Search

Background Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience significant health inequalities. Located within a European Commission funded pilot project, this paper presents a review of the health inequalities faced by LGBTI people and the barriers health professionals encounter when providing care. Methods A narrative synthesis of 57 papers including systematic reviews, narrative reviews, meta-analyses and primary research. Literature was searched in Cochrane, Campbell Collaboration, Web of Science, CINAHL, PsychINFO and Medline. The review was undertaken to promote understanding of the causes and range of inequalities, as well as how to reduce inequalities. Results LGBTI people are more likely to experience health inequalities due to heteronormativity or heterosexism, minority stress, experiences of victimization and discrimination, compounded by stigma. Inequalities pertaining to LGBTI health(care) vary depending on gender, age, income and disability as well as between LGBTI groupings. Gaps in the literature remain around how these factors intersect to influence health, with further large-scale research needed particularly regarding trans and intersex people. Conclusion Health inequalities can be addressed via changes in policy, research and in practice through health services that accommodate the needs of LGBTI people. With improved training to address gaps in their knowledge of LGBTI health and healthcare, health professionals should work in collaboration with LGBTI people to address a range of barriers that prevent access to care. Through structural change combined with increased knowledge and understanding, services can potentially become more inclusive and equally accessible to all.

Background: Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience significant health inequalities. Located within a European Commission funded pilot project, this paper presents a review of the health inequalities faced by LGBTI people and the barriers health professionals encounter when providing care. Methods: A narrative synthesis of 57 papers including systematic reviews, narrative reviews, meta-analyses and primary research. Literature was searched in Cochrane, Campbell Collaboration, Web of Science, CINAHL, PsychINFO and Medline. The review was undertaken to promote understanding of the causes and range of inequalities, as well as how to reduce inequalities. Results: LGBTI people are more likely to experience health inequalities due to heteronormativity or heterosexism, minority stress, experiences of victimization and discrimination, compounded by stigma. Inequalities pertaining to LGBTI health(care) vary depending on gender, age, income and disability as well as between LGBTI groupings. Gaps in the literature remain around how these factors intersect to influence health, with further large-scale research needed particularly regarding trans and intersex people. Conclusion: Health inequalities can be addressed via changes in policy, research and in practice through health services that accommodate the needs of LGBTI people. With improved training to address gaps in their knowledge of LGBTI health and healthcare, health professionals should work in collaboration with LGBTI people to address a range of barriers that prevent access to care. Through structural change combined with increased knowledge and understanding, services can potentially become more inclusive and equally accessible to all.

This report is a state-of-the-art review study carried out in the context of the European Union (EU) funded pilot project Health4LGBTI (SANTE/2015/C4/035). The review study focused on the health inequalities faced by LGBTI people (especially those in vulnerable situations) and the potential barriers faced by health professionals when providing their care. It brings together scientific research and grey literature in a way that leads to new insights and recommendations supported by evidence.

Gender dilemmas are formed where a woman's role and identity is constructed in alternative ways, ways which do not cohere with the ways prescribed and expected within a dominant gender discourse. Gender dilemmas give birth to internal discomfort and a loss of experiencing the self as meaningful. Gender dilemmas disempower and silence women. The following questions are addressed: Which processes and powers construct women in certain ways? How are the roles and identities of women formed during these processes? An analysis of a dominant gender discourse within the South African cultural context is discussed to increase the understanding of the constructed nature of the gender identity of women and to increase the understanding of gender dilemmas that silence and disempower women. A qualitative reflexive research design was chosen where a discourse analysis is performed (Terre Blanche & Durrheim, 1999: 148 ; Mouton, 1996: 102 ; Rommetveit, 1990: 90). Texts for the analysis came from transcriptions of ten in-depth, semi-structured individual interviews with nominated women. The analysis was done by combining the ideas on discourse analysis of Parker (1992: 6-20) and Terre Blanche and Durrheim (1999: 154-167). The analysis aims at increasing the understanding of the constructed nature of femininity and to generate further ways to understand gender dilemmas. This process opens up space for alternative reflections that could lead to change. Gender-dilemmas word gevorm waar 'n vrou se rol en identiteit gekonstrueer is op alternatiewe wyses wat nie ooreenstem met tradisionele konstruksies binne 'n dominante gender-diskoers nie. Gender-dilemmas gee oorsprong aan interne ongemak en 'n verlies aan selfsinvolheid. Vroue word daardeur verstil en ontmagtig. Die volgende vrae word aangespreek: Deur watter prosesse en kragte word die vrou gekonstrueer? Hoe word die rol en identiteit van die vrou gevorm deur hierdie prosesse? 'n Analise van 'n dominante gender diskoers binne die Suid-Afrikaanse kulturele konteks word bespreek om begrip vir die gekonstrueerde aard van die gender identiteit van vroue te genereer en om begrip te bevorder vir gender-dilemmas waardeur vroue verstil en ontmagtig word. 'n Kwalitatiewe reflektiewe navorsingsontwerp is gekies waartydens 'n diskoers- analise uitgevoer is. (Terre Blanche & Durrheim, 1999: 148 ; Mouton, 1996: 102 ; Rommetveit, 1990: 90). Tekste vir die analise is bekom uit die transkripsies van tien indiepte, semi-gestruktureerde individuele onderhoude met genomineerde vroue. Die analise is gedoen op grond van die diskoers-analise van Parker (1992: 6-20) en Terre Blanche en Durrheim (1999: 154-167). Die analise poog om begrip vir die gekonstrueerde aard van vroulikheid en om verdere verstaansmoontlikhede vir gender-dilemmas te genereer. Die potensiaal vir moontlike verandering onttaan hierin. (Health SA Gesondheid: interdisciplinary research journal: 2002 7(1): 10-20)

