Beyond LGBT: a qualitative exploration of the primary healthcare experiences and needs of underrepresented 2SLGBTQIA+ young adults in Manitoba
Bibliographic record
Abstract
Background: Though growing, the body of 2SLGBTQIA+ health research is small and privileges the experiences of white, gay and bisexual men, and lesbians. Further, research regarding the healthcare experiences of transgender individuals is dominated by binary gender identities, and little is known about the true prevalence of gender diversity. Research with the 2SLGBTQIA+ community has found this population is at increased risk for adverse health outcomes such as problematic drug use, domestic violence, depression, anxiety, and suicidal ideation. Primary healthcare cannot be utilized as a pathway to risk reduction if primary care practitioners (PCPs) are operating under heterocisnormative assumptions. Young adults (ages 19-30) have a whole life of healthcare needs ahead of them. Examining their unique experiences as young adults and members of the 2SLGBTQIA+ community can help to improve the quality of care they receive from their providers. Decreased utilization of primary healthcare because of barriers, such as discrimination, results in a reduction of preventative care that can be offered to patients. By dismantling barriers early in the life course, patients can safely engage with primary care and improve their long-term health outcomes. Objectives: Significant knowledge gaps exist in the research literature with regards to who among the 2SLGBTQIA+ community is represented in health research. No studies in the literature review specifically investigated the experiences of demisexual, asexual, pansexual, or polysexual individuals and none contained any consideration of romantic identity as a separate identity. The present study sought to begin to fill these gaps by listening to the voices of historically underrepresented 2SLGBTQIA+ community members by including a broader range of gender identities, sexual orientations, and romantic orientations, asking the research question: What are the primary healthcare experiences and needs of underrepresented young adults of the 2SLGBTQIA+ community in Manitoba? Methods: The study consisted of two phases. In phase one, 20 one-one-on interviews were conducted. Interviews were thematically coded using interpretive phenomenology analysis (IPA). In phase two, the themes that arose from the IPA coding were developed into a survey instrument. A draft version of the survey was shared via e-mail with interview participants to initially validate the captured themes and survey questions. Findings: The study revealed seven themes related to the primary healthcare experiences of underrepresented 2SLGBTQIA+ young adult patients: medical gaslighting, managing identity, the adverse impact of heterocisnormativity, frustration with medical education, rurality exasperating adverse experiences, navigating provider level factors to access affirming care, and the power of community care. Sixteen of the twenty participants in this study were either partially or fully closeted from their primary healthcare provider. Participants also provided recommendations for improving the quality of care that 2SLGBTQIA+ patients receive from their primary healthcare provider, which included mandatory 2SLGBTQIA+ education, licensing requirements, structural and system changes, and patient-centered care. Significance: The health literature to-date represents a narrow definition of the 2SLGBTQIA+ community. The inclusive nature of this study allowed for a wider range of identity expressions, including sexual/romantic orientation, and gender identity. This allowed for a deeper understanding of what it means to be a part of the 2SLGBTQIA+ community, and to further examine how these identities intersect with others in the primary healthcare context. Study findings may inform clinical guidelines to improve the quality of and access to healthcare for those in the 2SLGBTQIA+ community. Further, the study findings may also provide clinicians with an increased understanding of the complex needs of 2SLGBTQIA+ individuals and improve timeliness of recommending patients to appropriate secondary healthcare options.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.012 | 0.006 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".