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People who identify as LGBTIQ+ can experience assumptions, discomfort, some discrimination, and a lack of knowledge while attending physiotherapy: a survey


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Questions: What are the experiences of people who identify as lesbian, gay, bisexual, transgender, intersex, queer or related identities (LGBTIQ+) and attend physiotherapy? How could those experiences of physiotherapy be improved? Design: Primarily qualitative design using a purpose-built online survey. Participants: People aged 18 years or older, who self-identified as LGBTIQ+, and had attended physiotherapy in Australia. Methods: Open responses were analysed with thematic analysis and quantitative responses with descriptive statistics. Results: One hundred and fourteen participants responded to the survey, with 108 meeting all eligibility criteria. Four main themes were identified in the analysis, with almost all participants reporting experiences during physiotherapy interactions relating to at least one of the following themes: 'assumptions' about participants' sexuality or gender identity; 'proximity/exposure of bodies', including discomfort about various aspects of physical proximity and/or touch and undressing and/or observing the body; 'discrimination', including reports of overt and implicit discrimination as well as a fear of discrimination; and 'lack of knowledge about transgender-specific health issues'. Positive experiences were also evident across the first, third and fourth themes. Participants suggested or supported a number of ways to improve LGBTIQ+ experiences with physiotherapy, including: LGBTIQ+ diversity training for physiotherapists, education specific to the LGBTIQ+ population (particularly transgender health), and open options for gender provided on forms. Conclusion: People who identify as LGBTIQ+ can experience challenges when attending physiotherapy, including: erroneous assumptions by physiotherapists, discomfort, explicit and implicit discrimination, and a lack of knowledge specific to their health needs. Positive findings and participant-suggested changes offer ways to improve physiotherapy for LGBTIQ+ people across educational and clinical settings.
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People who identify as LGBTIQþcan experience assumptions, discomfort, some
discrimination, and a lack of knowledge while attending physiotherapy: a survey
Megan H Ross, Jenny Setchell
School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
Sexual and gender minorities
Gender identity
Physical therapy
Questions: What are the experiences of people who identify as lesbian, gay, bisexual, transgender, intersex,
queer or related identities (LGBTIQþ) and attend physiotherapy? How could those experiences of physio-
therapy be improved? Design: Primarily qualitative design using a purpose-built online survey. Participants:
People aged 18 years or older, who self-identied as LGBTIQþ, and had attended physiotherapy in Australia.
Methods: Open responses were analysed with thematic analysis and quantitative responses with descriptive
statistics. Results: One hundred and fourteen participants responded to the survey, with 108 meeting all
eligibility criteria. Four main themes were identied in the analysis, with almost all participants reporting
experiences during physiotherapy interactions relating to at least one of the following themes: assumptions
about participantssexuality or gender identity; proximity/exposure of bodies, including discomfort about
various aspects of physical proximity and/or touch and undressing and/or observing the body; discrimina-
tion, including reports of overt and implicit discrimination as well as a fear of discrimination; and lack of
knowledge about transgender-specic health issues. Positive experiences were also evident across the rst,
third and fourth themes. Participants suggested or supported a number of ways to improve LGBTIQþex-
periences with physiotherapy, including: LGBTIQþdiversity training for physiotherapists, education specic
to the LGBTIQþpopulation (particularly transgender health), and open options for gender provided on forms.
Conclusion: People who identify as LGBTIQþcan experience challenges when attending physiotherapy,
including: erroneous assumptions by physiotherapists, discomfort, explicit and implicit discrimination, and a
lack of knowledge specic to their health needs. Positive ndings and participant-suggested changes offer
ways to improve physiotherapy for LGBTIQþpeople across educational and clinical settings. [Ross MH,
Setchell J (2019) People who identify as LGBTIQDcan experience assumptions, discomfort, some
discrimination, and a lack of knowledge while attending physiotherapy: a survey. Journal of Physio-
therapy 65:99105]
© 2019 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under
the CC BY-NC-ND license (
A signicant, and increasing, number of Australians identify as not
being heterosexual (3 to 11%)
and/or gender diverse. Lesbian, gay,
bisexual, transgender, intersex, queer and related identities
(LGBTIQþ) civil rights have become a topic of increased social and
political debate in Australia and other countries over recent years.
Although this debate has resulted in reduced discrimination,
including policy changes such as legalisation of same-sex marriage in
some countries, stigma and inequity still exist.
Health and access to healthcare remain an important area of
inequity for LGBTIQþpeople.
Globally, LGBTIQþpeople experience
signicantly poorer health and greater barriers to healthcare.
Research consistently highlights poorer mental health,
much higher suicide rates than in the general population.
health is also poorer,
with those identifying as LGBTIQþmore likely
to be diagnosed with cardiovascular disease,
and disability.
One third of Australians who identify as LGBTIQþdo not disclose
their sexuality or gender identity when accessing healthcare,
reasons largely unresearched but proposed to be due to fear of
discrimination, including receiving poorer care.
Research has
highlighted that LGBTIQþpatients feel judged and receive subopti-
mal care from a variety of health professions, including medicine and
mental health,
and peri-natal care.
However, there
has been no research investigating how people who identify as
LGBTIQþexperience physiotherapy.
While similarities between physiotherapy and other health
professions exist, and previously identied barriers may apply
to all forms of healthcare, it is likely that there are barriers
unique to physiotherapy.
Physiotherapy can be innately inti-
mate, with undressing, critical observation and touch common
during treatment.
These aspects can be difcult to
negotiate, with some physiotherapy patients feeling uncom-
fortable or judged.
There may be similar effects for LGBTIQþ
Journal of Physiotherapy 65 (2019) 99105
1836-9553/© 2019 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (
journal homepage:
To address the dearth of literature on the topic, this studyaimed to
identify how people who identify as LGBTIQþexperience physio-
therapy. Understanding any key concerns will provide physiothera-
pists with opportunities to improve (where required) provision of
healthcare to LGBTIQþpeople.
Therefore, the research questions for this mixed-methods survey
1. What are the experiences of people who identify as LGBTIQþand
attend physiotherapy?
2. How could those experiences be improved?
People who identied as LGBTIQþand had attended physiotherapy
were invited to complete an online survey about their experiences of
physiotherapy. Recruitment was via social media, word of mouth, and
LGBTIQþorganisations in Australia. Snowballing was encouraged.
Data were collected using the online survey.
This method was
chosen because data needed to be collected from a large number of
participants to suit the study aim of seeking an overview of the ex-
periences of people identifying as LGBTIQþwith physiotherapy.
Study information was detailed online before providing consent and
entering the survey. Participants remained anonymous throughout
the survey. The survey was purpose-built and comprised questions
related to demographic data, and about participants experiences of
physiotherapy relating to their identity as LGBTIQþ(see Box 1 for an
overview of questions). The survey had one quantitative section
where participants identied (using a Likert scale) levels of support
for strategies to improve LGBTIQþexperiences of physiotherapy.
