Cultural Competency, Including Caring for LGBTQ+ Patients

LEARNING OUTCOME AND OBJECTIVES:  Upon successful completion of this continuing education course, you will be prepared to provide effective and respectful care for patients belonging to different populations, including those identifying as LGBTQ+. Specific learning objectives to address potential knowledge gaps include:

• Examine the intersection of oppression, discrimination, and implicit biases in order to provide nondiscriminatory care.
• Discuss elements of culturally competent care among different populations.
• Describe terminology that is inclusive and respectful of the LGBTQ+ community.
• Summarize health disparities, health risk factors, and clinical implications specific to members of the LGBTQ+ community.
• Identify best practices for culturally competent care for LGBTQ+ patients.

INTRODUCTION

Culture involves a combination of elements that are shared by certain ethnic, racial, religious, geographic, or social groups. Some of these elements include personal identification, language, thoughts, communications, actions, customs, beliefs, values, and institutions. These elements influence beliefs and belief systems surrounding health, healing, wellness, illness, disease, and delivery of health services. Cultural competence in healthcare can be defined as the ability of healthcare professionals to work or respond appropriately and effectively in cross-cultural situations using culture-specific skills in a manner that acknowledges and respects the culture of the patient (Windon, 2023).

In order to provide culturally competent care, nurses and other healthcare providers must be understanding and sensitive to the cultural characteristics common to certain populations, such as:

• Persons from various gender, racial, and ethnic backgrounds
• Persons from various religious backgrounds
• Children and older adults
• Veterans
• Persons with a mental illness
• Persons with an intellectual, developmental, or physical disability
• Lesbian, gay, bisexual, transgender, and questioning (LGBTQ+) persons

Providing care that adequately meets the diverse needs of patients from various cultural backgrounds is a necessary component of providing equitable healthcare for all individuals. Healthcare professionals can provide improved care to diverse patients through education and training, increased knowledge and skills, and changes in attitudes and behaviors (Toll, 2025).

OPPRESSION, DISCRIMINATION, AND CULTURAL BIAS IN HEALTHCARE

A person’s healthcare experience is influenced by the intersection of their sex, gender identity, race, ethnicity, sexual orientation, socioeconomic status, ability, and other social determinants. All these factors have an impact on a patient’s access to healthcare, health risks, and health outcomes. Any past and present discrimination, oppression, or fear related to these factors can greatly influence an individual’s actions to actively seek care when needed or, conversely, to defer their healthcare needs until a crisis occurs.

Providing whole-person, patient-centered care requires a healthcare professional to proactively consider the intersection between each person’s diverse identities and broader cultural factors. Such an “intersectionality” perspective should not lead to assumptions about an individual based on the minority groups with which they identify but should inform the clinical experience in a positive manner in order to respect and address each person’s unique needs (Vela et al., 2022).

Cultural Bias and the Provision of Care

When working with patients, it is especially important for clinicians to build a positive rapport as a way to counteract the exclusion, discrimination, and stigma their patients may have experienced previously in the healthcare environment. However, despite their best intentions, healthcare professionals may hold internalized cultural biases that affect their interaction with patients. For example, a clinician, case manager, or other staff member may say something or use body language that communicates a stereotype or negative message about a patient.

These biases can lead to unequal care and affect a patient’s decision to follow medical advice or return for follow-up care. Negative messages can also become internalized in the patient, adding to a person’s stress and contributing to negative mental and physical health outcomes (Vela et al., 2022).

A review of a number of research studies shows that bias in the healthcare community has far-reaching consequences for healthcare recipients.

