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      Improving pathways to primary health care among LGBTQ populations and health care providers: key findings from Nova Scotia, Canada

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          Abstract

          Background

          This study explores the perceived barriers to primary health care as identified among a sample of Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) identified individuals and health care providers in Nova Scotia, Canada. These findings, based on a province-wide anonymous online survey, suggest that additional efforts are needed to improve pathways to primary health among LGBTQ populations and in deepening our understanding of how to advance the unique primary health needs of these populations.

          Methods

          Data were collected from the LGBTQ community through an online, closed-ended anonymous survey. Inclusion criteria for participation were self-identifying as LGBTQ, offering primary health care to LGBTQ patients, being able to understand English, being 16 years of age or older, and having lived in Nova Scotia for at least one year. A total of 283 LGBTQ respondents completed the online survey which included sociodemographic questions, perceptions of respondents’ health status, and their primary health care experiences. In addition, a total of 109 health care providers completed the survey based on their experiences providing care in Nova Scotia, and in particular, their experiences and perceptions regarding LGBTQ access to primary health care and physician-patient interactions.

          Results

          Our results indicate that, in several key areas, the primary health care needs of LGBTQ populations in Nova Scotia are not being met and this may in turn contribute to their poor health outcomes across the life course.

          Conclusion

          A framework of intersectionality and health equity was used to interpret and analyze the survey data. The key findings indicate the need to continue improving pathways to primary health care among LGBTQ populations, specifically in relation to additional training and related supports for health care providers who work with these populations.

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          Most cited references14

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          Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study.

          We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia. In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper). Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed but unable to be obtained (hormone therapy and mental health services), history of violence (sexual and physical), substance use health behaviors (tobacco and alcohol), and interpersonal factors (family support and community connectedness). Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing. Multilevel interventions are needed for transgender populations, including legal protections and training for health care providers.
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            Taking action on the social determinants of health in clinical practice: a framework for health professionals.

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              Intersectionality and the determinants of health: a Canadian perspective

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                Author and article information

                Contributors
                Jacqueline.gahagan@dal.ca
                msubiranam@ub.edu
                Journal
                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                1475-9276
                13 June 2018
                13 June 2018
                2018
                : 17
                : 76
                Affiliations
                [1 ]ISNI 0000 0004 1936 8200, GRID grid.55602.34, School of Health & Human Performance, Health Promotion, Gender & Health Promotion Studies Unit (GAHPS Unit), Healthy Populations Institute (HPI), , Dalhousie University, ; 6230 South Street, Halifax, NS B3H 3J5 Canada
                [2 ]ISNI 0000 0004 1937 0247, GRID grid.5841.8, Advanced Studies Group on Violence, Clinical Psychology and Psychobiology Unit, , Universitat de Barcelona, Faculty of Psychology, ; Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain
                Article
                786
                10.1186/s12939-018-0786-0
                5998559
                29895297
                ea37d08e-01bc-4f69-963b-439d9cee3208
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 15 November 2017
                : 29 May 2018
                Categories
                Research
                Custom metadata
                © The Author(s) 2018

                Health & Social care
                lgbtq,primary health,health providers,health system,nova scotia
                Health & Social care
                lgbtq, primary health, health providers, health system, nova scotia

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