Inclusion criteria were: aged 18 years, self-identifying as
LGBTIQþ, had attended physiotherapy, and English speaking. Key
recruitment wording was Do you identify as LGBTIQþ?Haveyou
seen a physiotherapist? We want to hear from you.Participant
numbers were determined by the principle of saturation. Sufcient
saturation was considered to be reached when iterative analyses
during data collection demonstrated sufcient repetition and depth
of concepts in the data related to the study aims.
Theoretical underpinnings
This descriptive study was underpinned by the theory of rela-
tivism. That is: people have different experiences and there is no one
knowable version of reality.
This theoretical perspective allows the
possibility for no singular experience of people who identify as
LGBTIQþand attend physiotherapy, but rather there may be multiple
experiences. This reasoning is consistent with understandings of
pluralism (ie, many factors inuence peoples experiences) and
intersectionality (ie, these many factors affect each other).
For this
study, this means that people who identify as one aspect of LGBTIQþ
might have different physiotherapy experiences (eg, someone who
identies as a lesbian might have different experiences to a trans-
gender man). Further, sexuality and gender might not be the only
factors inuencing peoples physiotherapy experiences: other factors
such as race or social class might also have an effect. Consistent with
this theoretical approach, this study was designed to invite and detect
divergent experiences.
Data analysis
Data analysis was principally qualitative, with a small quantitative
component. For qualitative data, a descriptive thematic analysis
outlined by Braun and Clarke was used.
Analyses were conducted
by two physiotherapists, both of whom identify as LGBTIQþ:JSisan
experienced qualitative researcher and MHR is trained in qualitative
The analysis involved ve iterative stages. First, MHR and JS
independently read the entire dataset and made preliminary notes.
They then re-read the dataset and rened analyses into provisional
themes. Next, the authors discussed their independent analyses to
Box 1. Survey questions.
Participants were encouraged to provide as much detail as possible in response to the following questions:
Overall, how did you feel during your [physiotherapy] appointment/s?
Please describe any situations that made you think about your gender and/or sexual preference [during appointments]?
Please describe any conversations about your gender and/or sexual preference and why you did or did not discuss these.
Please describe any physiotherapy experiences where you felt comfortable or uncomfortable about your gender or sexual preferences.
Were any of your negative or positive LGBTIQþand physiotherapy experiences affected by other factors such as your race, ability, age,
religion, etc?
How do you think the physiotherapist themselves felt during your appointment in relation to your gender or sexual preference? Did they
mention their own gender and/or sexuality?
During your physiotherapy appointment/s, has anyone ever assumed anything about your gender and/or sexuality? If so, please describe
the assumptions and any effects on you.
Please indicate if you would have felt comfortable or uncomfortable discussing your gender/sexual preference with your physiotherapists.
Please describe any experiences you had with coming outabout any aspect of your gender and/or sexuality during any of your
appointments with a physiotherapist.
Do you have any suggestions of what could help your/other LGBTIQþpeoples experience of physiotherapy?
Thinking broadly about LGBTIQþpeople attending physiotherapy, would it be helpful if (Likert scale):
physiotherapists use gender-neutral language
there is an option for non-binaryon forms
physiotherapy workplaces displayed a small rainbow flag in the reception area
physiotherapy clinicsimages show a range of people of different genders and sexualities
physiotherapists receive LGBTIQþdiversity training
physiotherapists are more aware of health issues specific to LGBTIQþpeople
LGBTIQþ= lesbian, gay, bisexual, transgender, intersex, queer or related identities.
100 Ross and Setchell: LGBTIQ+ peoples experiences of physiotherapy
solidify themes and subthemes. MHR then coded all data into these
categories. The fth step was for the authors to further rene this
analysis to nalise coding. Any discrepancies were included in the
ndings. To enhance rigour, an experienced qualitative researcher
external to the study checked nal coding to ensure that results were
grounded in the data. The Consolidated Criteria for Reporting Quali-
tative Data (COREQ)
was also used for rigour; all relevant criteria
were satised. Quantitative data (Likert scale results) were analysed
using descriptive statistics.
In total, 114 people responded to the online survey, with 108 of
these meeting all of the eligibility criteria. The participantsages
ranged from 19 to 75 years. The sample was diverse in terms of living
situation, household income and education level (Table 1).
The participants identied with over 13 genders, including: 67
females (62%), eight transgender males (7%) and four non-binary
people (ie, identifying as neither male nor female, 4%) (Table 2 ).
There was also large variability in sexual orientation, with 41 (38%)
identifying as lesbian, 22 (20%) as gay and 16 (15%) as queer,
amongst 12 other orientations (Table 2). For readers who are un-
familiar with the terminology used in Ta bl e 2, a glossary is pre-
sented in Table 3.
Table 2
Participant gender and sexual orientation.
Characteristic Participants (n = 108)
Gender, n (%)
female 67 (62)
male 18 (17)
transgender male, transmasculine 8 (7)
non-binary 4 (4)
cis-female 3 (3)
gender queer 1 (1)
agender 1 (1)
uid 1 (1)
transmasculine non-binary guy 1 (1)
trans/non-binary 1 (1)
gender queer male 1 (1)
femme 1 (1)
butch female 1 (1)
Sexual orientation, n (%)
lesbian 41 (38)
gay 22 (20)
queer 16 (15)
bisexual 15 (14)
pansexual 4 (4)
heterosexual 3 (3)
bi/pansexual 2 (2)
bisexual/queer 1 (1)
asexual 1 (1)
panromantic 1 (1)
queer lesbian 1 (1)
homosexual 1 (1)
Participants chose more terms to explain their gender and sexual orientations than
presented here (gender n = 18, sexuality n = 17). Some similar terms are grouped.
Table 3
Glossary of gender and sexual orientation terminology. Adapted from the Anti-
Discrimination Commission Queensland
and the Human Rights Campaign.
Term Denition
Agender A term used to describe people who identify as being
without gender
Asexual Having a general lack of interest in sex and sexual desire
Binder Tight fabric worn around the chest to obscure the shape of
Bisexual Having an attraction to both males and females as sexual
partners though not necessarily simultaneously, in the same
way or to the same degree
Butch A word used to describe people who identify as lesbian and
whose appearance and behaviour are seen as traditionally
Cis-gender A person whose gender identity and biological sex (assigned
at birth) align
Gay A term to describe people who are primarily attracted to
people of the same sex as them
Gender binary A concept or belief that there are only two genders and that
ones biological or birth-assigned gender will align with
traditional social constructs of masculinity and femininity
Gender identity An inner sense of ones gender, which could be neither,
either, both, or moving around freely between or outside of
the gender binary
Femme A word to describe people who identify as lesbian and
whose appearance and behaviour are seen as traditionally
Fluid/Gender uid A person who does not identify with a sin gle xed gender or
has a uid or unxed gender identity
Heterocentric Having a heterosexual bias
Homosexual Sexual feeling for a person (or persons) of the same sex
Intersex A term used to describe people born with physical,
hormonal or genetic features that do not t medical norms
for female or male bodies
Lesbian A term used to describe women who are attracted to other
Misgendering Referring to a person in a way that does not reect their
gender identity
Non-binary Not identifying as either male or female
Panromantic Having a romantic attraction to people of all genders
Pansexual A term used to describe someone who has the potential for
attraction to people of any gender though not necessarily
simultaneously, in the same way or to the same degree
Queer An umbrella term used by the LGBTIQþcommunity to
describe a range of sexualities and gender identities that are
outside of heterosexual and gender binary norms
Transgender A term used to describe people who do not identify with the
biological sex they were assigned at birth
A term used to describe people who do not identify with the
biological sex they were assigned at birth they identify
with masculinity more than femininity or the reverse
Table 1
Characteristics of participants.
