care professionals in LGBT issues, with no language or setting restrictions. Inclusions and data extraction were conducted in duplicate. Narrative synthesis of educational evaluations was used. Educational materials were assessed using thematic synthesis. Results: From the searches, 165 full papers were evaluated and 19 studies were included in the narrative synthesis. Three were successful action-research projects in cancer services and in residential care. Sixteen sets of educational/training materials have been available since 2010. These varied in length, scope, target audience, and extent of development as classroom-ready materials. Conclusions: Despite the availability of appropriate training programmes for post-qualifying staff, recommendations to undertake training, best practice examples, and statements of good intent, LGBT people continue to report that they are experiencing discrimination or direct prejudice from health and/or social care services. Better training strategies using behaviour change techniques are needed.

The mental health needs and concerns of older people who identify as LGBTQ+: A narrative review of the international evidence

AIMS

To synthesize the best available evidence on the experiences and perceptions of older people who identify as LGBTQ + regarding their mental health needs and concerns.

DESIGN

A narrative review and critical appraisal of qualitative, quantitative, and mixed methods studies.

DATA SOURCES

A systematic search was undertaken across all of the databases including PsycINFO, MEDLINE, CINAHL, and Sociological Abstracts. International studies published in academic journals in the English language, from January 1995 - January 2019 were appraised. Studies had to involve older people identifying as LGBTQ + and who had experiences mental health issues.

REVIEW METHODS

Fourteen papers were selected for inclusion in the systematic review. A narrative analysis of the papers was used by synthesizing the key findings and organizing them into themes and concepts.

RESULTS

Following analysis of the data, the identified themes were: (a) LGBTQ + identity issues (b) risk and vulnerability factors, (c) coping strategies and resilience, (d) interventions and supports.

CONCLUSION

This review highlights key mental health-related issues that need to be taken into account in the creation and provision of appropriate, responsive and inclusive supports and services.

IMPACT

What were the main findings? Some older people who identify as LGBTQ + have experienced stigma, discrimination, and minority stress. However, many have developed coping strategies and resilience while others have developed mental health issues. It is necessary to have in place appropriate interventions and supports to effectively meet the needs of this population. Where and on whom will the research have impact? The review has significant implications for health and nursing policy and inform developments in nursing practice and nurse education.