Factors influencing LGBTQ+ disclosure decision-making by Canadian health professionals: A qualitative study

Abstract

Disclosure of LGBTQ+ identities at work may reap benefits, but may also exacerbate harms. Faced with ambiguous outcomes, people engage in complex concealment/disclosure decision-making. For health professionals, in contexts of pervasive heteronormativity where disclosure to patients/clients is deemed to violate professional boundaries, stakes are high. This qualitative study with 13 LGBTQ+ health professionals across Canada used semi-structured interviews to explore factors affecting disclosure decision-making, particularly attending to power structures at multiple levels. Most participants engaged in constant risk-benefit assessment, disclosing strategically to colleagues, rarely to clients/patients. At the individual level they were affected by degree of LGBTQ+ visibility. At the institutional level they were affected by the culture of particular professional fields and practice settings, including type of care and type of patients/clients, as well as colleague interactions. Professional power–held by them, and held by others over them–directly affected disclosures. Finally, intersections of queer identities with other privileged or marginalized identities complicated disclosures. Power relations in the health professions shape LGBTQ+ identity disclosures in complex ways, with unpredictable outcomes. Concepts of professionalism are infused with heteronormativity, serving to regulate the gender and sexual identity expression of queer professionals. Disrupting heteronormativity is essential to forge more open professional cultures.

“Are You—?” “AreYou?” Queer Advocacy at Contemporary Neoliberal Rape Crisis Centers

“…However, after communications with other LGBTQ+ people, it became apparent that my emphasis on disclosure or "coming out" may not have been well-suited to this study. Disclosure looks different depending on its social context, especially in spaces that specifically regulate sexual and gender performances like rape crisis centers (Beagan et al, 2022). LGBTQ + advocates did not "disclose" in the ways that LGBTQ+ people might have disclosed in nonantiviolence spaces; therefore, I could not use "disclosure" as a category of analysis the way that other studies might have used the concept.…”