Characteristic Participants (n = 108)
Age (yr), mean (SD) range 39 (9) 19 to 75
Place of residence, n (%)
metropolitan/urban 83 (77)
regional 16 (15)
rural/remote 8 (7)
not stated 1 (1)
Living situation, n (%)
partner/s 41 (38)
housemate/s 27 (25)
alone 18 (17)
partner/s þchild/ren 17 (16)
child/ren 5 (5)
parent/s 3 (3)
co-housing 1 (1)
partner in a co-operative household 1 (1)
y-in, y-outworker 1 (1)
foster carers 1 (1)
siblings 1 (1)
Household income (AUD), n (%)
,20 000 6 (6)
20 000 to 49 999 18 (17)
50 000 to 79 999 14 (13)
80 000 to 109 999 18 (17)
110 000 to 139 999 18 (17)
140 000 to 169 999 13 (12)
170 000 15 (14)
not stated 6 (6)
Level of education, n (%)
post-graduate 36 (33)
university 33 (31)
tertiary 20 (19)
high school 18 (17)
,high school 1 (1)
Number of visits to a physiotherapist, n (%)
.10 61 (57)
5 to 10 26 (24)
2 to 4 18 (17)
1 3 (3)
Participants were able to select multiple options.
Research 101
Participantsexperiences of physiotherapy (qualitative analysis)
Four themes were identied during analysis of the open responses
(see Table 4). Themes were: assumptions,proximity/exposure of
bodies,discrimination, and lack of knowledge about transgender
health issues. Participants are distinguished by participant numbers
(eg, P34).
Theme 1: Assumptions
Many participants mentioned that physiotherapists made as-
sumptions about them. There were two subthemes assumptions
about sexuality and assumptions about gender identity.
Assumptions about sexuality were that physiotherapists incor-
rectly assumed participants were heterosexual. For example, P32
(female, bisexual) said the physiotherapist had assumed my partner
was maleand another said her physiotherapist assumed I was
straight as I was being treated for a pregnancy-related condition
(P102, female, lesbian). Reactions to these assumptions were mixed.
Many participants expressed frustration or annoyance - often because
they then felt that they had to either disclose their sexual preference
(and risk discrimination) or lie (and hide aspects of their life). For
example, P81 (male, gay) said: I hate the feeling of having to come
out all the timeand another said she felt awkward having to make a
decision (whether) to come out or not, or if its safe to(P107, female,
lesbian). Other people (fewer) said they were not concerned by these
assumptions: It didnt bother me, although it is incorrect, it is the
societal norm and people cannot help assuming these things some-
times(P33, female, bisexual). In contrast, some participants reported
positive experiences when physiotherapists interacted with them in a
way that counteracted assumptions about their sexuality, for
example, P17 (female, queer) said: there was general conversation
about my partner.this helps to normalise things and put me at ease.
The second subtheme was assumptions about peoples gender
identity. Generally, it was assumed that people tted into gender
binary categories of male and female. That is, they were assumed to
be cis-gendered. For example, P38 who identied as non-binary
and panromanticexperienced assumptions across both subthemes
saying [physiotherapists] assumed I was a cis-gendered heterosexual
girl. Every. Single. Time. Thats the default, until I explain. In contrast,
assumptions about gender were received positively by transgender
participants when they were assumed to be the gender with which
they identied. For example, one participant said [the
physiotherapist] assumed I was genetic a transgender
female I was pleased by that(P63, transgender female).
A few participants mentioned assumptions implicit within the
broader physiotherapy environment. For example, P50 (trans/non-
binary, bisexual) said the environment in general wasnt outwardly
queer- or trans-friendly.there were assumptions that customers
were cis-gender and straightand P6 (female, queer) she felt like [it
was] an uber heterocentric space.
Theme 2: Proximity/exposure of bodies
The second theme was proximity/exposure of bodies, which
included subthemes of physical proximity and/or touch, and undressing
and/or observing the body. When physical proximity and/or touch were
part of physiotherapy sessions, some participants expressed a fear of
making therapists of the same gender as them uncomfortable. For
example, P80 (female, lesbian) said massages made me feel hyper
aware about my sexuality. They were strictly professional on her
behalf but I was still anxious that my sexuality might make her un-
comfortable. Male-identied participants highlighted similar
discomfort, for example, P71 (gender queer male, gay) said It wasnt
until there was body contact did I become aware/think about my
gender and sexuality.[W]ould this be more comfortable if I was a
straight male?. Some female-identied participants also mentioned
that they feared sexualisation from male physiotherapists for being
lesbians/women. For example, one participant said she didnt want to
be .seen as buying into any male lesbian fantasies’’ (P17, female,
When their body was exposed or observed, participants discussed
perceptions or fears of judgement for not tting into normative
gender conventions. For example, P30 (uid) said they presented
female but with unshaven legs [and] when the physio was so distant
and cold in her manner, [they] started to wonder whether she was
homophobic or transphobic. Some participants reported choosing to
hide their gender identity, for example, when my back was the issue I
would often have to take my shirt off and Id wear a bra instead of a
binder to avoid questions(P27, agender). Participants also expressed
concern that their biological sex may be exposed while undressed or
being observed. For example, P20 (transgender male) said he was
worried they would know/discover I wasnt biologically male [and]
would realise that I have female hips, etc. I didnt really want to tell
them I was trans.
Theme 3: Discrimination
The third identied theme was discrimination. There were two
subthemes: reports of discrimination by physiotherapists or other
staff, and the fear of discrimination.Reports of discrimination included
both explicit and implicit discrimination. Explicit discrimination was
reported infrequently, but included overt homophobic remarks, or
repeated misgendering. P39 (male transgender) said despite
repeatedly stating my gender and having my gender legally recog-
nised as male/listed as male in their systems, I was referred to as
femaleand she/herby the therapistand another transgender
participant stated that they told the physiotherapist my pronouns are
not optional. She kept forgettingdespite my beard(P40). Partici-
pants also experienced implicit discrimination, that is, the frequently
assumed heterosexuality and/or gender discussed in Theme 1 above.
Fear of discrimination was also commonly reported, and related to
both gender and sexuality. For example: I was unsure of whether
they would have an awkward or uncomfortable reaction and didnt
want to create an uncomfortable situation while I was in a vulnerable
or physically compromised position: at on my face with my clothes
off, or with the therapist manipulating a painful area(P50,
transgender/non-binary, bisexual).
Importantly this fear of discrimination resulted in some partici-
pants saying they did not disclose their gender or sexuality, even
when relevant. For example: My gender afrmation surgery causes
many problems in movement and posture, I wanted to tell the
practitioner why, but wasnt brave enough.[disclosure] would have
explained a great deal about my condition and very likely have
improved the quality of my care(P32, female).