This article serves as an introduction to discourse analysis. It therefore does not give an account for the whole research process. Due to logistical reasons, because this is a relatively new and multifaceted approach in research, this article involves only introductory remarks about discourse analysis as approach to qualitative, reflexive nursing research. Different postmodern ";approaches"; to qualitative nursing research derived from other disciplines are being rooted in nursing as epistemology. Discourse analysis is introduced as a Poststructuralist and Social Constructionist ";approach"; to nursing research developing within the postmodern line of thought. A qualitative exploratory research design was chosen that explored specific Poststructuralist and Social Constructionist literature on research by means of an in-depth literature review. The sample was chosen from Poststructuralist and Social Constructionist literature on research in general as these paradigms have not been described in South African literature on nursing research. The ideas on discourse analysis as a research ";approach"; of Parker (1992: 6-20) and Terre Blanche & Durrheim (1999: 154-167) are discussed. Discourse analysis could serve as a valuable ";approach"; in nursing research as it challenges current dominant ways of understanding or viewing the objects of study. This process opens up space for alternative reflections that could lead to change. Hierdie artikel dien as 'n inleiding tot diskoers-analise. Dit beoog dus nie om die hele navorsingsproses breedvoerig te bespreek nie aangesien diskoers-analise 'n relatief nuwe en multifasettige benadering in navorsing is. Vanweë logistiese redes word in hierdie artikel slegs inleidende gedagtes oor diskoers-analise as benadering tot kwalitatiewe, refleksiewe verpleegnavorsing ingesluit. Verskillende postmoderne ";benaderings"; tot kwalitatiewe navorsing word in die verpleegkunde as epistemologie beskryf en het begin wortelskiet. Diskoers-analise word bespreek as 'n ";benadering"; tot navorsing wat ontstaan het uit die Poststrukturalisme en Sosiale konstruksionisme binne die postmoderne denkstroom. 'n Kwalitatiewe, eksplorerende navorsingsontwerp is gekies waardeur 'n indiepte literatuurstudie onderneem is om diskoers-analise as ";benadering"; tot navorsing te ondersoek. Die literatuurstudie is op die paradigmas van Poststrukturalisme en Sosiale konstruksionisme gerig en die ";benadering"; tot navorsing wat uit hierdie paradigmas voortvloei aangesien hierdie raamwerke nog nie in Suid-Afrikaanse literatuur oor navorsing in die verpleegkunde vervat is nie. Die sienings oor diskoers-analise as ";benadering"; in navorsing van Parker (1992: 6-20) en Terre Blanche & Durrheim (1999: 154-167) word bespreek. Diskoers-analise kan as 'n waardevolle ";benadering"; tot navorsing in die verpleegkunde dien aangesien dit huidige dominante verstaanswyses bevraagteken. Dit skep ruimte vir alternatiewe refleksies en ander verstaansmoontlikhede waarbinne die potensiaal vir verandering dan ontstaan. (Health SA Gesondheid: interdisciplinary research journal: 2002 7(1): 3-9)

Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience.