Working Through Stigma: A Constructivist Grounded Theory of Delivering Health Services to Diverse 2SLGBTQ Populations

Abstract

Previous research inadequately explores processes and factors influencing the delivery of health services to sexual and gender minorities in ways that equitably attend to the infinite diversity held by these groups. This study employed Intersectionality and Critical Theories to inform Constructivist Grounded Theory methods and methodology; social categories of identity were strategically adopted to explore domains of power operating across multiple forms of oppression, think through subjective realities, and generate a nuanced rendering of power relations influencing health service delivery to diverse 2SLGBTQ populations in a Canadian province. Semi-structured interviews were conducted and the co-constructed theory of Working Through Stigma, with three interrelated concepts, depending on context, resolving histories, and surviving the situation, was generated . The theory depicts the concerns of participants and what they do about power relations influencing health service delivery and broader social contexts. While the negative impacts of stigma were widely and diversely experienced by patients and providers, ways of working within power relations emerged that would be impossible if stigma was not present, highlighting opportunities to positively impact those from stigmatized groups. As such, Working Through Stigma is a theory that flouts the tradition of stigma research; it offers theoretical knowledge that can be used to work within power relations upholding stigma in ways that increase access to quality health services for those whose historical underservicing can be attributed to stigma. In doing so, the stigma script is flipped and strategies for working against practices and behaviours that uphold cultural supremacies may be realized.

Intersectionality in nursing research: A scoping review

“…1 ). Of these, 320 articles were selected for full-text review to assess their relevance to our inclusion criteria, and 131 articles were included for the review ( Shahram et al., 2017 ; Hulko, 2009 ; Ngum Chi Watts et al., 2014 ; Kim and DeMarco, 2022 ; Thomas and Lightman, 2022 ; Edwards, 2021 ; Isaac, 2020 ; Sodré de Souza and Hiromi Tanaka, 2022 ; Kailemia et al., 2023 ; Duijs et al., 2023 ; Nepali et al., 2023 ; Haghiri-Vijeh, 2022 ; Lane, 2023 ; Holmgren et al., 2014 ; López et al., 2023 ; Cicero et al., 2023 ; Klusaritz et al., 2023 ; Aburizik et al., 2023 ; Acosta and Morris McEwen, 2023 ; Hill et al., 2023 ; Kemei et al., 2023 a; Kemei et al., 2023 b; Kemei et al., 2023 c; Luhanga et al., 2023 ; Keshet et al., 2015 ; Manca et al., 2022 ; Mehra et al., 2023 ; OjiNjideka Hemphill et al., 2023 ; Ojukwu et al., 2023 ; Salami et al., 2022 ; Nogueira et al., 2023 ; Small et al., 2022 ; Wiegand et al., 2023 ; O'Mahony et al., 2023 ; Pimienta et al., 2023 ; Giesbrecht et al., 2015 ; Crawford et al., 2023 ; Cuesta and Rämgård, 2016 ; McConnell et al., 2016 ; Höglund et al., 2016 ; Holmström et al., 2017 ; MacDonnell et al., 2017 ; Freeman et al., 2017 ; Guruge et al., 2010 ; Caiola et al., 2017 ; Coleman-Minahan, 2017 ; Van Dyke et al., 2017 ; Jörgensdotter Wegnelius and Petersson, 2018 ; Holtmann and Rickards, 2018 ; Pe...…”

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Uncovering the wider impact of COVID-19 measures on the lives of children with complex care needs and their families: A mixed-methods study protocol

“…A sex- and gender-based analysis (SGBA+) will be integrated into the research design to further understandings of sociostructural determinants of health influencing the experiences of children with complex care needs and their families during the COVID-19 pandemic. Paying attention to differences within a sample population during the recruitment phase will do more than allow us to describe our sample; points of comparison will be created and then used later when data are being analyzed to enhance qualitative trustworthiness [ 22 , 23 ]. The SGBA+ will be integrated into research methods by developing a REDCap sampling instrument and collecting participant sociodemographic data pertaining to employer and professional role (key informants only), age, and across PROGRESS+ variables (sex, gender, race, ethnicity, socioeconomic status, (dis)ability, and citizenship).…”

The Invisible Minority: Stigma and Sexual and Gender Diversity in Health Care

“…Emerging research suggests that reframing stigma as an opportunity to generate novel ways to work through and with power disparities characterizing health-care system interactions may improve access to and delivery of services (Lane, 2023). Exploring the ability of nurses and nursing to facilitate such change is both a challenge and an ethical imperative.…”