Table 4
Themes and subthemes identied in the qualitative analysis.
Description of theme
Assumptions This theme encompasses
participant descriptions of
the assumptions that were
made about their sexuality
and/or gender identity.
Assumptions of sexuality
Assumptions of gender
Proximity/exposure of bodies This theme relates to the
issues that participants
expressed when physiotherapy
included aspects of physical
proximity, touch, undress
and/or observation.
Physical proximity and/or touch
Undressing and/or observing the body
Discrimination This theme encompasses
participant reports of
discrimination, or fear of
discrimination, for being
Reports of discrimination
Fear of discrimination
Lack of knowledge of transgender health issues This theme encompasses
a lack of knowledge,
understanding or an
over-interest in
health issues.
no subthemes
LGBTIQþ= lesbian, gay, bisexual, transgender, intersex, queer or related identities.
102 Ross and Setchell: LGBTIQ+ peoples experiences of physiotherapy
Other participants similarly suggested they would have liked to
disclose, but felt it would risk the therapeutic relationship if [the
physiotherapist] wasnt supportive I would never be able to go back
to him and because his skills are so specialised I have limited options
(P44, female, bisexual/pansexual).
In contrast, a few participants said they had no fear of discrimi-
nation, for example, I have always felt completely comfortable with
my sexual preferences and gender when seeing my physiotherapist. I
have never been given any reason not to feel this way(P33, female,
bisexual). One participant clearly articulated the benets of feeling
safe to discuss their LGBTIQþstatus with their physiotherapist, for
example: We talk about our lives together.physios can be incredibly
healing and inspiring guides to reconnecting with those essential
parts of life(P16, cis-gender woman, bisexual).
Theme 4: Lack of knowledge about transgender health issues
The nal theme was a lack of knowledge or misunderstanding of
transgender-specic health concerns (eg, about hormone therapy,
surgeries, etc). For example, P40 (transmasculine, non-binary guy)
said he believed that he had to educate them and that they were
incorrectly blaming health issues on being trans. Some participants
expressed signicant distress about physiotherapistsover-curiosity,
for example, [it] felt like it had nothing to do with anything and [I]
felt they were being invasive about my personal life(P34, trans-
masculine, asexual). This was not always the case. One participant
reported a positive experience: my physio took my trans status in his
stride, and otherwise continued to work with me exactly as he had
previously(P21, female).
Participants level of support for strategies to improve care (Likert
scale results)
Participants supported a number of proposed ways to improve
LGBTIQþexperiences with physiotherapy. The degree of support for six
proposed recommendations is presentedin Figure 1. (For the numerical
data used to generate this gure, see Appendix 1 on the eAddenda). The
proposed improvements that the participants particularly supported
were: physiotherapists become more aware of health issues specicto
LGBTIQþpeople (94% likeor really likeidea), physiotherapists un-
dertake LGBTIQþdiversity training (93% likeor really likeidea), and
clinics display images with a range of people of different genders and
sexualities (93% likeor really likeidea). The idea of displaying a
rainbow ag (75% likeor really likeidea) and use of gender-neutral
language (72% likeor really likeidea) were comparatively less well
supported. Some participants expressed ambivalence about displaying
rainbow ags, stating the importance of physiotherapists having a
good understanding of LGBTIQþpeople. I would hate for it to be a token
gesture in place of actual support(P44, female, bisexual/pansexual).
They also highlighted the complexity of using gender-neutrallanguage,
suggesting that some prefer correct use of their gendered pronouns:
some transgender people really like it when they are addressed as the
pronoun that they identify with. This can boost their condence and
make them feel really good about themselves since its something
theyve been wanting and ghting for, for so long.(P25, transgender
The key nding of this study is that physiotherapy interactions
and environments may lack inclusivity of LGBTIQþpeople. This lack
is inconsistent with national and global policies that advocate for
inclusive and respectful physiotherapy treatment of all people.
ndings highlight that almost all participants reported experiences
relating to at least one of the following themes: assumptionsabout
sexuality and gender identity, proximity/exposure of bodies,
discrimination, and a lack of knowledge of trans health issues.
Positive experiences were also reported. However, as with any survey
of healthcare experiences, it is possible that people experiencing
challenges were more likely to respond. The ndings also suggest a
number of potential ways to improve experiences of physiotherapy
for people identifying as LGBTIQþ.
This study found physiotherapists often made erroneous as-
sumptions about LGBTIQþpeoples gender and sexuality. These as-
sumptions were aligned with the underlying heteronormativity of
physiotherapy that some participants mentioned, including as-
sumptions that people are heterosexual and conform to a binary
gender. This study shows that, like elsewhere in society,
sexuality and gender normativity are woven into physiotherapy as an
expected and general norm. Assumptions of gender and/or sexuality
are also pervasive elsewhere in healthcare,
manifesting in a va-
riety of ways as ingrained assumptions within healthcare systems,
including presumptuous use of pronouns, patient forms with male/
female checkboxes only, and assumptions about the need for
Unconscious heteronormative assumptions like
those seen in this study unintentionally result in feelings of invisi-
bility for LGBTIQþpeople,
and incorrect use of gender pronouns
can be distressing for transgender people and other people with non-
binary gender. Similar to other research ndings, participants in this
study supported mechanisms to address these issues, including the
use of inclusive intake forms
(eg, non-binarybeing an option)
and a willingness to use gender-neutral pronouns (eg, theyinstead
of heor she) when appropriate.
Another key nding is perhaps more specic to the physical ther-
apies. The proximity and exposure of bodies during consultation
brought up discomfort for some participants. As transgender and non-
binary people often experience judgement about their bodies,
physiotherapys intimate nature (touching, undressing, close observa-
tion of the body) may at times render it uncomfortable. Similar
discomfort has been noted in physiotherapy settings with other
In order to avoid judgement, participants
sometimes concealed their gender or withheld personal/health
0% 20% 40% 60% 80% 100%
Physiotherapists use gender-neutral language
There is an option for 'non-binary' on forms
Physiotherapy workplaces display a small rainbow flag in the reception area
Physiotherapy clinics' images show a range of people of different genders/sexualities
Physiotherapists receive LGBTIQ+ diversity training
Physiotherapists are more aware of health issues specific to LGBTIQ+ people
Percentage of participants
Proposed recommendation
Really don't like this idea Don't like this idea Not sure about this idea Like this idea Really like this idea
Figure 1. Participant responses to proposed recommendations to improve LGBTIQþpeoples experiences with physiotherapy. LGBTIQþ= lesbian, gay, bisexual, transgender,
intersex, queer or related identities.
Research 103
information that may have been important for their well-being.
Non-disclosure may impact psychological health
and, when rele-
vant to physiotherapy management, could be associated with poorer
physical health outcomes. Self-care improves when people of diverse
gender and/or sexuality feel comfortable to disclose LGBTIQþ
health issues to practitioners.
Consistent with other areas of health-
the current ndings recommend diversity training for
physiotherapists in LGBTIQþ-specic health issues (particularly trans-
gender health) to move towards greater trust for physiotherapists and
their clinics to be considered safe spaces. Although there is a paucity of
physiotherapy-specic resources in this area, there have been recent
developments, including an Australian educational video
and non-
academic articles in national physiotherapy publications.
