Applying a Capabilities Approach to Understanding Older LGBT People’s Disclosures of Identity in Community Primary Care

Abstract

Internationally, there is increasing recognition that lesbian, gay, bisexual and trans (LGBT) populations experience substantial public health inequalities and require interventions to address these inequalities, yet data on this population is often not routinely collected. This paper considers the case study of the UK, where there are proposals to improve government and health data collection on LGBT populations, but also a degree of apparent uncertainty over the purpose and relevance of information about LGBT status in healthcare. This paper applies a health capabilities framework, arguing that the value of health information about LGBT status should be assessed according to whether it improves LGBT people’s capability to achieve good health. We draw upon 36 older LGBT people’s qualitative accounts of disclosing LGBT status within UK general practice healthcare. Participants’ accounts of the benefits and risks of disclosure could be mapped against multiple domains of capability, including those that closely align with biomedical accounts (e.g., longevity and physical health), but also more holistic considerations (e.g., emotion and affiliation). However, across all domains, individuals tend to assess capabilities at an individual level, with relatively little reference to population-level impact of disclosure. Clearer articulation of the benefits of disclosure and data collection for the collective capabilities of LGBT populations may be a beneficial strategy for improving the quality of information on LGBT populations.

Communication about sexual orientation and gender between clinicians, LGBT+ people facing serious illness and their significant others: a qualitative interview study of experiences, preferences and recommendations

“…Our study recommendations may help to achieve national policy and monitoring standards (eg, NHS Sexual Orientation Monitoring Standard) 62. While person-centred care was central to our participants and the recommendations we have made, delivering such care provides opportunities for improved monitoring data to inform broader understandings of health needs, outcomes and inequalities 11 63…”

“…62 While person-centred care was central to our participants and the recommendations we have made, delivering such care provides opportunities for improved monitoring data to inform broader understandings of health needs, outcomes and inequalities. 11 63 …”

“…Data from 27 countries revealed that 8% of adults have a minority sexual orientation, and 1% identify as trans or non-binary 1. Despite legal advances to protect LGBT+ people from healthcare discrimination in many countries,2 experience and anticipation of discrimination within healthcare continue to be concerns, which can delay seeking health services 3–11. The acronym LGBT+ refers to lesbian, gay, bisexual and/or transgender people, and anyone who considers themselves to have a minority sexual orientation, gender identity or gender history (the relationship between gender identity and sex assignedat birth).…”

A Scoping Review of Older LGBTI People's Experiences of Homecare

“…It becomes your job and yours alone to explain, ignore, to forgive over and over again….You're always the one who has to, you know, soften the corners, make things right. (Furlotte et al, 2016, p. 439) Some have argued that the search for and implementation of common procedures in healthcare to facilitate the disclosure of gender identities and sexual orientations, could be guided by whether it provides users with a range of capabilities, in other words, enables or impedes their attainment of a wide-ranging health, including plain medical benefits, emotional health, and bodily autonomy (Toze et al, 2020).…”

Unheard voices: A qualitative study of LGBT+ older people experiences during the first wave of the COVID‐19 pandemic in the UK

“…LGBT+ people report poorer health than the general population (Kneale et al., 2019; Westwood et al., 2020), associated with minority stress (Correro et al., 2020; Fredriksen‐Goldsen et al., 2020; Frost et al., 2015; Lefevor et al., 2019), the cumulative effects of lifelong exposure to prejudice and discrimination (Fredriksen‐Goldsen et al., 2017), and increased health risk behaviours linked to stress adaptation (Bryan et al., 2017; Correro et al., 2020; Emlet et al., 2017). These inequalities are compounded by discrimination and fear of discrimination when accessing health and social care services, including inadequate understandings of LGBT+ older people's needs among care providers (Fredriksen‐Goldsen et al., 2014; Hafford‐Letchfield et al., 2018; Higgins et al., 2019; Toze et al., 2020). In response, this paper explores the experiences of LGBT+ older people and reports thematic findings from a qualitative study of data gathered from seventeen LGBT+ older people and key informants in seven LGBT+ community organisations working in England, Scotland and Wales, during July–August 2020.…”