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LGBTQ+ individuals' experiences of initial identity disclosure in primary healthcare services: a qualitative scoping
Polyxeni Tsiokanou1, Mary Gouva1, Christine Mantzouka2
1Department of Nursing, University of Ioannina, 4th kilometer National Highway Str. Ioannina-Athens, 45500, Ioannina, Greece.
Background:
Primary healthcare is central to equitable and high-quality care; however, access and utilisation remain uneven across population groups. LGBTQ+ individuals continue to experience discrimination, stigma and non-affirming practices within primary care settings. These experiences undermine trust, discourage identity disclosure and contribute to reduced engagement with services, delayed care and poorer health outcomes.
Objective:
To explore LGBTQ+ individuals' experiences of their initial identity disclosure encounters with primary healthcare professionals and how these influence their future engagement with care services.
Design:
Qualitative scoping review.
Information Sources:
The PubMed, CINAHL, and SCOPUS databases were systematically searched using a PICo-based strategy.
Methods:
A scoping review followed PRISMA-ScR guidelines, including qualitative studies. Articles were appraised, and the findings were synthesised to identify recurring themes across the reviewed literature.
Results:
Four thematic units emerged, namely: (a) Factors Shaping the Experiences of Identity Disclosure, (b) The Impact of Discriminatory Attitudes, (c) The Structure and Symbols of Health Institutions, (d) Navigating the Healthcare System.
Conclusions:
Initial identity disclosure encounters are pivotal in shaping LGBTQ+ individuals' long-term engagement with primary healthcare services, which depends on both anticipated and experienced trust. Establishing trust is predicated on individual qualities of healthcare providers and the structural/organisational context of primary care settings. Enhancing both individual and system-wide trust is crucial in fostering equitable and sustainable healthcare relationships.
Registration:
A study protocol was developed and registered with the Centre for Open Science (COS) as a scoping review and is publicly accessible under registration DOI 10.17,605/OSF.IO/ZXWGS - registered 24/10/2025.
Implications For The Profession And/Or Patient Care:
The triptych of developing self-aware, empathetic health professionals, educated within a culturally sensitive environment, and being capable of (re)structuring the primary care setting to become more inclusive are key implications of the review. This triptych is founded on developing a new scholarship of reflective practice, grounded in the science of the unique.
Impact:
Provide a mapping of the current literature's understanding of LGBTQ+ individuals' experiences of initial identity disclosure, highlight the roles that individuals and context play in these experiences, and argue for a new educational and practice approach tailored to each individual's uniqueness.
Reporting Method:
This study adheres to the EQUATOR guidelines and PRISMA-ScR checklist.
Patient Or Public Contribution:
Τhis study did not include patient or public involvement.
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