LGBTQ+ Healthcare Experiences in GR Survey Results��Conducted by:�Grand Rapids LGBTQ+ Healthcare Consortium��Board of Directors Meeting �January 19, 2022��Arly Winchester and Shahryar Oliai�

Table of Contents

Goals of the survey, where it was shared

Gender identity, residence, race/ethnicity, romantic /sexual orientation, location of care

DEMOGRAPHICS

02

OBJECTIVES

01

Looking forward, lessons learned, limitations

CONCLUSIONS

04

Preferred facility type, common topics

RESULTS ANALYSIS

03

2

A Note

This data was collected anonymously from participants to protect their privacy.

No research/survey process is perfect so this data should be used for educational purposes only and as a basis for further research.

Research into LGBTQ+ healthcare experiences -especially in West MI- is non-extensive and often focuses on the problems rather forming action plans and solutions.

3

1. Objectives

• Goals of the survey

​

• Distribution Process

​

​

​

4

Survey Goal

“In order to better understand the Grand Rapids LGBTQ+ community's needs, the GR LGBTQ+ Healthcare Consortium has drafted this survey. The goal is to understand disparities in healthcare, areas of improvement, and trends of the community. Responses are completely anonymous, but you may include your email for further follow up*. Thank you for your time!”

​

5

Distribution Process

Distribution Date:

• Nov 11th
• shared 3 places

​

• Nov 19th
• shared 6 places

​

• Dec 3rd
• shared 11 places

​

• Dec 22nd
• shared 2 places

​

6

Distribution Method:

• 9 Facebook groups/pages
• 7 LGBTQ+ focused
• 1 GVSU student social
• 1 GR activist group
• 4 emails to upper level WGS classes at GVSU
• 4 Discord servers
• 1 LGBTQ+ focused
• 2 GVSU student social
• 1 general social
• 1 Instagram post
• 1 GR activist page

2. Demographics

• Gender identity
• Residence
• Race/Ethnicity
• Sexual and Romantic Orientation
• Location of Care

​

7

Gender Identity

Top 5*:

Cisgender Woman - 55

Non-binary - 46

Transgender Man - 23

Transgender Woman - 23

Genderqueer/Genderfluid - 20

​

8

Fun Facts:

36 respondents chose more than one gender identity

• The most common combination was non-binary and another identity outside of the binary

​

Write-in options included:

• Demigirl
• Hydrangeaflux
• AFAB
• Femboy

* Respondents were able to choose more than one option.

Residence

9

Residence

10

Link to Google My Maps zip code distribution

Title

• Out of over 150 responses, around 20 identified as BIPOC (13%)

​

• The MI average is about 20%** and GR is around 27%**

​

• Given both the small sample size of the survey and # of BIPOC respondents, it is important to remember the limitations of the data.

​

11

* Respondents were able to choose more than one option.

** Source: US Census Bureau 2020 Quickfacts

Sexual and Romantic Orientation

Top 5* Sexual Orientations:

Queer - 62

Gay/Lesbian/Homosexual - 48

Bisexual - 40

Pansexual - 36

Asexual/Ace Spectrum -29

​

12

Top 5* Romantic Orientations:

Panromantic - 51

Gay/Lesbian/Homoromantic - 49

Biromantic - 38

Aromantic/Aro-Spectrum - 14

Straight/Heteroromantic - 8

* Respondents were able to choose more than one option.

Location of Care

13

Respondents stated that they seek care* at the following locations:

* Respondents were able to choose more than one option.

3. Results Analysis

• Preferred Facility Types
• Common Topics

​

14

Where would respondents prefer to seek healthcare?

15

• Wherever quality care is
• Healthcare w/o homo- and transphobia
• Treated like any other patient

Other

>23% of respondents

​

Largest groups:

Cisgender women-16

Homoromantic/ gay/lesbian-15

Gay/lesbian/

homosexual-14

Traditional

~37% of respondents

​

Largest groups:

Cisgender women-27

Queer-23

Panromantic-22

Either Type

~38% of respondents

​

Largest groups:

Queer-27

Panromantic-23

Non-binary identities-20

LGBTQ+ Focused

Obstacles and Challenges

16

Ongoing restrictions on gay and bisexual men having limitations on when they are able to donate blood.

