“Render a service worthy of me”: A qualitative study of factors influencing access to LGBTQ-specific health services

For a half-century, LGBTQ-specific health services have sought to address the unmet health care needs of LGBTQ people in the U.S. However, there is a dearth of research examining factors that influence LGBTQ care-seekers’ reasons for choosing LGBTQ-specific services and their experiences accessing care. This interview-based study explored factors that facilitate and inhibit access to LGBTQ-specific health services among a sample of 40 LGBTQ adults in a major U.S. city. Using framework analysis, emergent themes were organized into supply- and demand-side factors, guided by Levesque et al.’s (2013) framework for patient-centered health care access. Supply-side factors included provider empathy and affirmation, provider knowledge, comprehensive care, and provider-based stigma. Demand-side factors included care-seeker's willingness for self-disclosure, care-seeker beliefs placing primacy on health needs over LGBTQ identities, contentment with general providers, a lack of knowledge for service identification, and perceptions of ability to pay. Social aspects of care seeking were also identified, including desires for social belonging, collective self-esteem, and community solidarity. Findings suggest opportunities to enhance the fit between health care policy, LGBTQ-specific provider characteristics, and care-seeker needs, particularly for multiply-marginalized LGBTQ communities.