Healthcare Provision for the LGBT Community: A Scoping Review of Service Providers and User Perspectives
Abstract
Objective: This scoping review aimed to explore available literature on the knowledge, attitudes, and practices of healthcare professionals on providing care to the lesbian, gay, bisexual, or transgender (LGBT) community as well as the experiences and perspectives of the LGBT community on their healthcare.
Material and Methods: The following electronic databases were searched in December 2020: MEDLINE/PubMed, CINAHL, Web of Science, ProQuest, SCOPUS, and Embase for English-language publications; from 2010 to 2020.
Results: This review included 59 studies that were selected from 5,318 studies. This review revealed that there was an increase in publications regarding this topic across the world. This review identified four themes: (I) the current healthcare landscape for the LGBT community, (II) facilitators of and (III) barriers to healthcare access and utilization among the LGBT community, and (IV) varied facets of healthcare of relevance for LGBT healthcare users – communication, space, education and training, research, and policies.
Conclusion: This review serves as a valuable compass for future researchers seeking areas for deeper exploration and understanding. Nevertheless, the limitations of the study underscore the significance of exercising caution when interpreting its findings concerning challenges within LGBT healthcare.
Keywords
Full Text:
PDFReferences
Ekmekci PE. Do we have a moral responsibility to compensate for vulnerable groups? A discussion on the right to health for LGBT people. Med Health Care Philos 2016;20:335–41.
Centers for Disease Control and Prevention. About LGBT health [homepage on the Internet]. Atlanta: Department of Health & Human Services; 2014 [cited 2023 Sep 9]. Available from: https://www.cdc.gov/lgbthealth/about.htm
World Health Organization. Improving LGBTIQ+ health and well-being with consideration for SOGIESC [homepage on the Internet]. Geneva: WHO; [cited 2023 Sep 9]. Available from: https://www.who.int/activities/improving-lgbtqi-health-and-well--being-with-consideration-for-sogiesc
Hatzenbuehler ML, Rutherford C, McKetta S, Prins SJ, Keyes KM. Structural stigma and all-cause mortality among sexual minorities: Differences by sexual behavior? Soc Sci Med 2020; 244:112463.
Azagba S, Latham K, Shan L. Cigarette, smokeless tobacco, and alcohol use among transgender adults in the United States. Int J Drug Policy 2019;73:163-9.
Heslin KC, Alfier JM. Sexual orientation differences in access to care and health status, behaviors, and beliefs: Findings from the National Health and Nutrition Examination Survey, National Survey of Family Growth, and National Health Interview Survey. Nat Health Stat Rep. no 171. Hyattsville: National Center for Health Statistics; 2022 [cited 2023 Dec 23]. Available from: https://doi.org/10.15620/cdc:115982
Substance Abuse and Mental Health Services Administration. 2020 National Survey on Drug Use and Health: Lesbian, gay, & bisexual (LGB) adults (Annual Report). Rockville: SAMHSA; 2022 July [cited 2023 Dec 23]. Available from https://www.samhsa.gov/data/report/2020-nsduh-lesbian-gay-bisexual-lgb-adults
de Lange J, Baams L, van Bergen DD, Bos HMW, Bosker RJ. Minority stress and suicidal ideation and suicide attempts among LGBT adolescents and young adults: a meta-analysis. LGBT Health. 2022;9:222-37.
Hottes TS, Bogaert L, Rhodes AE, Brennan DJ, Gesink D. Lifetime prevalence of suicide attempts among sexual minority adults by study sampling strategies: a systematic review and meta-analysis. Am J Public Health 2016;106:e1-12.
Su D, Irwin JA, Fisher C, Ramos A, Kelley M, Mendoza DAR, Coleman JD. Mental health disparities within the LGBT Population: a comparison between transgender and nontransgender individuals. Transgend Health 2016;1:12-20.
