Constructing Wholeness in LGBTQ+ Healthcare Access: A Grounded Theory Model

LGBTQ+ individuals continue to experience substantial barriers to accessing affirming healthcare, including discrimination, structural inequities, and provider-level limitations. This study aimed to develop an emergent grounded theory model of constructing wholeness in healthcare.

This study employed a secondary constructivist grounded theory analysis of qualitative data from The Rainbow Connections Study, a community-based system dynamics project. Data were collected through eight group model-building sessions conducted via Zoom with 28 LGBTQ+ participants, including older adults, youth, transgender and gender-diverse individuals, and staff from the LGBTQ+ community center who also held service and practitioner roles; analytic claims are framed to reflect this mixed-role sample. Sessions were audio- and video-recorded, transcribed verbatim, and analyzed using open, axial, and selective coding procedures. Constant comparative methods, reflexive memoing, and member checking were used to support analytic rigor and trustworthiness.

Analysis revealed a dynamic process in which LGBTQ+ individuals encounter external forces within healthcare systems that alternately support or fragment their sense of self. In response, participants engaged in four interconnected internal processes-interconnecting selves, intra-community support, self-determined care, and meaning-finding-that facilitated movement toward wholeness. These processes were non-linear, iterative, and present across diverse identities and life stages.

The emergent theory of Constructing Wholeness in Connecting to Healthcare highlights that LGBTQ+ healthcare experiences extend beyond access and utilization to include identity integration, community reliance, and meaning making. Supporting LGBTQ+ health requires healthcare approaches that affirm wholeness, reduce structural harm, and recognize the central role of community in navigating care.