Restricted accessResearch articleFirst published online 2022-8
Assessing LGBTQ+ stigma among healthcare professionals: An application of the health stigma and discrimination framework in a qualitative,community-based participatory research study
This qualitative, community-based participatory research (CBPR) study examines the occurrence of LGBTQ+ stigma in healthcare guided by the Health Stigma and Discrimination Framework. We conducted focus groups with healthcare professionals, analyzed using a thematic analysis approach. Stigma drivers included knowledge deficits and transphobia. Facilitators were the binary organization of medical education and training, cisnormative system procedures, a lack of enforceable policy to reduce stigma, and workplace culture and norms. Stigma practices, such as prejudicial attitudes, gossip, and misgendering, primarily focused on transgender individuals. This study reinforces the need to reduce LGBTQ+ stigma in healthcare settings, with implications for multi-level interventions.
AleshireMEAshfordKFallin-BennettA, et al. (2019) Primary care providers’ attitudes related to LGBTQ people: A narrative literature review. Health Promotion Practice20(2): 173–187.
2.
American Medical Association (2019) Eliminating health disparities—Promoting awareness and education of sexual orientation and gender identity health issues in medical education H-295.878. American Medical Association.
3.
Association of American Medical Colleges (2014) Implementing curricular and institutional climate changes to improve health care for individuals who are LGBT, gender nonconforming, or born with DSD: A resource for medical educators. Association of American Medical Colleges.
4.
BaldwinADodgeBSchickVR, et al. (2018) Transgender and genderqueer individuals’ experiences with health care providers: What’s working, what’s not, and where do we go from here?Journal of Health Care for the Poor and Underserved29(4): 1300–1318.
CarabezRPellegriniMMankovitzA, et al. (2015) “Never in all my years. . . ”: Nurses’ education about LGBT health. Journal of Professional Nursing31(4): 323–329.
7.
CaseyLSReisnerSLFindlingMG, et al. (2019) Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans. Health Services Research54Suppl 2(Suppl 2): 1454–1466.
CiceroECReisnerSLSilvaSG, et al. (2019) Health care experiences of transgender adults: An integrated mixed research literature review. ANS. Advances in Nursing Science42(2): 123–138.
10.
CramerRHexemSLaPolloA, et al. (2017) State and local policies related to sexual orientation in the United States. Journal of Public Health Policy38(1): 58–79.
11.
DaiHHaoJ (2019) Sleep deprivation and chronic health conditions among sexual minority adults. Behavioral Sleep Medicine17(3): 254–268.
12.
ElliottMNKanouseDEBurkhartQ, et al. (2015) Sexual minorities in England have poorer health and worse health care experiences: A national survey. Journal of General Internal Medicine30(1): 9–16.
13.
GiacominiMKCookDJ, Evidence-Based Medicine Working Group, et al. (2000) Users’ guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid?JAMA284(3): 357–362.
14.
GoffmanE (1963) Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice-Hall.
15.
GrantJMMottetLATanisJ, et al. (2011) Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force.
16.
GreeneMZFranceKKreiderEF, et al. (2018) Comparing medical, dental, and nursing students’ preparedness to address lesbian, gay, bisexual, transgender, and queer health. PLoS One13(9): e0204104.
17.
HagenDBGalupoMP (2014) Trans* individuals’ experiences of gendered language with health care providers: Recommendations for practitioners. International Journal of Transgenderism15(1): 16–34.
18.
HatzenbuehlerMLPachankisJE (2016) Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth: Research evidence and clinical implications. Pediatric Clinics of North America63(6): 985–997.
19.
HolkupPATripp-ReimerTSaloisEM, et al. (2004) Community-based participatory research: an approach to intervention research with a Native American community. ANS. Advances in Nursing Science27(3): 162–175.
20.
IsraelBASchulzAJParkerEA, et al. (2001) Community-based participatory research: Policy recommendations for promoting a partnership approach in health research. Education for Health (Abingdon, England)14(2): 182–197.
21.
