About Cultural Competency in Nevada (342)Page 9 of 18

8. Sexual Orientation and Gender Identity or Expression

All of us have a sexual orientation and a gender identity. Sexual orientation is an inherent or immutable enduring emotional, romantic, or sexual attraction to other people. It is independent of a person’s gender identity. Gender identity is one's innermost concept of self as male, female, a blend of both or neither—how individuals perceive themselves and what they call themselves. Gender identity can be the same or different from their sex assigned at birth (HRC, 2024).

When seeking healthcare, lesbian, gay, bi-sexual, transgender, questioning, intersex, asexual people (LGBTQ+) are impacted by significant barriers. This can take the form of disrespect, discrimination, inadequate understanding of needs, and an inability to provide appropriate care. Many patients delayed seeking healthcare because of their identity and fear of discrimination from healthcare providers (Prasad et al., 2023).

The experience of discrimination among LGBTQ+ people is linked to higher incidence of serious illness, poorer health outcomes, more risky health behaviors, and difficulties accessing healthcare. When seriously ill LGBTQ+ people feel unable to share important aspects of identity, the impact can be devastating (Braybrook et al., 2023).

Competent communication is vital for LGBTQ+ inclusive care, building trusting relationships, informed decision making, and person-centered care. Poor communication and assumptions made by clinicians about patients’ gender and sexual orientation undermine clinical relationships, leading to disengagement and loss of trust. Specifically, heteronormativity* and cisnormativity** are pervasive and damaging (Braybrook et al., 2023).

*Heteronormativity: the assumption that being heterosexual is the “normal” sexual orientation.

**Cisnormativity: the assumption that having a gender identity that aligns with sex assigned at birth is the “normal” gender identity.

For intersex populations, there is limited research focused on their healthcare, but there is a tendency for intersexual adults to avoid healthcare due to traumatic healthcare experiences during childhood. These disparities in physical health and quality of care highlight the need to improve the healthcare experience for this population by providing focused training to healthcare professional students (Prasad et al., 2023).

The concept of intersectionality explains how LGBTQ+ individuals may be confronted with multiple interlinked forms of discrimination such as heteronormativity, ageism, ableism, and racism, that when combined, increase vulnerability to health inequities and lead to inferior clinical outcomes (Comeau et al., 2023).

The lived experiences of gender-diverse people can be respected using words that patients choose in their own terms, which may include gender-neutral terms or binary terms if preferred to affirm one’s gender (Marjadi et al., 2023).

The Human Rights Campaign Foundation’s Healthcare Equality Index (HEI) shows incredible growth in the number of healthcare institutions that are embracing and adopting LGBTQ+ inclusive policies and practices. An overview of the HEI 2022 indicates, diverse healthcare facilities across the U.S. are making tremendous strides toward LGBTQ+ patient-centered care. In unprecedented numbers, they are changing key policies, implementing best practices, and training their staff.

HEI includes four foundational elements of LGBTQ+ patient-centered care (HRCF, 2022):

  1. An LGBTQ+ inclusive patient non-discrimination policy.
  2. An LGBTQ+ inclusive visitation policy.
  3. An LGBTQ+ inclusive employment non-discrimination policy.
  4. Staff training in LGBTQ+ patient-centered care.