Bass B, Nagy H. Cultural competence in the care of LGBTQ patients [e-book]. In: StatPearls. Treasure Island: StatPearls Publishing; 2022 [cited 2023 Feb 7]. Available from https://www.ncbi.nlm.nih.gov/books/NBK563176/
Ahmed S, Domingue M, Forstein M, Hermanstyne K, Garcia L, Leli U, et al. Stress & trauma toolkit for treating LGBTQ in a changing political and social environment [homepage on the Internet]. Washington: American Psychiatric Association; [cited 2023 Sept 9]. Available from: https://www.psychiatry.org/psychiatrists/diversity/education/stress-and-trauma/lgbtq
Meier BM. Human rights in the World Health Organization: Views of the director-general candidates. Health Hum Rights 2017;19:293-8.
Mirza SAA, Rooney C. Discrimination prevents LGBTQ people from accessing health care [homepage on the Internet]. Washington: Center for American Progress; 2022 [cited 2023 Sept 9]. Available from: https://www.americanprogress.org/article/discrimination-prevents-lgbtq-people-accessing-health-care/
Pascoe EA, Richman LS. Perceived discrimination and health: a meta-analytic review. Psychological Bulletin 2009;135:531–54. doi: 10.1037/a0016059.
Powell A. Health care providers need better understanding of LGBTQ patients [homepage on the Internet]. Cambridge: Harvard University; 2018 [cited 2023 Sept 9]. Available from: https://news.harvard.edu/gazette/story/2018/03/health-care-providers-need-better-understanding-of-lgbtq-patients-harvard-forum-says/
Chung PH, Spigner S, Swaminathan V, Teplitsky S, Frasso R. Perspectives and experiences of transgender and non-binary individuals on seeking urological care. Urology 2021;148:47–52.
Rowe D, Ng YC, O’Keefe L, Crawford D. Providers’ attitudes and knowledge of lesbian, gay, bisexual, and transgender health. Fed Pract 2017;34:28–34.
Alencar Albuquerque G, de Lima Garcia C, da Silva Quirino G, Henrique Alves MJ, Moreira Belem J, dos Santos Figueiredo FW, et al. Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review. BMC Int Health Hum Rights 2016;16. Available from: https://doi.org/10.1186/s12914-015-0072-9
Martos AJ, Wilson PA, Meyer IH. Lesbian, gay, bisexual, and transgender (LGBT) health services in the United States: Origins, evolution, and contemporary landscape. PLoS One 2017;12:e0180544.
Bhatia J. LGBTQ acceptance growing in U.S. and other countries over time. [homepage on the Internet]. Washington: News & World Report; 2020 [cited 2023 Sept 9] Available from: https://www.usnews.com/news/best-countries/articles/2020-06-25/lgbtq-acceptance-growing-in-us-and-other-countries-over-time
Center for the Study of Inequality. What does the scholarly research say about the effects of discrimination on the health of LGBT people? [homepage on the Internet]. Ithaca: What We Know; 2021 [cited 2023 Feb 7]. Available from: https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-scholarly-research-say-about-the-effects-of-discrimination-on-the-health-of-lgbt-people/
Townsend E, Marval R. Can professionals actually enable occupational justice? Cad Bras Ter Ocup 2013;21:215–28.
Hafeez H, Zeshan M, Tahir MA, Jahan N, Naveed S. Health care disparities among lesbian, gay, bisexual, and Transgender Youth: A literature review. Cureus 2017;9:e1184 doi: 10.7759/cureus.1184.
Arksey H, O’Malley L. Scoping studies: Towards a methodological framework. Int J Soc Res 2005;8:19–32.
Keptner KM, McCarthy K. Mapping occupational therapy practice with postsecondary students: a scoping review. Open J Occup Ther 2020;8:1–17.
Peterson J, Pearce PF, Ferguson LA, Langford CA. Understanding scoping reviews. J Am Assoc Nurse Pract 2017;29:12–6.
Sucharew H. Methods for Research Evidence Synthesis: The scoping review approach. J Hosp Med 2019;14:416.
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. Prisma extension for scoping reviews (PRISMA-SCR): Checklist and explanation. Ann Intern Med 2018;169:467–73.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for Systematic Reviews. Syst Rev 2016;5.