This study found that many LGBTIQþpeople experienced, or
feared, discrimination related to their sexuality and/or gender iden-
tity while attending physiotherapy. For example, participants re-
ported resistance to use of preferred pronouns. Such discriminatory
behaviour is unacceptable, as both enacted and expected discrimi-
nation have signicant negative effects.
Fearing discrimination
suggests that physiotherapy may feel like a non-accepting environ-
ment, but may also be related to previous negative experiences or
participantsown anxieties. Although this study is the rst to explore
this in physiotherapy, LGBTIQþpeople experiencing discrimination
has been widely reported elsewhere in healthcare.
legislative advances in many countries,
signicant gaps remain in
delivering equitable healthcare for LGBTIQþpeople.
Access to and
utilisation of healthcare is adversely affected by experiences of
discrimination like those seen in the current study.
The current ndings highlight physiotherapistslack of under-
standing of specic health issues for the LGBTIQþcommunity,
particularly transgender health. A similar lack has frequently been
reported across healthcare professions.
While the complexities
of transgender healthcare and requirement for specialist training are
acknowledged, there is a pivotal role physiotherapists could play,
including in pelvic health.
Consistent with other areas of health-
participants in the current study strongly supported training
for physiotherapists in issues specic to LGBTIQþhealth. A recent
systematic review of LGBTIQþhealth inclusion in undergraduate and
professional healthcare training
highlighted the need for develop-
ment of evidence-based curricula covering terminology, stigma and
health issues specic to LGBTIQþpeople.
Inclusion of these
recommended areas in undergraduate and professional development
programs offers a way forward to improving physiotherapy experi-
ences of LGBTIQþpeople.
There are a number of methodological considerations when
applying these ndings beyond the context of this study. The study
was conducted in Australia, which has relatively progressive laws (eg,
same-sex marriage was legalised in 2017) and attitudes towards
people who identify as LGBTIQþ. The ndings are likely to be most
relevant to similar contexts. Further, the recruitment approach
(convenience sample) and uncertainty about uptake rate make it
unclear how common the experiences of physiotherapy reported in
this study are. For example, the results may disproportionately
represent people who are active in online LGBTIQþcommunities or
who access LGBTIQþservices, as these were some of the foci of
recruitment strategies. Nevertheless, with the large sample and di-
versity of participant characteristics, ndings are likely to be fairly
representative. It is also possible people who had experienced
problems were more likely to respond to the survey. The study tried
to minimise this effect by using neutral wording in study recruitment
material. Finally, as this study focused on physiotherapy patients and
did not explore the LGBTIQþidentities of physiotherapists, it would
be benecial to further research how this inuences these
Physiotherapists provide care for diverse people with unique
healthcare needs. This studysndings highlight that people who
identify as LGBTIQþcan experience challenges when attending
physiotherapy. Some people fear receiving, or have experienced,
discriminatory care, which may have negative consequences,
including patients withholding information important to their care,
or avoiding attending physiotherapy. Like any health professional,
physiotherapists have a responsibility to care for the well-being of all
patients, which includes providing a safe environment to discuss all
relevant aspects of their bodies and lives. Improved education of
physiotherapists and implementation of participant-suggested
changes offer ways forward for improving physiotherapy for
What is already known on this topic: Some people who
identify as LGBTIQþreceive suboptimal care in a variety of
health professions, including medicine, nursing, mental health,
and peri-natal care. However, there has been no research to
investigate how people who identify as LGBTIQþexperience
What this study adds: People who identify as LGBTIQþcan
experience challenges when attending physiotherapy, such as:
physiotherapists making incorrect assumptions about LGBTIQþ
patients; patients having concerns about revealing some infor-
mation and receiving discriminatory care; and physiotherapists
lacking knowledge about transgender health issues. Physiother-
apists could become more aware of health issues specific to
LGBTIQþpeople and adopt other strategies to make their prac-
tice more inclusive of this population.
eAddenda: Appendix 1 can be found online at DOI: https://doi.
Ethics approval: This study received ethics approval from the The
University of Queensland Human Research Ethics Committee
Competing interests: Nil.
Source of support: Nil.
Acknowledgements: The researchers would like to thank the
participants and the numerous people and organisations who helped
with study recruitment. Thank you to Laetitia Coles for providing
expert review of the analysis.
Provenance: Not invited. Peer reviewed.
Correspondence: Megan H Ross, School of Health and
Rehabilitation Sciences, University of Queensland, Australia;
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Research 105
... Negative experiences with healthcare are documented by 2SLGBTQIA + individuals, including reports of discrimination and/or harassment or denial of care from health providers [14][15][16][17], leading many patients to delay medical care or forego it entirely [18][19][20]. In physiotherapy, patients who identify as 2SLGBTQIA + have reported incorrect assumptions about their sexuality or gender identity from their therapists, physical discomfort, fear of discrimination, and frustrations with educating their own healthcare professionals about 2SLGBTQIA + health needs [21]. Physiotherapists identifying as 2SLGBT-QIA + have also highlighted the hetero-and cis-normative discourse present in physiotherapy practice, impacting 2SLGBTQIA + patients and peers alike [22]. ...
... Similarly, Canada was the first country to provide Census data (2021) on non-binary and transgender individuals [32]. However, despite these important steps towards greater inclusion in Canada, the 2SLGBT-QIA + community continues to face substantial barriers accessing safe and inclusive spaces for healthcare [12,13] and is met with various forms of discrimination in healthcare settings [14][15][16][17], including in physiotherapy [21]. As the new generations begins their careers, we may see changes in these behaviours and experiences, but results from the present study show greater attention to 2SLGBTQIA + inclusiveness in entry-level programs is warranted. ...
... Further work to examine these concepts is warranted. Ultimately, the evidence shows physiotherapists lack knowledge regarding inclusive practice and 2SLGBT-QIA + health which is an ongoing area of frustration for both 2SLGBTQIA + patients and clinicians [21,22]. ...
