Intersectional Stigma and Health Equity Promotion for LGBT People in Primary, Sexual/Reproductive, and Mental Health Care Settings

Lesbian, gay, bisexual, and transgender (LGBT) people are less likely to access health care and utilize routine health care than their cisgender, heterosexual counterparts (Aleshire et al. 2019; Zeeman et al. 2019). Additionally, they are more likely to report an unmet need for care due to experiences of heterosexism and cisgenderism in health care settings. Previous international LGBT health disparity studies have mainly utilized deficit-based models to understand poor health outcomes, while other research has shown resilience and good health among LGBT people (Fredriksen-Goldsen et al. 2014). Despite recent advancements in the international research field, very little is known about the health care experiences of LGBT people in Italy, as well as factors associated with health care professionals’ enactment of stigma against this population. The proposed project will apply the Health Equity Promotion Model (HEPM; Fredriksen-Goldsen et al. 2014) and its key theoretical perspectives (i.e., intersectionality, minority stress theory, life course perspective) to examine the experiences and health outcomes of LGBT people, considering their intersectional identities (i.e., sexual orientation, gender identity) and relevant socio-demographic characteristics, across primary, sexual/reproductive, and mental health care settings. The project will also identify factors associated with sexual- and/or gender-based stigma enacted by health care professionals, which contribute extensively to LGBT health disparities across these contexts. The project will include both qualitative and quantitative components, involving LGBT patients and health care professionals. In the qualitative component, 50 LGBT people (differentiated for gender, ethnicity, age cohort, socio-economic status, parenthood status, relationship status, and disability) and 50 primary health care, 50 sexual/reproductive health care, and 50 mental health care professionals will be interviewed online; in the quantitative component, 1,300 LGBT people and 1,145 health care professionals will complete two online questionnaire-based surveys, respectively. The results will contribute evidence-based sustainable resources for health care professionals, tailored to each of the investigated health care settings and emphasizing the impact of intersectional identities. Specifically, the resources will include a free massive open online course and guidelines for health care professionals to ensure non-harmful and effective work with LGBT patients. The proposed project directly supports the Agenda 2030 for Sustainable Development by the Department of Economic and Social Affairs of the United Nations (2015), aimed at guiding and stimulating action in areas of critical importance for humanity and the planet, including health and well-being (aim 3), gender equality (aim 5), and the reduction of inequalities (aim 10).