Levac D, Colquhoun H, O’Brien KK. Scoping studies: Advancing the methodology. Implement Sci 2010;5:69. doi: 10.1186/1748-5908-5-69.
Daudt HML, van Mossel C, Scott SJ. Enhancing the scoping study methodology: A large, inter-professional team’s experience with arksey and o’malley’s framework. BMC Med Res Methodol 2013;13:18. doi: 10.1186/1471-2288-13-48.
Caulfield J. How to Do Thematic Analysis | Step-by-Step Guide & Examples [homepage on the Internet]. Amsterdam: The Netherlands Scribbr; 2022 [cited 2023 Sep 10]. Available from: https://www.scirp.org/reference/referencespapers.aspx?referenceid=2818544
Hunt J. An initial study of transgender people’s experiences of seeking and receiving counselling or psychotherapy in the UK. Couns Psychother Res 2013;14:288–96.
Guss CE, Woolverton GA, Borus J, Austin SB, Reisner SL, Katz-Wise SL. Transgender adolescents’ experiences in primary care: a qualitative study. J Adolesc Health 2019;65:344–9.
De Santis JP, Cintulova M, Provencio-Vasquez E, Rodriguez AE, Cicero EC. Transgender Women’s satisfaction with healthcare services: a mixed-methods pilot study. Perspect Psychiatr Care 2020;56:926–38.
Angelino A, Evans-Campbell T, Duran B. Assessing Health Provider Perspectives regarding barriers American Indian/Alaska native transgender and two-spirit youth face accessing healthcare. J Racial Ethn Health Disparities 2020;7:630–42.
Keles S, Yilmaz Ozpolat AG, Yalim NY. Ethical discourse of psychiatrists about gender identity and sexual orientation: A qualitative study. Turk Psikiyatri Derg 2019.
Wang YC, Chang SR, Miao NF. Taiwanese nurses’ attitudes towards and knowledge about sexual minorities and their behavior of providing care to sexual minority patients: Results of an online survey. J Nurs Scholarsh 2020;52:605–12.
Bradford J, Reisner SL, Honnold JA, Xavier J. Experiences of transgender-related discrimination and implications for health: Results from the Virginia Transgender Health Initiative Study. Am J Public Health 2013;103:1820–9.
Cele NH, Sibiya MN, Sokhela DG. Experiences of homosexual patients’ access to primary health care services in Umlazi, kwazulu-natal. Curationis 2015;38:1522.
Müller A. Scrambling for access: Availability, accessibility, acceptability and quality of healthcare for lesbian, gay, bisexual and transgender people in South Africa. BMC Int Health Hum Rights 2017;17:16.
Apalı ÖC, Baba İ, Bayrakcı F, Değerli D, Erden A, Peker MS, et al. Experience of sexual and gender minority youth when accessing health care in Turkey. Int J Adolesc Med Health 2020;33:445–8.
Bauer GR, Zong X, Scheim AI, Hammond R, Thind A. Factors impacting transgender patients’ discomfort with their family physicians: A respondent-driven sampling survey. PLoS One 2015;10:e0145046.
Butler SS. Older lesbians’ experiences with home care: Varying levels of disclosure and discrimination. J Gay Lesian Soc Se 2017;29:378–98.
Gahagan J, Subirana-Malaret M. Improving pathways to primary health care among LGBTQ populations and health care providers: Key findings from Nova Scotia, Canada. Int J Equity Health 2018;17:76.
Kawano T, Cruz RF, Tan X. Dance/movement therapists’ attitudes and actions regarding LGBTQI and gender nonconforming communities. Am J Dance Ther 2018;40:202–23.
Paradiso C, Lally RM. Nurse practitioner knowledge, attitudes, and beliefs when caring for transgender people. Transgend Health 2018;3:47–56.
Aslan F, Şahin NE, Emiroğlu ON. Turkish nurse educators knowledge regarding LGBT health and their level of homophobia: a Descriptive–Cross Sectional Study. Nurse Educ Today 2019;76:216–21.