Full-text available
Background: Patients who identify as 2SLGBTQIA + report negative experiences with physiotherapy. The objectives were to evaluate student attitudes, beliefs and perceptions related to 2SLGBTQIA + health education and working with individuals who identify as 2SLGBTQIA + in entry-level physiotherapy programs in Canada and to evaluate physiotherapy program inclusiveness towards 2SLGBTQIA + persons. Methods: We completed a nationwide, cross-sectional survey of physiotherapy students from Canadian institutions. We recruited students via email and social media from August-December 2021. Frequency results are presented with percentages. Logistic regression models (odds ratios [OR], 95%CI) were used to evaluate associations between demographics and training hours with feelings of preparedness and perceived program 2SLGBTQIA + inclusiveness. Results: We obtained 150 survey responses (mean age = 25 years [range = 20 to 37]) from students where 35 (23%) self-identified as 2SLGBTQIA + . While most students (≥ 95%) showed positive attitudes towards working with 2SLGBTQIA + patients, only 20 students (13%) believed their physiotherapy program provided sufficient knowledge about 2SLGBTQIA + health and inclusiveness. Students believed more 2SLGBTQIA + training is needed (n = 137; 92%), believed training should be mandatory (n = 141; 94%) and were willing to engage in more training (n = 138; 92%). Around half believed their physiotherapy program (n = 80, 54%) and clinical placements (n = 75, 50%) were 2SLGBTQIA + -inclusive and their program instructors (n = 69, 46%) and clinical instructors (n = 47, 31%) used sex/gender-inclusive language. Discrimination towards 2SLGBTQIA + persons was witnessed 56 times by students and most (n = 136; 91%) reported at least one barrier to confronting these behaviours. Older students (OR = 0.89 [0.79 to 0.99]), individuals assigned female at birth (OR = 0.34 [0.15 to 0.77]), and students self-identifying as 2SLGBTQIA + (OR = 0.38 [0.15 to 0.94]) were less likely to believe their program was 2SLGBTQIA + inclusive. Older students (OR = 0.85 [0.76 to 0.94]) and 2SLGBTQIA + students (OR = 0.42 [0.23 to 0.76]) felt the same about their placements. Students who reported > 10 h of 2SLGBTQIA + training were more likely to believe their program was inclusive (OR = 3.18 [1.66 to 6.09]). Conclusions: Entry-level physiotherapy students in Canada show positive attitudes towards working with 2SLGBTQIA + persons but believe exposure to 2SLGBTQIA + health and inclusiveness is insufficient in their physiotherapy programs. This suggests greater attention dedicated to 2SLGBTQIA + health would be valued.
... Reported negative experiences within healthcare for 2SLGBTQIA+ individuals include discrimination, harassment, and denial of care from healthcare providers [1][2][3][4][5][6]. In physiotherapy specifically, patients who identify as 2SLGBTQIA+ have reported experiencing incorrect assumptions about their sexuality or gender identity from their physiotherapist, discomfort surrounding exposure and physical proximity of bodies, fear of experiencing discrimination, and frustrations with needing to provide education for their physiotherapist about their specific health needs [7]. Similar negative experiences have led some patients to delay or forego medical care entirely [8][9][10]. ...
... Additionally, some students expressed a lack of confidence in their ability to work with clients who identify as 2SLGBTQIA+ in a clinical setting and expressed their lack of knowledge of health considerations relevant to the population. These results support findings by Ross & Setchell where patients who identified as 2SLGBTQIA+ reported being frustrated with physiotherapists not knowing enough about 2SLGBT-QIA+ -specific health considerations [7]. Participants in this study also strongly suggested physiotherapists receive greater 2SLGBTQIA+ education [7]. ...
... These results support findings by Ross & Setchell where patients who identified as 2SLGBTQIA+ reported being frustrated with physiotherapists not knowing enough about 2SLGBT-QIA+ -specific health considerations [7]. Participants in this study also strongly suggested physiotherapists receive greater 2SLGBTQIA+ education [7]. Our findings suggest a student's 1) level of confidence in their ability to communicate with 2SLGBTQIA+ persons, 2) feelings of preparedness to discuss issues related to sex and gender with clients, and 3) level of competency in assessing a client who identifies as 2SLGBTQIA+ were all strongly related to one another. ...
Full-text available
Abstract Background Individuals who identify as 2SLGBTQIA+ report worse health outcomes than heterosexual/cisgender counterparts, in part due to poor experiences with healthcare professionals. This may stem from inadequate 2SLGBTQIA+ health and inclusiveness training in health professional student education. The purpose of the study was to evaluate knowledge, behaviours, and training related to 2SLGBTQIA+ health education and inclusiveness for entry-level physiotherapy students in Canada. Methods We conducted a nationwide, cross-sectional survey with physiotherapy students from accredited Canadian physiotherapy programs. We administered the survey through Qualtrics and recruited students through targeted recruitment emails and social media posts on Twitter and Instagram between August and December 2021. Survey responses are reported as frequencies (percentage). We also completed multivariable logistic regressions to evaluate associations among question responses related to working with 2SLGBTQIA+ individuals (i.e., communication, feeling prepared and assessment competency). Covariates included training hours (
... shortly before the COVID-10 epidemic, Ross & Setchell found that LGBTIQ people experienced challenges when attending physiotherapy, which included erroneous assumptions by physiotherapists, discomfort, explicit and implicit discrimination, and a lack of knowledge specific to their health needs (Ross & Setchell, 2019). ...
... • open options for gender provided on forms (Ross & Setchell, 2019). ...
Full-text available
This is an international review on research on the impact of COVID-19 on LGBTIQ+ people. It documents how LGBTIQ+ people were already disadvantaged in numerous areas before the epidemic, but that COVID-19 and the lockdowns increased there plight, espcially for the most vulnerable groups among them.
... Only a small number of schools consider sexual identity. This is in line with a study from Ross et al. (2019) showing that people identifying as LGBTIQ + report discriminatory experiences, discomfort, and lack of knowledge when attending physiotherapy. Ion et al. (2021) also state that gender identity has to be part of the nursing curricula. ...
Full-text available
Background Knowledge of sex, gender and further diversity categories is important to achieve equitable and individualized healthcare. An official statement of the German government stipulates the mandatory integration of sex and gender aspects into the curricula of health professions. Here we aim at evaluating the extent of curricular integration as well as barriers and factors supporting the integration. Methods The study was conducted online between January and March 2020. Three semi-standardized questionnaires were developed and sent to the deans of all medical faculties and a random sample of 197 (36.7%) heads of nursing schools (NS) and 97 (33.9%) heads of physiotherapy schools (PS). They were asked about the extent of curricular integration of diversity aspects as well as barriers and aspects facilitating the integration. Results The response rate was 75.6% (n=31; MS), 52.5% (n=94; NS) and 54.6% (n=53; PS). The highest level of curricular integration was achieved by 3.7% (MS), 4.8% (NS) and 6.4% (PS). Teachers were indicated to be mainly responsible for the integration (MS: 36%; NS: 73%; PS: 65%). Sociocultural aspects were integrated to a lesser extent in MS curricula compared to NS and PS. Qualitative analysis showed lack of gender theory in curricula. Conclusions Sex and gender aspects are integrated into around 30% of medical, nursing and physiotherapy curricula. Main supporting factors were the integration into the German National Learning Catalogue of Medicine and framework curricula. Case discussions were considered to be the most suitable teaching format. Future directions are the integration of gender theories.