Giving Blood

• Unnecessary conversations around birth control
• Uterus removal for single/childless AFAB folks
• Lack of access to birth control options on the bus route.

Reproductive Health

Lack of challenges due to being straight passing (i.e. an LGBTQ+ person in a relationship with someone of the opposite gender).

Passing

• Finding affirming providers
• Difficulty receiving holistic care
• Wait times for specialists
• Accessing HRT, STD testing, other medication/care.

Difficulty Navigating

• Queer friendly providers with unfriendly/unaffirming front facing staff
• Lack of education/ training/knowledge on LGBTQ+ experiences and behaviors (especially for transgender and non-binary patients, as well as sex education)
• Being unaware of resources
• Making assumptions/ uninformed comments based on a patient’s identity
• Heavily reliant on word of mouth.

Lack of Resources/

Knowledge

17

Obstacles and Challenges

• Cost barriers to HRT and other medication
• Insurance companies facilitating barriers (like prior authorization)
• Unclear directions for navigating insurance*

Affordability/Insurance

• Religious iconography possibly creating unsafe environments due to religious trauma
• Being dismissed as a patient due to identity
• Inability to assess whether provider is affirming ->coming out possibly leading to a dangerous situation

Discrimination, DEI, and Religion

• Gender markers misaligning in order to receive care/coverage for HRT, surgeries, gender-affirming care,etc.

• Relying on word of mouth in order to find affirming/avoid discriminatory providers
• Conservative/religious community fostering discrimination that carries into healthcare.

18

Obstacles and Challenges

Gender-related Care and Discrimination

​

• Mistreatment, discrimination, transphobia, and bias from providers and staff due to gender identity
• Assumptions on identity/pronouns/partner based on anatomy and/or gender expression, leading to deadnaming, misgendering, and uncomfortable interactions
• Lack of providers and staff informed and trained to treat trans* patients in all stages of the transition process, with many being over-budget or have long wait times
• Patients needing to educate their provider on LGBTQ+ topics
• Inconsistent ways of marking a chosen name and pronouns in a patient’s chart
• Added bias towards non-binary and gender non-conforming patients (i.e. they/them and neopronoun usage)
• Medical gate-keeping (i.e. being trans/non-binary “enough”).

If you could change one thing…

19

• Little to no roadblocks for uterine removal
• Greater education around safe sex for LGBTQ+ folks

Reproductive Health

• Less attribution of health issues/concerns to a patient’s weight and weight alone

Fat Acceptance

• More readily available assistance with cost and insurance
• Affordability/free of charge in terms of insurance, copays, and overall costs -with options to avoid medical debt
• Patient advocacy centers for navigating issues with providers, staff, insurance, etc.

Insurance

If you could change one thing…

20

• Non-judgmental environments no matter a patient’s medical history, identity, status, etc.
• Transparency on biases among providers and staff
• Use of inclusive and diverse language/examples
• More BIPOC/LGBTQ+/diverse providers and staff
• Caring for survivors of sexual assault of all identities
• Caring for patients who fall outside of hetero/cisnormative relationships and identities when it comes to sexual health.

Inclusivity & Training

• Transparency about staff and provider identities as well as more BIPOC/ LGBTQ+ providers and staff
• Updated terminology (elimination of DSM-IV language) and gender-neutral/inclusive wording, pronouns, etc.
• Insurance coverage of all gender-affirming care and surgeries
• Communication between patient, provider, and insurance in order to ensure as little stress as possible
• Required training on how to interact with, be an ally to, and care for transgender and non-binary patients.