Davis Jr. E. The 10 Worst Countries for Gender Equality, Ranked by Perception [homepage on the Internet] Washington: USA News & World Report; [cited 2023 Sept 9]. Available from: https://www.usnews.com/news/best-countries/slideshows/10-worst-countries-for-gender-equality-ranked-by-perception
Save the Children. The main causes and factors of gender inequality in India [homepage on the Internet]. New Delhi: Save the Children; 2023 [cited 2023 Sept 9]. Available from: https://balrakshabharat.org/blog/others/causes-gender-inequality/
Hyunsoo Y. Gender equality: Korea has come a long way, but there is more work to do [homepage on the Internet]. 2021 [cited 2023 Sept 9]. Available from: https://www.oecd.org/country/korea/thematic-focus/gender-equality-korea-has-come-a-long-way-but-there-is-more-work-to-do-8bb81613/
Eskici G, Alan H, Eskin Bacaksiz F, Gumus E, Cakir H, Harmanci Seren AK. Under the same rainbow: a study on homophobia and discrimination among private sector health care professionals. J Nurs Manag 2020;29:3–15.
Kirlew MI, Lord H, Weber J. Exploring health and social care professionals’ initial perceptions of caring for trans patients. Nurs Stand 2020;35:44–9.
Stein GL, Berkman C, O’Mahony S, Godfrey D, Javier NM, Maingi S. Experiences of lesbian, gay, bisexual, and transgender patients and families in hospice and palliative care: Perspectives of the palliative care team. J Palliat Med 2020;23:817–24.
Wong B. Column: Homophobia is not an Asian value [homepage on the Internet]. Time: Time; 2020 [cited 2023 Feb 7]. Available from: https://time.com/5918808/homophobia-homosexuality-lgbt-asian-values/
Howard SD, Lee KL, Nathan AG, Wenger HC, Chin MH, Cook SC. Healthcare experiences of transgender people of color. J Gen Intern Med 2019;34:2068–74.
Eady A, Dobinson C, Ross LE. Bisexual people’s experiences with mental health services: a qualitative investigation. Community Ment Health J 2011;47:378–89.
Barefoot KN, Smalley KB, Warren JC. A quantitative comparison of the health-care disclosure experiences of rural and nonrural lesbians. Stig Health 2017;2:195–207.
Banerjee SC, Walters CB, Staley JM, Alexander K, Parker PA. Knowledge, beliefs, and communication behavior of Oncology Health-Care Providers (hcps) regarding lesbian, gay, bisexual, and transgender (LGBT) patient health care. J Health Commun 2018;23:329–39.
Baldwin A, Dodge B, Schick VR, Light B, Scharrs PW, Herbenick D, et al. Transgender and genderqueer individuals’ experiences with health care providers: What’s working, what’s not, and where do we go from here? J Health Care Poor Underserved 2018;29:1300–18.
Eisenberg ME, McMorris BJ, Rider GN, Gower AL, Coleman E. “it’s kind of hard to go to the doctor’s office if you’re hated there.” A call for gender-affirming care from transgender and gender diverse adolescents in the United States. Health Soc Care Community 2020;28:1082–9.
Thu Do T, Van Nguyen A. ‘they know better than we doctors do’: Providers’ preparedness for Transgender Healthcare in Vietnam. Health Sociol Rev 2020;29:92–107.
Dietert M, Dentice D, Keig Z. Addressing the needs of transgender military veterans: Better Access and more comprehensive care. Transgend Health 2017;2:35–44.
Snyder BK, Burack GD, Petrova A. LGBTQ youth’s perceptions of primary care. Clin Pediatr (Phila) 2016;56:443–50.
Ali N, Fleisher W, Erickson J. Psychiatrists’ and psychiatry residents’ attitudes toward transgender people. Acad Psychiatry 2015;40:268–73.
Lefkowitz AR, Mannell J. Sexual health service providers’ perceptions of transgender youth in England. Health Soc Care Community 2017;25:1237–46.
