Recommendations for promoting affirming healthcare for gender and sexual minorities with intersecting marginalized identities

Abstract

Background: Many existing implementation frameworks neglect inequity. Theories of intersectionality can help implementation researchers understand the multiplicative burden of certain inequities experienced by people with intersecting marginalized identities. The current project provides an example of engaging primary care providers, staff, and patients in prioritizing recommendations to improve services for lesbian, gay, bisexual, transgender, queer, and other gender and sexual minoritized (LGBTQ+) people from diverse racial, ethnic, cultural, and economic backgrounds.

Methods: We used the Nominal Group Technique (NGT) to guide two one-time sessions with providers (n = 6) and staff (n = 8) affiliated with four primary care clinics in the United States. These participants brainstormed responses to a single focal question designed to elicit ideas for improving services for LGBTQ+ people with intersecting marginalized identities. Participants then discussed and ranked the ideas generated and considered specific strategies for ranked ideas. Finally, we conducted two focus groups with LGBTQ+ primary care patients (n = 7, n = 4) to obtain their insights into the recommendations for improving services.

Results: The highest-ranked idea by providers was to mandate ongoing high-quality professional development for primary care personnel. The highest-ranked ideas by staff were to offer safe spaces characterized by an ambient atmosphere with trained personnel and LGBTQ+ visuals and to increase availability and funding for transgender providers and services delivered by transgender people and others skilled in caring for this community. Patients affirmed the recommendations from the NGT, while emphasizing inclusive representation in primary care spaces and for providers and staff to critically reflect of their own backgrounds.

Conclusions: Providers, staff, and patients highlighted the importance of continuing education and training to offer affirming, safe, and equitable care for LGBTQ+ people with intersecting marginalized identities. These implementation suggestions may be helpful for primary care clinics in developing inclusive and equitable medical environments. Further, the NGT, followed by a review of findings by impacted patients, may be useful when considering equitable implementation focused on meeting the needs of people with intersecting marginalized identities.

Keywords: Gender minority; Health equity; Intersectionality; Primary care; Sexual minority.