Aligning values and behaviours in LGBTQIA+ affirming care: primary care providers' perspectives

The lesbian, gay, bisexual, transgender, queer, intersex, asexual and other related communities (LGBTQIA+) possess rich and diverse lived experiences yet continue to face systemic barriers to safe and affirming healthcare. This study examined the key features of such care from the perspective of primary care providers who deliver affirming care to LGBTQIA+ people. Thirty-one clinicians across varied disciplines shared their insights through semi-structured interviews. These were analysed using reflexive thematic analysis informed by queer theory and a relativist epistemology. Two overarching concepts were identified across participants' experiences: their values (purpose, principles and qualities) that underpinned their practices (ways of providing affirming care) that were grounded in intentionality, reflection and relationality. Four key themes were generated that intersected with practices and values: 1) values-driven healthcare, 2) (un)learning biases, reflection, and sociocultural awareness, 3) mitigating the power imbalance in the patient-provider relationship, and 4) valuing lived experience. These themes describe key features of delivering safe and affirming healthcare for participants. The findings highlight the importance of addressing both the observable (behaviours and practices) and unobservable (values) when implementing interventions to improve healthcare provision for LGBTQIA+ people.