Logie CH, Lys CL, Dias L, Schott N, Zouboules MR, MacNeill N, et al. “automatic assumption of your gender, sexuality and sexual practices is also discrimination”: Exploring sexual healthcare experiences and recommendations among sexually and gender diverse persons in Arctic Canada. Health Soc Care Community 2019.
Landau N, Hamiel U, Tokatly Latzer I, Mauda E, Levek N, Tripto-Shkolnik L, et al. Paediatricians’ attitudes and beliefs towards transgender people: A cross-sectional survey in Israel. BMJ Open 2020;10:e031569.
Beagan B, Fredericks E, Bryson M. Family physician perceptions of working with LGBTQ patients: Physician training needs. Can Med Educ J 2015;6:e14-22.
Hulbert-Williams NJ, Plumpton CO, Flowers P, McHugh R, Neal RD, Semlyen J, et al. The cancer care experiences of gay, Lesbian and bisexual patients: a secondary analysis of data from the UK cancer patient experience survey. Eur J Cancer Care (Engl) 2017;26.
Johnson AH, Hill I, Beach-Ferrara J, Rogers BA, Bradford A. Common barriers to healthcare for transgender people in the U.S. Southeast. Int J Transgend Health 2019;21:70–8.
Dorsen C, Van Devanter N. Open arms, conflicted hearts: Nurse-practitioner’s attitudes towards working with lesbian, gay and bisexual patients. J Clin Nurs 2016;25:3716–27.
Agardh C, Weije F, Agardh A, Nyoni J, Ross MW, Kashiha J, et al. Using pharmacists and drugstore workers as sexual healthcare givers: a qualitative study of men who have sex with men in Dar es Salaam, Tanzania. Glob Health Action 2017;10:1389181.
Della Pelle C, Cerratti F, Di Giovanni P, Cipollone F, Cicolini G. Attitudes towards and knowledge about lesbian, gay, bisexual, and transgender patients among Italian nurses: An observational study. J Nurs Scholarsh 2018;50:367–74.
Laiti M, Parisod H, Pakarinen A, Sariola S, Hayter M, Salanterä S. LGBTQ+ students’ experiences of Junior High School Nursing in Finland: A qualitative study. J Sch Nurs 2020;37:491–502.
Abdessamad HM, Yudin MH, Tarasoff LA, Radford KD, Ross LE. Attitudes and knowledge among obstetrician-gynecologists regarding lesbian patients and their health. J Womens Health (Larchmt) 2013;22:85–93.
Carabez RM, Eliason MJ, Martinson M. Nurses’ knowledge about transgender patient care. Advances in Nursing Science. Adv Nurs Sci 2016;39:257–71.
Kattari SK, Hasche L. Differences across age groups in transgender and gender non-conforming people’s experiences of health care discrimination, harassment, and victimization. J Aging Health 2015;28:285–306.
Koh CS, Kang M, Usherwood T. ‘I demand to be treated as the person I am’: Experiences of accessing primary health care for Australian adults who identify as gay, lesbian, bisexual, transgender or queer. Sex Health 2014;11:258-64.
Clark KA, White Hughto JM, Pachankis JE. “what’s the right thing to do?” correctional healthcare providers’ knowledge, attitudes and experiences caring for transgender inmates. Soc Sci Med 2017;193:80–9.
Poushter J, Kent N. The global divide on homosexuality persists [homepage on the Internet]. Washington: Pew Research Center; 2020 [cited 2023 Feb 7]. Available from: https://www.pewresearch.org/global/2020/06/25/global-divide-on-homosexuality-persists/
Coulter RWS, Kenst KS, Bowen DJ, Scout. Research funded by the National Institutes of Health on the health of lesbian, gay, bisexual, and transgender populations. Am J Public Health 2014;104:e105-12.
Kalra S, Pathak V, Jena B. Qualitative research. Perspect Clin Res 2013;4:192.
