Health-promoting and adverse pathways in the healthcare experiences of LGBTQIA+ individuals: a qualitative investigation

The current study investigated the healthcare experiences of LGBTQIA+ individuals from the perspective of the health equity promotion model, focusing on the factors that promote or hinder equitable healthcare pathways across diverse settings. A sample of 154 LGBTQIA+ individuals living in Italy responded to two open questions concerning their positive and negative experiences within healthcare settings related to their LGBTQIA+ identities. Thematic analysis identified two main themes: (1) health-promoting pathways, encompassing three subthemes (i.e. affirmation of LGBTQIA+ identities, non-judgemental attitudes and lack of prejudice, professional competence and education about LGBTQIA+ health needs); and (2) adverse pathways, encompassing four subthemes (i.e. cis-heteronormative assumptions, homo-transphobic attitudes, lack of competence and information, consequences of negative healthcare experiences). Barriers to accessing and utilising healthcare services were linked to professionals’ affirming attitudes, validation of LGBTQIA+ identities, (lack of) professionalism and prejudice, quality of information provided, and patient perceptions of competence in LGBTQIA+ health needs. The findings suggest that training on the specific health needs of LGBTQIA+ populations should be included in mental and medical healthcare curricula to enhance care quality, dismantle cis-heteronormative beliefs, and mitigate homo-transphobic attitudes that negatively impact the health trajectories of LGBTQIA+ individuals.