LGBTQ+ Considerations Related to Physical Therapy: A Qualitative Study in Washington State

Abstract

There is little known of lesbian, gay, bisexual, transgender, queer or questioning and other sexual and gender minorities’ (LGBTQ+) experiences and recommendations related to physical therapy services. The LGBTQ+ community is a collective of people with diverse identities related to gender identity and sexuality. As a broadly defined group, this community has faced marginalization and health disparities, though has also demonstrated resiliency. This study aimed to use community-based engagement and a strengths-based approach to answer the following research questions: 1) How do people who identify as LGBTQ+ describe experiences related to the utilization of physical therapy services?; and 2) In what ways can the physical therapy profession support equitable health and provide equitable health care for people who identify as LGBTQ+? The study used a grounded theory approach was informed by the Standards for Reporting Qualitative Research (SRQR). Data were collected via recorded semi-structured interviews. Eligibility criteria included adults who identified as LGBTQ+, had either had physical therapy or tried to access physical therapy, spoke English, and resided in Washington State. Analysis used coded transcriptions to develop a theoretical model. Nineteen participants completed interviews. The first question resulted in a theoretical model describing interrelated overall themes of ‘quality of care,’ ‘intersectionality,’ and ‘patient safety.’ This emphasized patient treatment and access for high quality health, diverse experiences as whole human beings, and safety related to emotional, psychological, and physical well-being in the physical therapy environment. The second question resulted in recommendations for implementing an ‘inclusive organizational environment,’ ‘establishing trust,’ and being involved in ‘the bigger picture’ as it relates to health and physical therapy. Recommendations included trauma-informed practices, having options that respond to peoples’ preferences for disclosure and environmental safety considerations, authentically carrying out practices, gender and sexuality training for providers and personnel, actively engaging in continuing education and engagement with the LGBTQ+ community, and working collaboratively for financial, holistic, and preventive care that promotes equitable LGBTQ+ health. By targeting those in the LGBTQ+ community as experts, this research acknowledges the importance of stakeholder engagement related to physical therapy utilization and can inform future clinical practice, research, policy, and professional education.