Health care practices and relationships: The experiences of queer women and primary care providers

Women who identify as lesbian, bisexual, transgender or 'queer' (LBTQ) face social exclusion that can translate into significant health inequities. Yet we have inadequate explanations for how exactly social exclusion determines health outcomes. LBTQ women may engage in behaviours that are detrimental to health, to some extent in response to intolerance. They are less likely to seek out health care services, in part because many experience health care as discriminatory. Furthermore, primary care providers frequently lack adequate training for working effectively with queer women. Even with the best of intentions, practicing from a position of presumed neutrality may leave providers woefully unable to take into account the ways in which social conditions influence the lives and health of queer women. Everyday health care practices and ways of relating with patients, at individual and institutional levels, may unintentionally reproduce patterns of heterosexism, homophobia and intolerance for gender ambiguity. We need to better understand how health care practices and relationships may unwittingly contribute to health inequities for LBTQ women, as well as how some health care providers challenge those patterns to optimize care. This phenomenological study will examine how queer women in two Canadian cities (Halifax and Vancouver) experience health care, as well as how primary care providers experience their work with queer women. In each site 20-25 women, 15-20 nurses and 15-20 general practice physicians will participate in one-on-one interviews and focus groups. Findings from the proposed study will help to identify strategies for effective health care in the context of social exclusion. It will explicate ways in which routine practices - individual and/or institutional - may reproduce social exclusion for LBTQ women, contributing to health disadvantages. The results will be valuable for education and continuing education with primary care providers.