Introduction Providing culturally responsive, patient-centered care is crucial for ensuring safe and positive health care experiences for individuals with diverse gender identities and sexual orientations. Doing so requires adequate training and knowledge of the health professionals involved in those health care experiences. Review of Literature Individuals identifying as lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other related identities (LGBTQIA+) experience significant barriers to health and positive health care experiences. In physical therapy, research has identified that individuals who identify as LGBTQIA+ experience discrimination, discomfort, and lack of practitioner knowledge about health needs. The aim of this study was to determine how, and to what extent, content related to LGBTQIA+ individuals is included in Australian physical therapy curricula as well as perceived barriers to inclusion. Subjects Physical therapy program directors (PDs) as of January 2022 for all Australian universities that deliver physical therapy programs (n = 24). Methods A Qualtrics survey was emailed to PDs to collect quantitative and qualitative data regarding the inclusion and mode of delivery of LGBTQIA+ content, as well as the perceived importance, and barriers to inclusion, of LGBTQIA+ curricula. Results Twenty-four (100%) universities (PD or proxy) responded to the survey. More than 62% (15/24) of PDs reported that their programs included LGBTQIA+ content with 88% (21/24), indicating that LGBTQIA+ content is relevant to the physical therapy curriculum. Time devoted to LGBTQIA+ content ranged from 0 to 6 (median 2–4) hours across any year, delivered primarily in general or foundational courses (37%). Perceived lack of trained faculty (14/22; 64%) and time (13/22; 59%) were barriers to the integration of LGBTQIA+ specific content into the curriculum. Discussion Our results indicate that the physical therapy curriculum may be contributing to ongoing negative experiences of individuals identifying as LGBTQIA+ with physical therapy encounters. Although most (87%) physical therapy program leaders in Australia believe that LGBTQIA+ specific content is relevant to the training of new graduates, content is included in only 62% of curricula. Perceived barriers to inclusion of LGBTQIA+ specific curriculum were a lack of time and appropriately trained faculty. Externally developed content is available to address limited expertise within programs, but faculty may require guidance on how to overcome perceived lack of time (ie, space in the curriculum). Conclusion Most Australian physical therapy programs include LGBTQIA+ content to a limited extent in their curricula, indicating a lack of perceived importance relative to other topics. In this way, Australian universities are maintaining the pervasive heteronormativity of the physical therapy profession and are complicit in the ongoing health disparities between the LGBTQIA+ and heteronormative communities.
Introduction: Individuals identifying as lesbian, gay, bisexual, transgender, queer, intersex, asexual and other related identities (LGBTQIA+) experience challenges with healthcare, including physiotherapy. To understand potential contributions to poor experiences, this study explored physiotherapists' experiences and perspectives about working with members of LGBTQIA+ communities. Methods: This study employed a qualitative research design, suitable for exploring the experiences and perspectives of individuals within the physiotherapy context. The sample consisted of physiotherapists working in Australia who participated in a larger survey study. Data were collected via semi-structured interviews which were audio-recorded and transcribed verbatim. Data analysis was conducted using a relativistic and queer theoretical framework with a reflexive thematic approach. Results: Eighteen physiotherapists with diverse sexual orientations participated in the interviews. While all participants identified as women or men, not all used binary gender pronouns. Five key themes were developed: 1) "anti-discrimination" regarding choice of language and providing safe environments; 2) "current and historical discrimination" against LGBTQIA+ individuals; 3) "taking an equality approach" when working with LGBTQIA+ patients; 4) "knowledge of LGBTQIA+ health" in a broad sense and specifically with transgender and gender-diverse people; and 5) "managing own reactions" with respect to individual biases and discomfort. Conclusion: Underpinning all themes was the overarching concept of cis/hetero/endonormativity. Assuming normativity when working with LGBTQIA+ patients, is likely to have negative effects on patients' mental health, the therapeutic relationship and quality of care. In order to improve diversity, safety, inclusion and equity of care for LGBTQIA+ individuals, it is vital that normativity within physiotherapy is challenged.
Objective: To identify and map research into the visibility of LGBTQIA+ people and their relationships in healthcare, with the view to inform future research and practice. Method: Five databases were systematically searched for published and grey literature. Primary research reporting on visibility of LGBTQIA+ people in healthcare was included. Two reviewers independently screened the studies until an acceptable level of agreement was reached. A narrative synthesis was conducted and findings mapped to a taxonomy of microaggressions involving three sub-categories: microinsults, microassaults and microinvalidations. Results: The microaggressions identified included Microinsults: 'Perception of health professionals' knowledge and comfort' and 'Disclosure'; Microassaults: 'Discrimination and stigma'; Microvalidations: 'Accessing and navigating through services', 'Encounters of assumptions and stereotypes', 'Validating identities and including relationships', and 'Reading the environment'. Conclusion: Despite growing societal acceptance, microaggressions still exist within healthcare. Groups within LGBTQIA+ communities have varying levels of visibility in research and healthcare based on the studies included. Practice implications: The limited visibility of LGBT and lack of visibility of QIA+ people and their relationships in healthcare highlight the need to include the views of all LGBTQIA+ communities in research, and to ensure health professionals and clinical services are equipped to address this (in)visibility gap.
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Purpose: In this study, we explored experiences and feelings of safety in public facilities in relation to psychological well-being among transgender and gender nonconforming (TGNC) youth in the Midwest in the summer of 2016, in the context of ongoing legislative proposals and regulations regarding school and public bathroom use in the United States. Methods: We used a mixed-method approach, with (1) a self-administered, paper-and-pencil survey of 120 TGNC youth, focusing on differences of self-esteem, resilience, quality of life (QoL), perceived stigma, feelings of safety, and experiences of public facility use and (2) two focus group interviews (n=9) in which TGNC youth discussed individual perceptions, attitudes, and experiences of bathroom use outside participants' homes. The samples consisted predominantly of individuals assigned female at birth and currently of trans-masculine identity. Results: TGNC youth in our sample who reported that they had felt unsafe in bathrooms due to appearance or gender identity had significantly lower levels of resilience (mean(felt safe)=125.7 vs. mean(felt unsafe)=116.1; p=0.03, Cohen's d=0.44) and QoL (mean(felt safe)=59.1 vs. mean(felt unsafe)=51.9; p=0.04, Cohen's d=0.39), compared to those who felt safe. Meanwhile, feeling unsafe in bathrooms was associated with a greater level of perceived LGBT stigma (mean(felt safe)=2.3 vs. mean(felt unsafe)=2.6; p=0.03, Cohen's d=0.41) and problematic anxiety in the past year (χ² (1)=4.06; p=0.04). Individuals in the focus groups provided specific examples of their experiences of and concerns about locker room or bathroom use in public facilities, and on the impact of school bathroom-related policies and legislation on them. Conclusion: Perceptions of safety related to bathroom use are related to psychological well-being among TGNC youth. Our predominantly trans-masculine youth sample indicated that choice of bathroom and locker room use is important and that antiharassment policies need to support students' use of their choice of bathrooms. This is particularly important information given debate of so-called bathroom bills, which attempt to restrict public bathroom use for TGNC youth, creating less choice and more stress and fear among these individuals.