JenningsLBarcelosCMcWilliamsC, et al. (2019) Inequalities in lesbian, gay, bisexual, and transgender (LGBT) health and health care access and utilization in Wisconsin. Preventive Medicine Reports14: 100864.
Lacombe-DuncanA (2016) An intersectional perspective on access to HIV-related healthcare for transgender women. Transgender Health1(1): 137–141.
24.
Lelutiu-WeinbergerCEnglishDSandanapitchaiP (2020) The roles of gender affirmation and discrimination in the resilience of transgender individuals in the US. Behavioral Medicine46(3–4): 175–188.
25.
LernerJERoblesG (2017) Perceived barriers and facilitators to health care utilization in the United States for transgender people: A review of recent literature. Journal of Health Care for the Poor and Underserved28(1): 127–152.
26.
LewisRJEhlkeSJShappieAT, et al. (2019) Health disparities among exclusively lesbian, mostly lesbian, and bisexual young women. LGBT Health6(8): 400–408.
27.
LimFJohnsonMEliasonM (2015) A national survey of faculty knowledge, experience, and readiness for teaching lesbian, gay, bisexual, and transgender health in baccalaureate nursing programs. Nursing Education Perspectives36(3): 144–152.
28.
LisyKPetersMDJSchofieldP, et al. (2018) Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care: A systematic review and meta-synthesis. Psycho-oncology27(6): 1480–1489.
29.
McLeroyKRBibeauDStecklerA, et al. (1988) An ecological perspective on health promotion programs. Health Education Quarterly15(4): 351–377.
30.
MorenzAMGoldhammerHLambertCA, et al. (2020) A blueprint for planning and implementing a transgender health program. Annals of Family Medicine18(1): 73–79.
31.
MorrisMCooperRLRameshA, et al. (2019) Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: A systematic review. BMC Medical Education19(1): 325.
32.
NyumbaTOWilsonKDerrickCJ, et al. (2018) The use of focus group discussion methodology: Insights from two decades of application in conservation. Methods in Ecology and Evolution9(1): 20–32.
33.
Obedin-MaliverJGoldsmithESStewartL, et al. (2011) Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. Journal of the American Medical Association306(9): 971–977.
34.
ReisnerSLRadixADeutschMB (2016) Integrated and gender-affirming transgender clinical care and research. Journal of Acquired Immune Deficiency Syndromes: JAIDS72Suppl 3(Suppl 3): S235–S242.
35.
SchaferTBaldwinA (2019) The provider perspective: Barriers to caring for gender minority patients. Presentation at the American Public Health Association Annual Meeting, Philadelphia, PA.
36.
SimoniJMSmithLOostKM, et al. (2017) Disparities in physical health conditions among lesbian and bisexual women: A systematic review of population-based studies. Journal of Homosexuality64(1): 32–44.
37.
StanglALEarnshawVALogieCH, et al. (2019) The health stigma and discrimination framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine17(1): 31.
38.
StannahJDaleEElmesJ, et al. (2019) HIV testing and engagement with the HIV treatment cascade among men who have sex with men in Africa: A systematic review and meta-analysis. The Lancet. HIV. 6(11): e769–e787.
39.
StewartKO’ReillyP (2017) Exploring the attitudes, knowledge and beliefs of nurses and midwives of the healthcare needs of the LGBTQ population: An integrative review. Nurse Education Today53: 67–77.
40.
WalshDHendricksonSG (2015) Focusing on the “T” in LGBT: An online survey of related content in texas nursing programs. Journal of Nursing Education54(6): 347–351.
41.
WantaJWNiforatosJDDurbakE, et al. (2019) Mental health diagnoses among transgender patients in the clinical setting: An all-payer electronic health record study. Transgender Health4(1): 313–315.
42.
White HughtoJMMurchisonGRClarkK, et al. (2016) Geographic and individual differences in healthcare access for U.S. transgender adults: A multilevel analysis. LGBT Health3(6): 424–433.
43.
WilsonEKennyADickson-SwiftV (2018) Ethical challenges in community-based participatory research: A scoping review. Qualitative Health Research28(2): 189–199.
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