Optimising sexual health and wellbeing services for raciosexual minorities in England using constructivist grounded theory

Abstract

Background Racism, stigma, and discrimination can result in poor experiences, marginalisation, misinformation, and thus detrimental health outcomes for racially and sexually minoritised (Lesbian, Gay, Bisexual, Trans and Queer+ Black Persons of Colour (LGBTQ+ BPoC) identifying) individuals. By considering what culturally safe, sensitive, and inclusive services can look like, we can begin to advocate for better, more appropriate health service development. This study aims to examine the experiences of racially and sexually minoritised individuals in accessing sexual health services to develop a theoretical explanation of how to optimise sexual health and well-being services for raciosexual minorities in England. Design Charmaz's constructivist grounded theory was used to develop a theoretical explanation of how to optimise sexual health and well-being services for raciosexual minorities in England. Fourteen in depth interviews were used to collect data. Broun and Clarke's thematic analysis was used to analyse the data. Results From five fundamental themes, three key factors emerged from the data i) access to credible sexual health information, ii) culturally competent lived experience leadership, and iii) culturally safe environments and conditions. Findings highlight disparities with regards to access, outcomes, and experiences of care for raciosexual minority individuals in England. Factors such as the absence of lived experience practitioners, a lack of sensitivity and privacy, and a lack of diverse prevention options were said to compromise the accessibility and usability of existing sexual health services. Similarly, factors such as practitioner competency, trauma-informed approaches, access to practical information, were all said to optimise this experience, leading to greater openness and likelihood of service user engagement (see Figure 25). Conclusion In line with the recommendations made by the participants of this study, culturally safely, sensitivity, and inclusivity remain key drivers toward the design of more optimal sexual health provision in England. This will be achieved through an improved access to credible sexual health information, an increase in lived experience practitioners, provision of cultural competency training across the workforce, and the curation of culturally safe clinical environments and conditions. While it will require significant changes, where intersectionality is honoured, a shift will be observed toward a more optimal sexual health service delivery model. In turn, improved access, experiences, and overall health and wellbeing outcomes will be noted for raciosexual minorities in England.