• Results from a 2024 study involving 21,851 patients showed that female patients were less likely to be prescribed pain-relief medications compared to male patients.
• Results from a 2019 study showed that more than 80% of medical students had an implicit bias against lesbian and gay people.
• Although ageism (stereotypes, prejudices, and discrimination against older adults) scores among healthcare workers are low, a systematic review of 15 studies conducted between 2014 and 2024 showed that less knowledge about aging can contribute to higher ageism scores.
• A 2020 study showed that 83.6% of respondents implicitly preferred people without disabilities and viewed people with disabilities as having a lower quality of life due to their disabilities.
• A 2023 screening of studies related to weight stigma experienced by individuals with overweight and obesity found that patients with higher weight often reported negative interpersonal interactions with healthcare providers who exhibited biased attitudes about the causes and controllability of the patients’ weight.
• A literature review from 2024 concluded that clinicians treating patients from low-socioeconomic-status backgrounds may make decisions based on implicit bias and stereotyping of these individuals.
  (Guzikevits et al., 2024; Smith Haghighi, 2023; Fernández-Puerta et al., 2024; Job et al., 2024; Ryan et al., 2023)

Studies have shown that no matter how individuals may feel about prejudiced behavior, everyone is susceptible to biases based on cultural values and stereotypes that were embedded in their belief systems from a young age. To increase one’s own awareness of internal bias, it is helpful to notice times when biased attitudes and beliefs may arise. Such internal awareness is the first step in making changes. Internal questions to ask may include:

• How do my current beliefs help me?
• What might I lose if I change my beliefs?
• How might my current beliefs harm others?
• How might it benefit me and others to change my beliefs?
  (NCCC, n.d.)

It is important for clinicians and case managers to focus on remaining open and compassionate by consciously intending to set aside assumptions and get to know a patient as an individual. For example, when first meeting a new patient who is a transgender man, the clinician can imagine what it might be like for this person to see a new provider for the first time. Instead of focusing on the patient’s gender identity and when or if he has transitioned, the clinician or case manager can focus on getting to know him as a person, such as understanding where he lives and works and more about his family support.

CULTURAL COMPETENCY AMONG DIFFERENT POPULATIONS

Best Practices for Culturally Competent Care Regarding Race, Ethnicity, and Religion

Best practices for culturally competent care include screening and providing resources to address needs related to health disparities, learning about racial and ethnic differences among diverse populations, being more inclusive of alternative methods of healing, and being aware of how personal religious beliefs can impact care of the patient.

A patient’s race, ethnicity, or religion may contribute to various healthcare-related considerations:

• Physiologic variations make some groups more prone to certain diseases and conditions, such as sickle cell anemia among non-Hispanic Black Americans or Tay-Sachs disease among Eastern European Jews.
• A patient’s reaction to pain may be culturally prescribed; for example, Middle Eastern and Hispanic cultures encourage the open expression of emotions related to pain while Asian cultures value stoicism.
• Different ethnic groups have different norms of psychological well-being and acceptance of mental illness.
• Perceptions of appropriate personal space and physical contact, including between the sexes, vary among cultures.
• Different food preferences among cultural groups can be a factor in whether a patient is receiving adequate nutrition while in a hospital or other healthcare setting.
• Cultural views on sex roles, families, and relationships may impact areas such as decision-making, privacy, and information sharing among patients, loved ones, and healthcare providers.
• Most cultures use traditional herbal remedies, so it is important to ask a patient if they are taking anything in addition to prescriptions.
  (Galanti, 2019)

A patient’s religion/spirituality is often an important consideration in regard to medical decisions and culturally competent care. Therefore, healthcare providers should be aware of and respectful of a patient’s religious beliefs as they relate to issues such as diet, medicines that may include animal products, modesty, the preferred gender of their health providers, prayer times that may interfere with treatment regimens, and more.

Similarly, many patients may turn to their religious faith in order to reduce their anxieties, respond to healthcare challenges, and make difficult healthcare decisions, including end-of-life care and preparations. Health professionals should therefore provide an opportunity for patients to discuss their religious and spiritual beliefs and tailor their evaluation and treatment to meet patients’ specific needs.

Best Practices for Culturally Competent Care of Children

Culturally competent care of children requires an awareness of cultural differences that may have an impact on growth/development as well as other healthcare-related concerns. For instance:

• Common diets and feeding practices differ among groups and may contribute to nutritional or weight status in children.
• Parenting styles and health promotion behaviors can vary significantly, such as encouraging or discouraging independence in infants and toddlers.
• Practices such as infants and small children sharing a bed with parents may be of significance for the comfort of pediatric inpatients.
• Emotional development, such as acceptance around crying, can be affected by cultural views.
• For adolescents, cultural values and attitudes toward sexuality vary.

