31 October 2022

The third instalment of our new extension to our Bulletin ‘In the Journals’ focuses broadly on the LGBTQIA+ community in healthcare. With thanks to RCSLT members Jenny Ray and Alex Wormall for their contributions to this edition.

The aim of this feature is to bring some research to the fore that members may want to consider in their practice. It highlights and summarises pieces of recent research in a range of areas, relevant to anti-racism, equality, diversity, and inclusion in the health professions and among service users, and offers short commentary pulling the themes together, as well as some thoughts on the potential implications.

We will not offer a critical appraisal of the article. We encourage members to always cast a critical eye on information they read and interpret findings and conclusions to an appropriate degree, based on the specifics of the study itself. Inclusion of articles in this feature does not represent RCSLT endorsement or alignment with the views presented.

If you’d like to get involved in writing the next instalment or suggesting some papers to feature, please email katie.chadd@rcslt.org.

Effective provision in mental health

This article explores the experiences of lesbian, gay and bisexual (LGB) clients in clinical settings and suggests these are influenced by provider attitudes, LGB cultural competence, the creation of a safe therapeutic space, and skilfully navigated conversations.

This systematic review – drawing on 24 peer-reviewed published articles written between 2000-2020 – used findings from client-focused and provider-focused studies to develop a holistic interpretation of the impact of provider practice on service provision for LGB clients in mental health settings. This was achieved through a narrative synthesis, thematic summary approach.

Service provider attitudes varied from positive to negative towards LGB clients. LGB knowledge and attitudes played a significant role in provider-client rapport-building and client disclosure of sexual orientation. Positive experiences involved creation of safe spaces, skilfully navigated conversations that avoided heterosexism, and visible onsite cues. The findings recommend that service providers should ensure culturally competent practice with LGB clients, and that competence can be enhanced with specific LGB training.

The authors comment that “LGB consumers may be fearful of having their LGB identity rejected and therefore look for cues that a provider is affirming of LGB people.”

Summary written by Jenny Ray (she/her), highly specialist SLT, Homerton Healthcare NHS Foundation Trust, London.

Twitter: @JennyHRay

Interactions in healthcare

In this systematic review the authors cover qualitative literature exploring the interaction between healthcare professionals and their gay, lesbian, and bisexual (LGB) clients in a healthcare setting.

Of the 348 articles identified through searches on CINAHL and Medline, 20 met the criteria for inclusion in this review. 11 studies were patient perspectives, six focused on healthcare professionals, and three studies included perspectives from patients and healthcare professionals. Data from transgender patients was excluded “as transgender health experiences are different and often more negative than LGB patients”.

The authors found:

  • There is often a lack of knowledge about LGB issues from healthcare professionals
  • Healthcare professionals having some specific LGB knowledge helps to foster a more comfortable environment for patients
  • More patients than healthcare professionals felt that disclosure of sexual orientation is important to gain appropriate care
  • Patients often encounter heteronormative attitudes
  • Negative attitudes and perceived judgment were often present in sessions.

The authors feel this review provides a strong evidence base that could inform policy and guidance given to healthcare professionals, and that the presence of specific university course modules and appropriate staff training could improve staff knowledge surrounding “LGB specific issues, and could also reduce the levels of heteronormativity, negativity and judgment.”

Summary written by Alex Wormall (he/him), specialist SLT, Rowan House, Hyde.

Twitter: @wormito Instagram: @thewormito.

Student attitudes

This cross-sectional study surveyed 107 physiotherapy students from one UK training university. It aimed to explore students’ attitudes, knowledge and practice related to supporting LGBTQIA+ patients.

Participants were asked about their exposure to LGBTQIA+ people, competence, and attitudes and beliefs around providing care. They also completed a modified version of the Heteronormative Attitudes and Beliefs Scale (HABS). Data were analysed descriptively and using independent-samples t-tests to explore group differences based on proximity to LGBTQIA+ community, who had clinical or professional exposure to, or formal or informal education about the topic.

Many respondents were themselves LGBTQIA+ or had a close personal contact. Few reported contact with LGBTQIA+ patients, and most had not received formal education. There was a relationship between proximity to the LGBTQIA+ community and HABS score (where those who were closer to the LGBTQIA+ had less heteronormative beliefs), competency and attitudes in clinical settings towards LGBTQIA+ patients and awareness of healthcare needs. Neither informal or formal learning were associated with competence and awareness

The authors suggest that “understanding the content of physiotherapy LGBTQIA+ teaching may help identify why it is currently ineffective in improving attitudes, awareness and self-rated competence” should be explored in future research.

Commentary

Whilst these pieces of research were conducted in fields beyond speech and language therapy specifically (albeit still closely aligned), there are some relevant and important findings for speech and language therapists (SLTs). They highlight that people who are LGBTQIA+ may be more likely than their heterosexual counterparts to have a negative experience of healthcare if service providers and practitioners do not have sufficient knowledge about and respect for the LGBTQIA+ community. All pieces identified that practitioner attitudes were fundamental in effective or ineffective care, which may be moderated by educational exposure to LGBTQIA+ topics.

Such findings resonate with older research conducted in the field of speech and language therapy (e.g Hancock and Haskin, 2015), which found that while speech and language pathology students had ‘generally positive feelings’ towards LGBTQ groups, knowledge about LGBTQ culture was lacking, as was its focus in the curriculum.

Implications

SLTs, student SLTs and SLT educators should incorporate aspects of LGBTQIA+ culture and health needs into their education and professional development plans. This may include explorations to facilitate conversations and interactions with patients, and/or specific ‘cultural competence’ /LGBTQIA+ training. Developments to services to ensure they are more equitable to LGBTQIA+ individuals may be made at the individual patient, service, or trust level.

SLTs could reflect on their own biases and explore any cis- or hetero- normative attitudes and beliefs that may be impinging their practice. This may be involve considering the questions asked on taking a case history, the assessment and therapy materials used and the targets for interventions developed.

Inclusive practice journals roundup: part one

First instalment focuses broadly on evidence around bias in healthcare professionals

Inclusive practice journals roundup: part two

Second instalment focuses broadly on language and linguistics and the impact of colonialism

RCSLT journals collection

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