Examples of barriers faced by health professionals when providing care
Examples of barriers faced by LGBTI people when accessing care
Knowledge and training
Many generic and specialist health professional lack the appropriate knowledge regarding lives and related health(care) needs of LGBTI people as well as lack the appropriate culturally competent skills necessary to meet the needs of LGBT(I) people (Alessi et al., 2016; Bailey et al., 2014; Budge et al., 2013; Chakraborty et al., 2011; Elliott et al., 2015; Gonzales & Henning-Smith, 2015; Jones, 2016; Moe & Sparkman, 2015; Pennant et al., 2009; Sanders, Carter, & Lwin, 2015; Sharek et al., 2015; Sherriff et al., 2011; Utamsingh et al., 2016; Zeeman et al., 2016).
In a mixed-methods research design combining quantitative survey and qualitative interview methods (n=144 and n=36 respectively), only 41% of older LGBT people in healthcare thought health professionals had sufficient knowledge of LGBT issues leaving a staggering 59% who did not (Sharek et al., 2015).
Appropriate training is required to redress these key gaps in the knowledge of health professionals (Moe & Sparkman, 2015).
Example of limited knowledge from rapid-reviews:
Rapid-reviews overwhelmingly drew attention to literature highlighting the seemingly limited education and training opportunities available for health professionals to address the specific health needs of LGBTI people in Member States. In Finland according to a survey conducted by American Psychiatric Association, only 30% of psychologists and psychology students were familiar with issues concerning gender variance and trans people meaning that 70% did not have the relevant knowledge. Several rapid-reviews from MS provided examples of quotes from the grey literature showing the need to increase knowledge to tackle ignorance around LGBTI issues.
Some reviews highlighted specifically literature showing that some health professionals have limited knowledge of how to support LGB youth who might be struggling with their sexual orientation:
"I think you have to be very precise and I personally think that I do not have sufficient knowledge, information, ideas on how to deal with it. How to guide a young person who is in an identity crisis? What am I? Am I gay, lesbian, bisexual? What does that mean? How do I bring it out or how do I do that? How do I find it?" (Health professional, Netherlands)
(Source: Report – Emmen et al., 2014 Jong & anders. Nederlands Jeugdinstituut en Movisie) Rapid-reviews highlighted that in some MS, state funded specialist services to support gender transitioning were reported as being difficult to access or not provided by a range of MS [x9 MS: Bulgaria, Croatia, Czech Republic, Denmark, Finland, France, Portugal, Romania, Slovakia]. Some practitioners did not have the relevant training to provide treatment for trans people.
“I have contacted 16 doctors from [name] and local towns. Most of them wrote back to me explaining that they do not work with people like me and they have no information [about the options of transitioning in Slovakia]. They know nothing, they are not trained or they simply wrote to me that they are not interested in meeting me.” (Anonymous, 20 year-old, Slovakia)
(Source: Guidebook - Transfúzia 2015 The standards of trans-inclusive environment in the healthcare system. Transfúzia)
Questions to consider
1. LGBT(I) people are more likely to come out if they know health professionals will uphold their confidentiality and privacy. How could practitioners work in partnership with LGBTI people to reassure and protect their confidentiality and privacy in healthcare settings?
2. What kind of documentation, pathways, and protocols can be developed to specifically target the health needs of LGBTI people?
Learning points
Health professionals should show greater cultural awareness and sensitivity towards gender and sexual plurality, and recognise that people might identify as LGBTI. In this way, health professionals can foster better holistic care and greater social inclusion in health settings.
Where LGBT(I) people are informed of who has access to their information and are asked to provide consent prior to information being shared with other professionals or related agencies, they are more likely to ‘come out’.
Disclosure of sexual orientation can (but not always) bring health benefits and greater levels of satisfaction with care received due to better communication between health professionals and LGB people. Where health professionals hold positive attitudes towards LGBT people, ‘coming out’ is more likely.
Where health professionals accept LGBTI people unconditionally without making judgements and show respect in their interactions with LGBTI people, they are more likely to open up and in return trust health professionals.
Practitioners should use affirmative language that acknowledge the LGBTI status of patients without judgement, for example by using the same terms that patient uses to describe themselves or by using language appropriate to the gender identity of trans people.
Trans (and intersex) people may have particular needs for recording demographic information and health status for example where their chosen name and gender identity differs from their legal designated name and sex. This may need including both legal name, preferred name, gender identity and pronoun.
Greater consistency in care provided, including by one practitioner, could offer the opportunity needed to provide person centred care allowing for mutual respect and trust to develop over time.
Training is needed to develop knowledge of the intersecting needs of LGBTI people relating to sexual orientation, gender identity, sex characteristics, ethnicity, age, disability and socio-economic status is required.
3.5.7 Summary
This section has explored how healthcare providers can both knowingly and unknowingly perpetuate homophobia, bi-phobia, interphobia and transphobia. LGBTI people may not disclose their sexual orientation, or gender identity or sex characteristics, but can be encouraged to do so, through ensuring confidentiality, and by health professionals refraining from making judgements and not presuming people are heterosexual and cisgender. Health workers have an ethical responsibility and duty of care to provide high quality health services, regardless of the sexual orientation, gender identity or sex characteristics of their patients. They could play an important role in accepting LGBTI people without judgement and acknowledge any feelings of fear that may accompany treatment to facilitate greater uptake health services. LGBTI people can be encouraged to work in partnership with health professionals to provide appropriate treatment and care by verbalising their specific health needs or by ‘coming out’ in health settings (when relevant) that offer a safe environment. Institutional issues, such as literature that assumes heterosexuality, overlooks specific health needs related to other sexual orientations. Furthermore, where there are numerous health providers this can lead to a lack of consistency in care for LGBTI people, and mitigate against positive experiences of healthcare. Research suggests that healthcare providers require better knowledge of LGBTI healthcare and that training can be beneficial to reducing health inequities. In order to provide access to healthcare, more knowledge is needed to understand the barriers that both health professionals face when providing care, as well as the barriers LGBTI people face when accessing health services and knowledge of how these barriers can be overcome.
3.6 What examples of promising practice exist to address the health needs of LGBTI