Clinicians must consider these and other cultural habits, beliefs, language, and ethnicity in order to provide appropriate care for all children and families (Ricci et al., 2024).

In order to improve health equity, culturally competent care should be provided in primary care, particularly during well-child visits. Results from recent research indicated that care provided in pediatric primary care offices that is rated by caregivers as culturally sensitive is correlated with higher-quality well-child care (Okoniewski et al., 2022).

Examples of interventions that support culturally competent care include:

• Offering the use of language supports, such as professional medical interpreters or healthcare workers qualified to translate, to all patients
• Explaining health issues based on social or cultural values
• Providing evidence of a health issue’s influence on a cultural group
  (Okoniewski et al., 2022)

Best Practices for Culturally Competent Care of Older Adults

Older adults are generally considered to be those ages 65 years and older. In the United States, the population of older adults is expected to double to 83.7 million individuals by 2050 (IHI, n.d.). Health disparities become magnified in the older adult population, and issues around race, ethnicity, sex, gender identification, sexual orientation, and disability continue to impact these patients’ access to healthcare and outcomes (Taylor et al., 2022).

Older adults have different healthcare needs due to normal physiologic changes of aging, the increasing prevalence of age-related disease, and other psychosocial factors. Despite these differences, culturally competent care for older patients requires nurses to avoid bias and discrimination based on age (referred to as ageism).

Stereotypes about aging, particularly in North America, are primarily negative—a time of ill health, loneliness, dependency, and poor physical and mental functioning (Palsgaard et al., 2022). Such negative attitudes toward and discriminatory treatment of older adults are present throughout the healthcare community and affect the quantity and quality of care provided to older patients, putting them at increased risk for undertreatment or overtreatment. For example, if a nurse has the belief that older adults are less healthy, less alert, and more dependent, then their initial assessment of the patient will reflect this belief (Swan & Evans, 2024).

A few common myths and realities about older adults include:

• Myth: Old age means mental deterioration. In reality, neither intelligence nor personality normally decrease because of aging.
• Myth: Older adults are not sexually active. In reality, although less frequent, sexual activity lasts well into their 90s in healthy older adults.
• Myth: Bladder problems are a problem of aging. In reality, incontinence is not a part of aging; it generally has a root cause and requires medical attention.
  (Taylor et al., 2022)

Best Practices for Culturally Competent Care of Veterans

Military service members, their families, and veterans have unique needs that require a culturally competent approach to healthcare services. There are approximately 18 million veterans as well as 2.1 million military service members in the United States. Approximately 6% of Americans have been in or are currently in the military (Inoue et al., 2023).

Combat and military experiences directly and indirectly impact veterans’ health and well-being. It is important to recognize how military experiences may be associated with different adverse outcomes in order to provide quality interventions and support services.

The key elements of military culture include:

• Chain of command
• Strict routine and structure
• Respect for authority and oneself
• Strength (not asking for help)
• Honor (used to being trusted)
• Aggression (faster, harder, louder, meaner)

Health disparities unique to the veteran population include increased comorbidities and the mental and physical effects of trauma experienced during their service. Disparities can vary according to the sex, race, sexual orientation, age, and socioeconomic status of the veteran (Tran & Huang, 2022).

Approximately 66% of male and 58% of female veterans experienced injuries related to their past deployments, in addition to additional chronic health conditions and comorbidities. Experience while in combat raises a veteran’s risk of stroke, arthritis, asthma, and lung disease. Common chronic health conditions among veterans include:

• Posttraumatic stress disorder (PTSD)
• Chronic pain
• Sleep problems
• Anxiety
• Depression
  (Mosalpuria et al., 2024)

Best practices for culturally competent care of veterans include avoiding common stereotypes about the veteran population, caring in a trauma-informed manner, understanding and being sensitive of the multiple comorbidities of veterans, and understanding the long-term effects that military culture may have had on the patient.

Common stereotypes about the veteran population include:

• All veterans are in crisis.
• All veterans have posttraumatic stress disorder and/or substance use issues.
• All veterans served in combat.
• All veterans have access to Department of Veterans Affairs (VA) healthcare.
• All veterans are homeless.
• All veterans want to be thanked for their service.
  (CalVet, n.d.)

