Chard Sidonie, Karabelas-Pittman Sawyer, Martin Kel, Chapple Elliot, Messenger David, Bartels Susan A, Walker Melanie
School of Medicine, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, D02YN77, Ireland.
Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada.
BMC Health Serv Res. 2025 May 26;25(1):751. doi: 10.1186/s12913-025-12684-y.
Equity-deserving groups (EDG), including those who identify as two-spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex, and/or asexual (2SLGBTQQIA+), are disproportionately treated in the Emergency Department (ED). This study aimed to understand ED care experiences of 2SLGBTQQIA+ individuals compared to those who do not identify with an equity-deserving group in Kingston, Canada, ultimately aiming to enhance inclusivity and better meet healthcare needs.
Data were collected through a mixed qualitative/quantitative cross-sectional study using a novel electronic survey tool (Spryng.io), which purposely integrates qualitative and quantitative data, while minimising researcher bias. A community-based participatory approach was employed to involve community stakeholders. Participants were recruited from the Kingston Health Sciences Centre's ED, Urgent Care Centre, and at community-based organisations. Quantitative data were analysed using chi-squared tests, while qualitative data underwent thematic analysis. Results were triangulated. Focus group discussions with community partners were then undertaken to contextualise findings.
Compared to persons who did not identify as belonging to an EDG (n = 949), 2SLGBTQQIA+ individuals (n = 118) felt their identity had a more negative impact on their care (p < 0.0001) and experienced more judgment and disrespect from healthcare providers (HCPs) (p < 0.0001). Four themes emerged from triangulation of qualitative and quantitative data: (1) mixed emotions regarding ED care; (2) transgender and non-binary health care considerations; (3) unmet mental health needs; and (4) lack of patient-centred care for 2SLGBTQQIA+ patients.
2SLGBTQQIA+ individuals often face unmet mental health care needs, requiring tailored mental health care provision in the ED. Intersectionality within the 2SLGBTQQIA+ population underscores the importance of trauma-informed care. Strategies to improve 2SLGBTQQIA+ healthcare include implementing safer spaces, clear feedback mechanisms, referrals to gender-affirming specialists, and privacy in triage. Further research should assess the impact of educational interventions on HCP knowledge and patient experiences in the ED.
应公平对待群体（EDG），包括那些认同双性人、女同性恋、男同性恋、双性恋、跨性别者、酷儿、存疑者、双性人及/或无性恋者（2SLGBTQQIA+），在急诊科（ED）受到的对待存在不成比例的差异。本研究旨在了解加拿大金斯顿地区2SLGBTQQIA+个体与那些不认同应公平对待群体的个体在急诊科的就医经历，最终目标是提高包容性并更好地满足医疗保健需求。
通过一项混合定性/定量的横断面研究收集数据，使用一种新型电子调查工具（Spryng.io），该工具特意整合了定性和定量数据，同时尽量减少研究人员的偏差。采用基于社区的参与式方法让社区利益相关者参与进来。参与者从金斯顿健康科学中心的急诊科、紧急护理中心以及社区组织招募。定量数据使用卡方检验进行分析，而定性数据则进行主题分析。对结果进行了三角验证。随后与社区伙伴进行焦点小组讨论，以便将研究结果置于具体情境中。
与不认同属于应公平对待群体的人（n = 949）相比，2SLGBTQQIA+个体（n = 118）觉得他们的身份对其就医产生了更负面的影响（p < 0.0001），并且受到医疗服务提供者（HCPs）更多的评判和不尊重（p < 0.0001）。定性和定量数据的三角验证得出了四个主题：（1）对急诊科护理的复杂情绪；（2）跨性别和非二元性别人士的医疗保健考量；（3）未满足的心理健康需求；（4）对2SLGBTQQIA+患者缺乏以患者为中心的护理。
2SLGBTQQIA+个体经常面临未满足的心理健康护理需求，在急诊科需要提供量身定制的心理健康护理。2SLGBTQQIA+群体内部的交叉性凸显了创伤知情护理的重要性。改善2SLGBTQQIA+医疗保健的策略包括营造更安全的空间、建立明确的反馈机制、转介至性别确认专家以及在分诊时保护隐私。进一步的研究应评估教育干预对医疗服务提供者知识以及急诊科患者就医体验的影响。
