10/27/2020

Why Your Health Education Needs to Be LGBTQ-Inclusive

Healthwise Communications Team

Health disparities exist among many groups, including the LGBTQ community. The good news is that healthcare systems are positioned to make a huge dent in this inequity. Internal clinician education and inclusive patient resources can go a long way toward crushing inequality in health care and overcoming legislation that makes many LGBTQ Americans hesitant to trust providers with their care.

 

Everyone deserves access to quality health care. LGBTQ people have many of the same health concerns as anyone else, but healthcare policy and unique physiological needs mean they don’t always get the information they want and need.

  • Legal discrimination in access to insurance, health care, and employment (to which insurance is often tied) makes it harder to get care.
  • A shortage of providers who are knowledgeable about LGBTQ health means fewer options to choose from.
  • Misunderstandings often exist about which health screenings LGBTQ people need, based on which body parts they have and the kinds of sex they have.
  • It’s often impossible to know ahead of time whether a provider or hospital system is knowledgeable about and supportive of LGBTQ issues.
  • Fear of discrimination or judgment may keep some people from seeking care when they need it.

 

Why Should LGBTQ Health Be a Consideration for Healthcare Systems?

Making sure that every patient feels welcome, supported, and understood helps the community live longer, healthier, happier lives. But healthcare systems—who, let’s face it, do have to balance care with budgets and other resources—also reap rewards of their own.

  • Greater patient satisfaction and retention
  • Opportunities to broaden their patient base
  • Fewer unnecessary hospital admissions and readmissions
  • Increased revenue through new patients
  • Targeted community outreach programs
  • Improved ability to help patients manage their conditions
  • Traffic-driving listing opportunities, such as GLMA and the HRC’s Health Equity Index, which share information about LGBTQ-friendly health organizations

Understanding how social determinants and other factors affect the health of LGBTQ people allows providers to address conditions their patients are at risk for or may already be dealing with. Depending on their gender identity, sexual orientation, and other social determinants, LGBTQ people can be at a higher risk of nicotine use, depression, suicide, homelessness, STIs, and obesity.1

Just last week, the American Heart Association went so far as to say that discrimination contributes to poor heart health for LGBTQ adults.2 “LGBTQ individuals are delaying primary care and preventative visits because there is a great fear of being treated differently,” says Billy A. Caceres, Ph.D., R.N., FAHA, chair of the writing group for the statement and an assistant professor at the Columbia University School of Nursing. “Being treated differently often means receiving inadequate or inferior care because of sexual orientation or gender identity.”3

Knowing a person’s sex and gender makes it possible to focus on these risk factors. For example, a transgender woman should still understand her need for prostate cancer screenings. Some practices actually ask about gender on their new patient paperwork. But many don’t, and patients may be hesitant to bring it up (or not even realize that it would be helpful information).

So how can you help LGBTQ people get the care they need?

 

Provide LGBTQ-Inclusive Patient Education—Every Time, for Every Patient.

Research shows that LGBTQ people often find providers through community referrals.

“Local LGBT patient communities have longstanding word-of-mouth referral networks, particularly among the transgender population, to facilitate health care access by capitalizing on existing community knowledge.”4

Think about it: A patient comes to you for something like a COVID-19 test or a sprained ankle. You have no idea what their gender is, and you don’t ask because it doesn’t seem relevant to the visit. You then hand them a piece of patient education that features a photo of a white cisgender husband and wife with their two white children. Or perhaps it mentions the symptoms that “men and women” should watch for.

If that person is gay, lesbian, or non-gender-conforming, how likely do you think they are to come back next time they need a doctor? And how likely are they to recommend you to another LGBTQ person looking for a physician? Even if they’re straight, many allies may choose not to continue using your healthcare system.

Here’s how one doctor lost six patients he’d been seeing for years.

“My mom and I were kind of scared to tell our family doctor that I was trans,” says Cody, who began transitioning in his early teens. “She was an older woman who had mentioned several times that she was active in her church, and there wasn’t anything in her office showing whether she’d welcome LGBTQ patients.”

Cody’s parents finally decided to switch the entire family—all six of them—to a new provider who had been recommended by several members of a transgender support group.

“My old doctor might have been okay with me, but who knows? I wasn’t looking for a giant pride flag or anything, just a few same-sex couples in photos, or some gender-neutral language in the stuff she printed out for me. That would have been enough for me to trust her with my news.”

Cody’s story is a perfect example of why all health education should be inclusive. Providing LGBTQ-specific content is also important, and the more of it you have, the better. But it can’t stop there. Ensuring that every piece of material you share and every conversation you have makes your patients feel wanted and valued will help you build the kinds of trusting patient-provider relationships that lead to open conversations, better health outcomes, and greater retention rates.

 

At the time, Cody was protected under the Affordable Care Act, in which the term “sex” had been determined to include “gender.” But that definition of sex discrimination has since been narrowed and now only provides protection based on a person’s sex at birth—it no longer covers transgender people.5 Whether or not Congress intended this reading is almost beside the point. What matters is that people now feel vulnerable.

"Even if no one actually does discriminate more because of the rule, you've created a fear," warns Katie Keith, a health law professor at Georgetown University.6

In a perfect world, no one would ever feel afraid to seek medical care. But in the imperfect world we live in, letting patients know that you welcome and understand them, regardless of gender, sex, or sexual orientation, can go a long way toward making lost legal protections less damaging.

 

How to Provide LGBTQ-Inclusive Health Education

It may sometimes feel like anything you say will be interpreted as exclusionary or biased. The first step is mindfulness—looking at your content with inclusivity in mind.

A health education company that has experience using best practices for writing inclusive language can be invaluable here, because they use a team of writers, editors, and medical experts to create the content you need

A few starting points for creating LGBTQ-inclusive content:

  • Avoid assuming the reader’s gender. Use “you” instead of gender-specific pronouns.
  • Use caution with terms like “men” and “women.” In some cases, such as patient education about cervical cancer screenings, it may be more appropriate to say, “anyone with a cervix” rather than “women.”
  • Focus on actions and behaviors when possible, rather than gender identities or sexual orientation.
  • Seek user feedback from members of the LGBTQ community. There’s no one better qualified to evaluate your LGBTQ content.
  • Think about whether your graphics and photos are inclusive or exclusive.

Finally, if you need help finding health care providers who have been recommended by LGBTQ patients, or if you know someone who does, check out GLMA.org and the Human Rights Campaign’s Healthcare Equality Index.


1. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health
2. https://newsroom.heart.org/news/discrimination-contributes-to-poorer-heart-health-for-lgbtq-adults
3. https://www.youtube.com/watch?v=HGlCllHQXl0
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605169/
5. https://www.americanprogress.org/issues/lgbtq-rights/news/2020/10/15/491582/repealing-affordable-care-act-devastating-impacts-lgbtq-people/
6. https://www.npr.org/sections/health-shots/2020/06/12/868073068/transgender-health-protections-reversed-by-trump-administration