Best Practices for Culturally Competent Care of a Patient with a Mental Illness

The responsibility for providing mental health care must be shared across the multidisciplinary workforce, requiring skilled clinicians to deliver both physical and mental health services in diverse clinical settings. Physical and mental health education, training, and services, however, have historically functioned independently from each other, and as a result those caring for patients with physical disorders report a lack of training and feeling inadequately prepared to care for their patients’ mental health care needs. In addition, they report a lack of access to appropriate training and support in the workplace (McInnes et al., 2022).

Frustrations reported by staff related to caring for patients experiencing mental illness seem to arise from knowledge gaps or skill deficits, and mostly relate to ineffective therapeutic interaction, leaving the caregivers with feelings of inadequacy and professional dissatisfaction. Nonpsychiatric healthcare professionals often report having to struggle to provide care for patients with mental illness without having the sort of specialized training that is standard for those who work in psychiatric facilities, such as:

• De-escalation
• Communication skills
• Suicide prevention
• Addressing potential violence and aggression
• Maintaining a safe environment

In addition, negative attitudes toward mental illness by healthcare professionals have been reported. These attitudes can have adverse consequences for people with mental illness, from delays in seeking care to decreased quality of care provided.

Effective ways to interact with a patient with a mental illness include:

• Be patient when attempting to communicate; do not rush or pressure the patient to talk.
• Answer questions briefly, quietly, calmly, and honestly.
• Counter distractibility and poor concentration by giving the patient clear, simple, and concrete instructions.
• Attempt to educate patients about any inappropriateness of their behavior without criticizing or blaming them.
• Avoid judging the person, and do not give negative feedback.
• Avoid verbal confrontations with the person.
• Encourage the patient to respect the personal space of others.
• Provide consistent limits on behaviors and verbal abuse; make sure all staff are clear about these limits and that they reinforce them.
• Encourage and support any ideas the person has that are realistic and in keeping with their healthcare regimen. It is far more effective to suggest alternative strategies rather than to forbid an action.
• Encourage the person to organize and slow thoughts and speech patterns by focusing on one topic at a time and asking questions that require brief answers only.
• If a patient’s thoughts and speech become confused, cease the conversation and help to calm the patient by sitting quietly together.
• Offer PRN medications and watch for adverse side effects.
• Encourage participation in relaxation exercises such as deep breathing.
• Acknowledge what patients are experiencing but remind them that they are not in danger, they will be okay, and you are there to help.
• Speak in short, simple sentences and encourage the patient.
• Remind patients to breathe; if they are hyperventilating, have them breathe into their hands cupped over the mouth and nose or a small paper bag.
• Guide the patient through a simple, distracting physical task, such as raising the arms over the head.
  (Martin, 2024; Vera, 2024)

Best Practices for Culturally Competent Care of Patients with Disabilities

People with disabilities experience barriers to obtaining the healthcare services they need. The barriers can be physical or psychological.

• Physical barriers can include steps and curbs that prohibit a person with a mobility impairment from accessing a healthcare facility or a weight scale that cannot accommodate a person using a wheelchair.
• Psychological barriers can include poor communication, inadequate knowledge related to disabilities, and biased attitudes such as stereotyping, prejudice, and discrimination. Clinicians can feel that patients with disabilities act “entitled” to accommodations that they need.
  (CDC, 2025c)

The Americans with Disabilities Act of 1990 prohibits discrimination toward patients with disabilities. However, this does not mean that discrimination does not still occur. Discrimination, whether acknowledged or implicit, prevents people with disabilities from receiving proper care. In turn, this lack of care leads to health disparities (National Archives, 2025).

