Singh Rajinder Sonia, Zamarin Kim, Eckstrand Kristen L, Sklar Marisa, Sturm Robert, Willging Cathleen
Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.
Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
BMC Health Serv Res. 2025 Apr 23;25(1):585. doi: 10.1186/s12913-025-12708-7.
Many existing implementation frameworks neglect inequity. Theories of intersectionality can help implementation researchers understand the multiplicative burden of certain inequities experienced by people with intersecting marginalized identities. The current project provides an example of engaging primary care providers, staff, and patients in prioritizing recommendations to improve services for lesbian, gay, bisexual, transgender, queer, and other gender and sexual minoritized (LGBTQ+) people from diverse racial, ethnic, cultural, and economic backgrounds.
We used the Nominal Group Technique (NGT) to guide two one-time sessions with providers (n = 6) and staff (n = 8) affiliated with four primary care clinics in the United States. These participants brainstormed responses to a single focal question designed to elicit ideas for improving services for LGBTQ+ people with intersecting marginalized identities. Participants then discussed and ranked the ideas generated and considered specific strategies for ranked ideas. Finally, we conducted two focus groups with LGBTQ+ primary care patients (n = 7, n = 4) to obtain their insights into the recommendations for improving services.
The highest-ranked idea by providers was to mandate ongoing high-quality professional development for primary care personnel. The highest-ranked ideas by staff were to offer safe spaces characterized by an ambient atmosphere with trained personnel and LGBTQ+ visuals and to increase availability and funding for transgender providers and services delivered by transgender people and others skilled in caring for this community. Patients affirmed the recommendations from the NGT, while emphasizing inclusive representation in primary care spaces and for providers and staff to critically reflect of their own backgrounds.
Providers, staff, and patients highlighted the importance of continuing education and training to offer affirming, safe, and equitable care for LGBTQ+ people with intersecting marginalized identities. These implementation suggestions may be helpful for primary care clinics in developing inclusive and equitable medical environments. Further, the NGT, followed by a review of findings by impacted patients, may be useful when considering equitable implementation focused on meeting the needs of people with intersecting marginalized identities.
许多现有的实施框架忽视了不平等问题。交叉性理论可以帮助实施研究人员理解具有交叉边缘化身份的人群所经历的某些不平等的多重负担。当前项目提供了一个让初级保健提供者、工作人员和患者参与确定优先建议的例子，这些建议旨在改善为来自不同种族、民族、文化和经济背景的女同性恋、男同性恋、双性恋、跨性别者、酷儿及其他性别和性取向少数群体（LGBTQ+）提供的服务。
我们使用名义小组技术（NGT）来指导与美国四家初级保健诊所的提供者（n = 6）和工作人员（n = 8）进行的两次一次性会议。这些参与者针对一个单一的核心问题集思广益，该问题旨在引出改善为具有交叉边缘化身份的LGBTQ+人群提供服务的想法。参与者随后讨论并对产生的想法进行排名，并考虑针对排名想法的具体策略。最后，我们与LGBTQ+初级保健患者（n = 7，n = 4）进行了两次焦点小组讨论，以获取他们对改善服务建议的见解。
提供者排名最高的想法是要求为初级保健人员提供持续的高质量专业发展。工作人员排名最高的想法是提供以有经过培训的人员和LGBTQ+视觉元素的环境氛围为特点的安全空间，以及增加为跨性别提供者以及由跨性别者和其他擅长照顾这个群体的人提供的服务的可及性和资金。患者肯定了名义小组技术得出的建议，同时强调在初级保健场所要有包容性的代表性，并且提供者和工作人员要批判性地反思自己的背景。
提供者、工作人员和患者强调了继续教育和培训对于为具有交叉边缘化身份的LGBTQ+人群提供肯定性、安全性和公平性护理的重要性。这些实施建议可能有助于初级保健诊所营造包容和公平的医疗环境。此外，在考虑以满足具有交叉边缘化身份的人群需求为重点的公平实施时，名义小组技术以及随后由受影响患者对结果进行审查可能会有所帮助。
