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      “I felt like a freak when I would go to the doctor”: Investigating healthcare experiences across the lifespan among older LGBT and transgender/gender diverse adults

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          Abstract

          In the past several decades, the United States has enacted civil rights legislation protecting lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations from discrimination, including enacting proactive healthcare laws such as the Affordable Care Act. However, given today’s divisive politics, LGBTQ people’s access to appropriate and respectful health care is precarious. This study explored the disconnections from and connections to health care and the respective health effects among two self-identified groups: i) older LGBT adults and ii) transgender and gender-diverse (TG/GD) adults. Using a life course perspective, qualitative data from 17 older LGBT and TG/GD participants were analyzed. Thematic and content analyses indicated that despite progress made, discrimination and prejudice in obtaining health care persist, particularly among TG/GD people of color. The results highlight the ongoing challenges LGBTQ populations face as they risk being denied care by healthcare providers and disconnected from the healthcare system.

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          Naturalistic inquiry

          Yvonna Lincoln, Egon Guba, Joseph Pilotta (1985)
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            Structural competency: Theorizing a new medical engagement with stigma and inequality

            Jonathan M. Metzl, Helena Hansen (2014)
            This paper describes a shift in medical education away from pedagogic approaches to stigma and inequalities that emphasize cross-cultural understandings of individual patients, toward attention to forces that influence health outcomes at levels above individual interactions. It reviews existing structural approaches to stigma and health inequalities developed outside of medicine, and proposes changes to U.S. medical education that will infuse clinical training with a structural focus. The approach, termed “structural competency,” consists of training in five core competencies: 1) recognizing the structures that shape clinical interactions; 2) developing an extra-clinical language of structure; 3) rearticulating “cultural” formulations in structural terms; 4) observing and imagining structural interventions; and 5) developing structural humility. Examples are provided of structural health scholarship that should be adopted into medical didactic curricula, and of structural interventions that can provide participant-observation opportunities for clinical trainees. The paper ultimately argues that increasing recognition of the ways in which social and economic forces produce symptoms or methylate genes then needs to be better coupled with medical models for structural change.
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              New Directions in Life Course Research

              Karl Mayer (2009)
              Article 0 comments Cited 131 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Qual Res Med Healthc
                Journal ID (iso-abbrev): Qual Res Med Healthc
                Journal ID (publisher-id): QRMH
                Title: Qualitative Research in Medicine & Healthcare
                Publisher: PAGEPress Publications, Pavia, Italy
                ISSN (Electronic): 2532-2044
                Publication date (Electronic): 04 April 2024
                Publication date Collection: 13 March 2024
                Volume: 8
                Issue: 1
                Electronic Location Identifier: 11879
                Affiliations
                Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University , Cleveland, OH, United States
                Author notes
                Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University 11235 Bellflower Rd, Cleveland, OH 44106, USA. 415.517.7885. roni.diamant-wilson@ 123456case.edu

                Contributions: RDW was the primary researcher and author. She transcribed the interview recordings, coded and analyzed the data, and wrote the manuscript. MRN and BG collected data, transcribed the interview recordings, coded and analyzed the data, and edited the manuscript. DMP, the co-principal investigator in the original project, collected data and advised us throughout the study. LJM and SEM, co-principal investigators in the original project, reviewed the manuscript and provided feedback.

                Conflict of interest: The authors declare no conflicts of interest.

                Patient consent for publication: Written informed consent was obtained from a legally authorized representative(s) for anonymized patient information to be published in this article.

                Availability of data and materials: All data generated or analyzed during this study are included in this published article.

                Disclosures: This project was supported by the Clinical and Translational Science Collaborative of Cleveland, funded by the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Science Award grant, UL1TR002548. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. No artificial intelligence (AI-assisted technologies) was used to create the submitted work.

                Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

                Article
                DOI: 10.4081/qrmh.2024.11879
                PMC ID: 11017958
                PubMed ID: 38629058
                SO-VID: 0cb0e441-48c5-427b-a3bd-bdefae8254c3
                Copyright © Copyright © 2024, the Author(s)
                License:

                This work is licensed under a Creative Commons Attribution NonCommercial 4.0 License (CC BY-NC 4.0).

                History
                Date received : 26 September 2023
                Date accepted : 24 January 2024
                Page count
                Figures: 3, Tables: 1, Equations: 0, References: 44, Pages: 10
                Funding
                Funding: This study received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors.
                Categories
                Subject: Article

                Keywords: gay,lesbian,bisexual,transgender,queer,gender diverse,healthcare,qualitative,health provider
                Data availability:
                Keywords: gay, lesbian, bisexual, transgender, queer, gender diverse, healthcare, qualitative, health provider

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