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Table 1 Domains, factors, and feedback loops influencing regional LGBTQ + people’s access to quality primary healthcare

From: When primary healthcare meets queerstory: community-based system dynamics influencing regional/rural LGBTQ + people’s access to quality primary healthcare in Australia

Domain

Factor

Feedback Loop/ Antecedent/ Consequence

Action Area Endorsement

Past “✓”

Future “❤”

Queer Literacy

Queer health not in depth in education

A

 

❤❤❤

HSPs understanding, knowledge, and awareness of Queer lived experience and identities

R1, R2, R3, A

  

Health professionals recognise the special needs of LGBT people

R1

✓✓✓✓

 

Recognise lack of support and connectedness for LGBT people

R1

 

❤

Service provider assumptions based on cis-heteronormativity medical specialisation

R5, A

✓

 

Service providers misuse gender and sex binaries, misgender, and assume gender/sex

R5, A

✓✓✓

 

Refer to physical attribute rather than gender

R5

  

Conversations about differing needs in social connectedness

R1

✓✓✓

❤

GPs see social connectedness as a need for referral

R1

 

❤

Queer social connectedness and networks referral pathways

C

  

Queer Advocacy

PHC and HSPs consulting with Queer communities and advocacy groups

n/a

✓

 

Responsibility of the institutions/system not individuals

n/a

  

Queer advocacy (self, systemic, collective)

n/a

✓✓✓✓

❤

Self-advocating (but shouldn’t have to)

R5, A

  

Ability to advocate

A

  

Internalised homophobia (Queerphobia)

A

  

Queer Space

Current Queer health research, information, education/training by HSPs embedded in practice

R2

 

❤❤❤

Power of health professionals with clients

n/a

  

Promoting Queer safe spaces

C

✓✓✓

❤

Queer-friendly HSPs, services, and spaces

R2, R3

 

❤

Seek out Queer-run services and spaces

A, C

✓✓

 

Availability and proximity of Queer service providers

R4

✓✓

❤❤

Waiting lists

R4

  

Capacity and need to travel to Melbourne

R4

✓✓

 

Queer Presence

Healthcare system is based/designed on cis-heteronormative foundation

A

✓

❤

Inclusiveness of healthcare system with Queer health professionals

R3

 

❤

Disclosure of health professional’s Queer identity in the healthcare system

R3

✓✓✓

❤❤

Intersectional Queer Life

Intersectionality to/in healthcare

n/a

✓

 

Accessibility to/in healthcare (more than wheelchair access)

n/a

✓✓

 

Policy is accountable to Queer communities’ lived experience

n/a

  

Policy is resourced and reviewed

n/a

  
  1. PHC  Primary Healthcare, HSP  Health Service Providers, LGBT  Lesbian, Gay, Bisexual, Trans, Queer = Umbrella term referring to LGBT people of any gender, as well as people of any other minority sexuality and gender identity (e.g., third gender, non-binary, two-spirit); R1 = Feedback Loop 1: Aware, Recognise, Talk, Refer, Network; R2 = Feedback Loop 2: Power, Disclosure, Inclusiveness; R3 = Feedback Loop 3: Current Queer Lived Experience Embedded in Queer Health Services, Research, and Education; R4 = Feedback Loop 4: Availability and Capacity of Queer Health Service Providers; R5 = Feedback Loop 5: Queer Advocacy Promoting Queer Life and Identities. All feedback loops are “reinforcing” (R). A = antecedent factor; C = consequent factor. n/a = factors raised by the participant group but not yet linked with other factors. More ticks (“✓”) = greater the focus of past actions; More hearts (“❤”) = greater the need for future action
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BMC Public Health

ISSN: 1471-2458

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