Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 30:11:1251565.
doi: 10.3389/fpubh.2023.1251565. eCollection 2023.

Implementation of LGBTQ+ affirming care policies in the Veterans Health Administration: preliminary findings on barriers and facilitators in the southern United States

Rajinder Sonia Singh  1   2   3   4 , Sara J Landes  2   3   4 , Cathleen E Willging  5 , Traci H Abraham  1   2   4   6 , Pamela McFrederick  7   8 , Michael R Kauth  8   9 , Jillian C Shipherd  8   10   11 , JoAnn E Kirchner  1   2   3   4
Affiliations

Implementation of LGBTQ+ affirming care policies in the Veterans Health Administration: preliminary findings on barriers and facilitators in the southern United States

Rajinder Sonia Singh et al. Front Public Health. .

Abstract

Background: In the United States Department of Veterans Affairs (VA), veterans who are lesbian, gay, bisexual, transgender, queer, and similar gender and sexual minoritized people (LGBTQ+) experience health disparities compared to cisgender, heterosexual veterans. VA's LGBTQ+ Health Program created two healthcare policies on providing LGBTQ+ affirming care (healthcare that is inclusive, validating, and understanding of the LGBTQ+ population). The current project examines providers' barriers and facilitators to providing LGBTQ+ affirming care and LGBTQ+ veterans' barriers and facilitators to receiving LGBTQ+ affirming care.

Methods: Data collection and analysis were informed by the Consolidated Framework for Implementation Research, which was adapted to include three health equity domains. Data collection involved telephone interviews conducted with 11 VA providers and 12 LGBTQ+ veterans at one rural and one urban VA medical center, and one rural VA community clinic. Qualitative data were rapidly analyzed using template analysis, a data reduction technique.

Results: Providers described limited education, limited time, lack of experience with the population, and a lack of awareness of resources as barriers. Providers discussed comfort with consulting trusted peers, interest in learning more about providing LGBTQ+ affirming care, and openness and acceptance of the LGBTQ+ community as facilitators. LGBTQ+ veterans described a lack of provider awareness of their needs, concerns related to safety and discrimination, and structural discrimination as barriers. LGBTQ+ veterans described positive relationships with providers, knowledge of their own healthcare needs, and ability to advocate for their healthcare needs as facilitators. Although VA's LGBTQ+ affirming care policies are in place, providers and veterans noted a lack of awareness regarding specific healthcare processes.

Conclusion: Allowing more time and capacity for education and engaging LGBTQ+ veterans in determining how to improve their healthcare may be the path forward to increase adherence to LGBTQ+ affirming care policies. Engaging patients, especially those from marginalized backgrounds, in strategies focused on the uptake of policy may be a path to improve policy implementation. It is possible that creating truly collaborative structures in which patients, staff, providers, leadership, and policymakers can work together towards policy implementation may be a useful strategy. In turn, improved policy implementation would result in increased physical and mental health for LGBTQ+ veterans.

Keywords: LGBTQ+; implementation; inequity; policy implementation; veterans.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Similar articles

See all similar articles

Cited by

References

    1. Connors J, Casares MC, Honigberg MC, Davis JA. LGBTQ health disparities In: Lehman JR, Diaz K, Ng H, Petty EM, Thatikunta M, Eckstrand K, editors. The equal curriculum. Cham: Springer International Publishing; (2020). 13–31.
    1. Frost DM, Lehavot K, Meyer IH. Minority stress and physical health among sexual minority individuals. J Behav Med. (2015) 38:1–8. doi: 10.1007/s10865-013-9523-8, PMID: - DOI - PMC - PubMed
    1. Blosnich JR, Foynes MM, Shipherd JC. Health disparities among sexual minority women veterans. J Women's Health. (2013) 22:631–6. doi: 10.1089/jwh.2012.4214, PMID: - DOI - PMC - PubMed
    1. Blosnich JR, Marsiglio MC, Gao S, Gordon AJ, Shipherd JC, Kauth M, et al. . Mental health of transgender veterans in US states with and without discrimination and hate crime legal protection. Am J Public Health. (2016) 106:534–40. doi: 10.2105/AJPH.2015.302981, PMID: - DOI - PMC - PubMed
    1. Brown GR, Jones KT. Mental health and medical health disparities in 5135 transgender veterans receiving healthcare in the veterans health administration: a case–control study. LGBT Health. (2016) 3:122–31. doi: 10.1089/lgbt.2015.0058 - DOI - PubMed

Publication types