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Introduction: Poor access of lesbian, gay, bisexual and transgender (LGBT) people to healthcare providers with clinical and cultural competency contributes to health inequalities between heterosexual/cisgender and LGBT people. This systematic review assesses the effect of educational curricula and training for healthcare students and professionals on LGBT healthcare issues. Methods: Systematic review; the search terms, strategy and process as well as eligibility criteria were predefined and registered prospectively on PROSPERO. A systematic search of electronic databases was undertaken. Screening for eligible studies and data extraction were done in duplicate. All the eligible studies were assessed for risk of bias. The outcome of interest was a change in participants’ knowledge, attitude and or practice. Results: Out of 1171 papers identified, 16 publications reporting 15 studies were included in the review. Three were non-randomized controlled studies and 12 had a pre/post-design; two had qualitative components. Bias was reported in the selection of participants and confounding. Risk reported was moderate/mild. Most studies were from the USA, the topics revolved around key terms and terminology, stigma and discrimination, sexuality and sexual dysfunction, sexual history taking, LGBT-specific health and health disparities. Time allotted for training ranged from 1 to 42 hours, the involvement of LGBT people was minimal. The only intervention in sub-Saharan Africa focused exclusively on men who have sex with men. All the studies reported statistically significant improvement in knowledge, attitude and/or practice post-training. Two main themes were identified from the qualitative studies: the process of changing values and attitudes to be more LGBT inclusive, and the constraints to the application of new values in practice.Conclusions: Training of healthcare providers will provide information and improve skills of healthcare providers which may lead to improved quality of healthcare for LGBT people. This review reports short-term improvement in knowledge, attitudes and practice of healthcare students and professionals with regards to sexual and LGBT-specific healthcare. However, a unified conceptual model for training in-terms of duration, content and training methodology was lacking.
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Objectives. We investigated health disparities among lesbian, gay, and bisexual (LGB) adults aged 50 years and older. Methods. We analyzed data from the 2003–2010 Washington State Behavioral Risk Factor Surveillance System (n = 96 992) on health outcomes, chronic conditions, access to care, behaviors, and screening by gender and sexual orientation with adjusted logistic regressions. Results. LGB older adults had higher risk of disability, poor mental health, smoking, and excessive drinking than did heterosexuals. Lesbians and bisexual women had higher risk of cardiovascular disease and obesity, and gay and bisexual men had higher risk of poor physical health and living alone than did heterosexuals. Lesbians reported a higher rate of excessive drinking than did bisexual women; bisexual men reported a higher rate of diabetes and a lower rate of being tested for HIV than did gay men. Conclusions. Tailored interventions are needed to address the health disparities and unique health needs of LGB older adults. Research across the life course is needed to better understand health disparities by sexual orientation and age, and to assess subgroup differences within these communities.
AIMThe purpose of the study was to examine how the lesbian, gay, bisexual, and transgender community (LGBT) population is represented and portrayed in mainstream obstetrical nursing courses, curricula, textbook, and syllabi. BACKGROUND Researchers have indicated that LGBT patients are often dissatisfied with their health care experiences because of the limited training received by nursing professionals. METHOD This study employed a qualitative, intrinsic case study researchmethod. Qualitative data were collected via document reviews and unstructured interviews with open-ended questions. The data were analyzed by theme analysis and constant comparison. RESULTS Data analysis indicated that nurse faculty are not knowledgeable about LGBT obstetrical health issues and how to incorporate LGBT issues into the curriculum. CONCLUSION There is a critical need for faculty development on how to infuse information on LGBT content in obstetrics curricula.
Background: An inclusive health curriculum within undergraduate and continuing professional development programmes (CPD) should include issues related to people whom identify as LGBT+. Objectives: The aim of this systematic review was to examine the education and training requirements of undergraduate students and health professionals regarding the inclusion of LGBT+ health issues. Design: A systematic review of the available published empirical studies. Data sources: A systematic literature search was undertaken of the following databases: CINAHL, PubMed, PsycINFO, Embase and Sociological Abstracts. All papers reviewed were from the years 2007 to 2017 and written in English. Review methods: Three research questions informing the literature review were: (i) What are the education and training requirements of undergraduate students and health professionals regarding the health needs of LGBT+ people? (ii) What are the approaches utilized in the education and training of undergraduate students and health professionals regarding the health needs of LGBT+ people? (iii) What are the best practice examples of the education and training of undergraduate students and health professionals? Following the application of definitive criteria, 22 papers were included in the review. Quality appraisal and data extraction was undertaken by the two authors. Results: The 22 papers were reviewed in detail in the final data analysis and synthesis where four main themes were identified: (1) Cultural competence and inclusivity. (2) Existing knowledge of LGBT+ health-related issues. (3) Curriculum developments and outcomes. (4) Evidence of best practice in education delivery. Conclusion: The review highlights the importance of the inclusion of LGBT+ health-related issues within the health curriculum and continuing professional development programmes and the implications for education and training, clinical practice and research.
This article presents findings from a small-sample, exploratory focus group study examining LGT persons’ descriptions of healthcare experiences and perceptions of best practices in healthcare. Goals of the study were to identify areas in which healthcare experiences can be improved through enhancements in healthcare provider education, consciousness-raising, skill development, and/or healthcare system. This article presents focus group data, which revealed major interpersonal and healthcare system-level themes, including similarities and differences between and among sexual orientation/gender identity groups (lesbian, gay, HIV+ gay men, and transgender individuals). Implications are discussed for improved quality in LGBT healthcare delivery, health professions’ education, patient–provider relationships, and reducing social injustices associated with discriminatory healthcare experiences. © 2017 The Society for the Psychological Study of Social Issues
Sexual and gender minorities experience disparities in mental and physical health often attributed to structural discrimination through policies that do not promote equal rights and interpersonal–intrapersonal processes. Social issues research on stigma and intergroup relations can explicate the intervening processes that explain health. In this introduction to the special issue entitled Translating Stigma and Intergroup Relations Research to Explain and Reduce Sexual and Gender Minority Health Disparities, we call social issues researchers to focus their work on sexual and gender minority stigma and intergroup relations processes in order to understand and ultimately reduce health disparities.
Trans people experience high rates of attempted suicide and suicidal ideation. No study to date has collated the various findings concerning correlates of trans suicide. This systematic review aimed to summarize the available data and provide recommendations based on this evidence. Articles were included if they were published before November 2016, were in English, were peer reviewed, and presented data concerning trans people’s suicide attempts or ideation. Nine databases were searched, and 30 articles were selected. Discrimination emerged as strongly related to suicidal ideation and attempts, whereas positive social interactions and timely access to interventions appeared protective. Limitations included differences in how articles defined trans people or measured suicide and in their largely cross-sectional nature, making assumptions about causality in reference to lifetime ideation or attempts impossible. However, results clearly indicated a need to work at both individual and structural levels to reduce society- and service-level discrimination, enhance peer support, and ensure access to required interventions. The review highlights the need to explore suicidality in the trans population both in relation to general suicide models and in relation to models of minority stress.
Nearly fifteen years have passed since this author’s publication which examined the depth of education and training for medical students and practicing physicians specific to clinical competence in the care of lesbian and gay patients in the United States. Since then, there has been an explosion of research gains which have shed a steady light on the needs and disparities of lesbian and gay healthcare. This rich literature base has expanded to include bisexual and transgender (LGBT) healthcare in peer-reviewed journals. Despite these research gains underscoring a call for action, there continues to be a dearth of cultural competency education and training for healthcare professionals focused on clinical assessment and treatment of LGBT patients. This article will focus exclusively on the current status of medical and nursing education and training specific to clinical competence for LGBT healthcare. We are long overdue in closing the clinical competency gap in medical and nursing education to reduce the healthcare disparities within the LGBT community.