Date of Award

2023-05-21

Degree Name

PhD Education for Social Justice

Dissertation Committee

Suzanne Stolz, EdD, Chair; Jillian Tullis, PhD, Member

Keywords

Federally Qualified Health Centers, community health centers, cultural competence, culturally competent healthcare, LGBTQ health disparities, health equity

Abstract

Despite increased advocacy and funding, significant inequities in healthcare access, quality of care, and health outcomes have continued to persist for lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) communities. Intersecting marginalized identities such as race, gender, and disability compound health inequities faced by LGBTQ folx. These inequities are not random; rather, they result from deeply embedded homophobia, transphobia, ableism, and racism that pervade the U.S. healthcare system. An exploratory comparative case study was completed using qualitative data collection methods (i.e., key informant interviews, focus groups, and document analysis) to investigate how two California-based Federally Qualified Health Centers (FQHCs) that specialize in serving LGBTQ populations assess the needs and provide culturally competent care to the queer community. Health provider cultural competence is often cited as a promising practice in health disparities literature; however, there is a lack of agreement as to what the construct means and how it should be enacted. Critical race theory and queer theory served as the theoretical paradigm supporting the design and analysis of this study. In total there were 41 study participants consisting of 10 key health center leaders, 21 health center staff/providers, and 10 health center patients/clients. Using grounded theory analysis techniques, 14 themes were identified from the data. From those themes, five study findings emerged. Findings suggested both study sites primarily use patient advisory groups, existing patient data, and community outreach to identify LGBTQ healthcare needs. Despite differing patient demographics, these sites also use similar care strategies to meet the needs of LGBTQ individuals, including hiring staff who are reflective of the population; providing specialty care

services (e.g., sexual health and gender-affirming care); taking a holistic patient-centered care approach; creating a welcoming and affirming clinic environment; providing care in an open, nonjudgmental way; and partnering with other organizations. Workforce training was seen as important to providing culturally competent care for LGBTQ individuals, yet both study sites reported lacking the ongoing training opportunities they need. Findings suggested although there may be several common components as to what defines LGBTQ cultural competence specific to an FQHC setting, a nuanced critical approach is needed. Keywords: Federally Qualified Health Centers, community health centers, cultural competence, culturally competent healthcare, LGBTQ health disparities, intersectionality, health equity

Document Type

Dissertation: Open Access

Department

Learning and Teaching

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