Flores A. Social acceptance of LGBTI people in 175 countries and locations [homepage on the Internet]. Los Angeles: Williams Institute; 2022 [cited 2023 Feb 7]. Available from: https://williamsinstitute.law.ucla.edu/publications/global-acceptance-index-lgbt/
Kreitzer MJ. How does nature impact our wellbeing? [homepage on the Internet]. Taking Charge of Your Health & Wellbeing. Minneapolis: The University of Minnesota; [cited 2023 Feb 7]. Available from: https://www.takingcharge.csh.umn.edu/how-does-nature-impact-our-wellbeing.
Acree ME, McNulty M, Blocker O, Schneider J, Williams H ‘Herukhuti.’ Shared decision-making around anal cancer screening among black bisexual and gay men in the USA. Cult Health Sex 2019;22:201–16. doi: 10.1080/13691058.2019.1581897.
Agenor M, Bailey Z, Krieger N, Austin SB, Gottlieb BR. Exploring the cervical cancer screening experiences of Black Lesbian, bisexual, and Queer Women: the role of patient-provider communication. Women & Health 2015;55:717–36. doi: 10.1080/03630242.2015.1039182.
Alpert AB, CichoskiKelly EM, Fox AD. What Lesbian, gay, bisexual, transgender, queer, and intersex patients say doctors should know and do: a qualitative study. J Homosex 2017;64:1368–89. doi: 10.1080/00918369.2017.1321376.
Apalı ÖC, Baba İ, Bayrakcı F, Değerli D, Erden A, Peker MS, et al. Experience of sexual and gender minority youth when accessing health care in Turkey. Int J Adolesc Med Health 2020;33:445–8. doi: 10.1515/ijamh-2019-0206.
Arbeit MR, Fisher CB, Macapagal K, Mustanski B. Bisexual invisibility and the sexual health needs of adolescent girls. LGBT Health 2016;3:342–9. doi: 10.1089/lgbt.2016.0035.
Bartholomaeus C, Riggs DW, Sansfaçon AP. Expanding and improving trans affirming care in Australia: experiences with healthcare professionals among transgender young people and their parents. Health Social Rev 2024;58–71. doi: 10.4324/9781032722443-5.
Buchman, KJ. The effect of discrimination and stigma on Health Care Access: Qualitative research with Transgender Tennesseans [dissertation]. 2010.
Burton CW, Lee J-A, Waalen A, Gibbs LM. “things are different now but”: Older LGBT adults’ experiences and unmet needs in health care. J Transcult Nurs 2019;31:492–501. doi: 10.1177/1043659619895099.
Fish J, Williamson I. Exploring lesbian, gay and bisexual patients’ accounts of their experiences of cancer care in the UK. Eur J Cancer Care 2016;27. doi: 10.1111/ecc.12501.
Kamen CS, Alpert A, Margolies L, Griggs JJ, Darbes L, Smith-Stoner M, et al. “Treat us with dignity”: a qualitative study of the experiences and recommendations of lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients with cancer. Support Care Cancer 2018;27:2525–32. doi: 10.1007/s00520-018-4535-0.
Ross MH, Setchell J. People who identify as LGBTIQ+ can experience assumptions, discomfort, some discrimination, and a lack of knowledge while attending physiotherapy: a survey. J Physiother 2019;65:99–105. doi: 10.1016/j.jphys.2019.02.002.
Kapanda L, Jumbe V, Izugbara C, Muula AS. Healthcare providers’ attitudes towards care for men who have sex with men (MSM) in Malawi. BMC Health Serv Res 2019;19. doi: 10.1186/s12913-019-4104-3.
Riggs DW, Bartholomaeus C. Australian Mental Health Professionals’ competencies for working with Trans Clients: a Comparative Study. Psychol Sex 2016;7:225–38. doi: 10.1080/19419899.2016.1189452.
Vijay A, Earnshaw VA, Tee YC, Pillai V, White Hughto JM, Clark K, et al. Factors associated with medical doctors’ intentions to discriminate against transgender patients in Kuala Lumpur, Malaysia. LGBT Health 2018;5:61–8. doi: 10.1089/lgbt.2017.0092.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.