Gender Affirming Care

If you could change one thing…

21

• More trauma informed spaces/providers
• Reduction/elimination of referrals
• Separation of religion and politics from medicine
• Increase accessibility and ease of finding resources, care, and providers -noticeable indication that a provider has received training
• Decrease in wait times for pressing health issues and specialists; universal healthcare

Eliminating Barriers

• Changing protocols on treating and operating on intersex newborns/patients
• Better coordination of FMLA requests
• Less automation of phone responses
• Increased access to testing for ADHD, ASD, dyslexia, etc
• More local options with less localization (specialists being the only one in the county/side of the state).

Respondent Ratings

22

* Others include private practices, non-affiliates, and unknown providers

Coverage Needs

23

Statistical Analysis

Pearson's Chi-squared Test for Categorical Variables

Interpretation: Since the p-value is less than 0.05, we reject the null hypothesis that two categories are not associated with each other.

​

Better said, the closer the p-value to zero, the more association/stronger relationship exists between two categories!

​

24

Statistical Analysis

25

Remember! e-15 exponentiation means x10^-15

4. Conclusions

• Lessons Learned and Limitations
• Looking Forward

26

Lessons Learned

27

• Pretest the survey
• Indicate all sources of distribution including contact and URL links
• Include Age of the respondents for better mix and analytics
• Explore more venues for survey distribution
• various organizations
• consortium’s stakeholders and general membership
• other websites, online discussion boards or forums, social media networks
• Limit free text responses, asking three top choices
• Refining the rating options on health facilities for better consistency
• Cast a broader, wider net to include more BIPOC, and balance in the geographical areas
• Translate the survey to other common languages (Spanish, Vietnamese etc.)
• Explore providing the survey to those without internet/technology access
• Data and results storge, access and security

Future Explorations

28

• Ensure health facilities address patients with proper SOGI*pronouns
• Harassment or Violence (Physical, Sexual and Verbal)
• Disclosure of one’s sexuality and gender identification without their permission
• Exclusion from events or activities
• Substance abuse and misuse
• Relationship status/Partner Status
• Disability status and type/category
• Education level
• Life satisfaction
• Safety level in their communities
• Immediate, local, school, work or with their partners
• Level of openness in their personal life about being LGBTQAI+
• With family, friends, employers, neighbors and roommates Avoidance behaviors about their SOGI
• Develop focus groups based on specific issues via zoom/in person

* SOGI: Sexual Orientation and Gender Identity

Other Comments

29

1. Comprehensive training on LGBTQAI+ (10/59 = 17%)
2. Often in their attempt to be kind, the healthcare providers and staff do not ask enough question, thus declining care provisions greatly (7/59 = 12%)

​

• Misgendering/misidentifying the patient and/or partner during the doctor appointment (6/59 = 10%)
• Hard to find doctors caring for the transgender community (5/59 = 8.5%)

While this survey was revealing and offered consistent information by the respondents, we need a larger identified population to gain insights that can be generalized and applied more confidently, and thus gain new insights

Learn More

30

Recent research and discussion:

Choi et al.: Catalyzing a Nursing Response to Healthcare Discrimination Against Transgender and Nonbinary Individuals (2020)

Kcomt et al.: Healthcare avoidance due to anticipated discrimination among transgender people (2020)

Nowaskie et al.: A multicenter, multidisciplinary evaluation of 1701 healthcare professional students’ LGBT cultural competency: Comparisons between dental, medical, occupational therapy, pharmacy, physical therapy, physician assistant, and social work students (2020)

Toman, Lindsay: Navigating medical culture and LGBTQ identity (2019)

Towns, Jennifer: Insidious Trauma, Heteronormative Steeping, and Helpseeking: Exploring the Non-Heterosexual Experience in Rural Northern Michigan (2020)

Kempf et al.: Transgender and Gender Non-Binary Healthcare Coverage in State Medicaid Programs: Recommendations for More Equitable Approaches (2021)

Thank You!

Please Share Your Questions Now or Via the Following E-mails:

​

Grand Rapids LGBTQAI+ Healthcare Consortium

grlgbtqhealthcareconsortium.org

​

Arly Winchester

arlywinchesterlgbtqhcc@gmail.com

arlywinchester@cherryhealth.com

​

Shahryar (Shawn) Oliai

oliai@saroyallc.com

​

​

​

31