Examples of elements of culturally competent care for patients with disabilities include:

• Ensuring all facilities are accessible in compliance with ADA requirements
• Providing individuals with access to communication aids and services, such as medical interpreters, signers, audio recordings, etc.
• Using people-first language as a way of communicating with people with disabilities by focusing on the person first instead of the disability (see below)
• Practicing disability etiquette when interacting, such as:
  • Mobility impairments: Don’t push or touch someone’s wheelchair; bring yourself down to the person’s eye level to speak to them; and select a location to interact comfortably without a large distance between speakers.
  • Visual impairments: Identify yourself at the start of an interaction and let the patient know when you are leaving; don’t speak to or touch a working service animal; and acclimate the patient to the layout of the facility as well as any accessibility features.
  • Hearing impairments: Politely get the patient’s attention before beginning a conversation; speak directly to the person, not the interpreter; don’t assume they can read lips; don’t obscure your face; and speak in normal tones.
  • Speech disorders: Don’t speak for the person or try to finish the person’s sentences; ask the person to repeat or repeat yourself to confirm you understood.
  • Developmental disabilities: Speak clearly using simple words; do not use “baby talk” or talk down to the person; do not assume they cannot make their own decisions unless you’ve been told otherwise.
• Learning about the Americans with Disabilities Act of 1990 to better understand a clinician’s legal responsibilities for providing culturally competent care for people with disabilities
• Ensuring patient education materials are available in large type, Braille, or audio format
• Speaking to the patient directly instead of communicating only with the caregiver
• Requesting feedback from patients on how they feel they can be accommodated better in the future
• Using the words that the person with a disability has stated they prefer
  (Quality Interactions, 2024; Disability:IN, 2025)

GENERAL TIPS FOR PEOPLE-FIRST LANGUAGE

Tips	Use	Do Not Use
(CDC, 2025b; EARN, n.d.)
Emphasize abilities, not limitations	Person who uses a wheelchair Person who uses a device to speak	Confined or restricted to a wheelchair, wheelchair-bound Can’t talk, mute
Do not use language that suggests the lack of something	Person with a disability Person of short stature Person with cerebral palsy Person with epilepsy or seizure disorder Person with multiple sclerosis Person with cystic fibrosis A person who is deaf/blind, or a person who is hearing/visually impaired Person who is in recovery from a substance use disorder	Disabled, handicapped Midget Cerebral palsy victim Epileptic Afflicted by multiple sclerosis Victim of/suffering from/stricken by cystic fibrosis The Deaf/The Blind Addict
Emphasize the need for accessibility, not the disability	Accessible parking or bathroom	Handicapped parking or bathroom
Do not use offensive language	Person with a physical disability Person with an intellectual, cognitive, or developmental disability Person with an emotional or behavioral disability, a mental health impairment, or a psychiatric disability	Crippled, lame, deformed, invalid, spastic Slow, simple, moronic, retarded, defective, afflicted, special person Insane, crazy, psycho, maniac, nuts
Avoid language that implies negative stereotypes	Person without a disability	Normal person, healthy person
Do not portray people with disabilities as inspirational only because of their disability	Person who is successful, productive	Has overcome their disability/is courageous

CULTURALLY COMPETENT CARE FOR LGBTQ+ PATIENTS

Even though social acceptance of LGBTQ+ individuals has been increasing, LGBTQ+ patients continue to face barriers to culturally competent care, including stigma and discrimination. For these patients, access to healthcare that is unbiased and culturally affirming remains a challenge in most parts of the United States (Franklin, 2023).

People within the LGBTQ+ population are extraordinarily diverse, representing every social class and ethnicity in every geographical area and every profession (HRC, n.d.). Healthcare professionals who practice cultural sensitivity in working with LGBTQ+ patients can have a positive impact and increase trust as they continue to understand the individual needs of their patients.

Terms and Definitions

To better understand the LGBTQ+ population and their unique health concerns, it is important to define and clarify some basic concepts of gender identity and sexual orientation. Terms and definitions are ever evolving, and clinicians must update their knowledge regularly to provide effective and respectful care for all patients. It is also important that clinicians have the comfort and sensitivity to ask their patients how they would like to be addressed in terms of identifiers of gender identity and sexual orientation in a respectful, honest, and open-minded manner.

(Terminology described in this course is taken from recognized sources at the time the course was written. These terms may not reflect every individual’s personal preference, may become outdated even as they are mentioned in current clinical references, and may not reflect all local and regional variations.)

• Anatomical sex: the presence of certain female or male biologic anatomy (including genitals, chromosomes, hormones, etc.); also referred to as assigned sex at birth (ASAB)
• Asexual (A): people with no or little sexual attraction to other people
• Bisexual (B): men and women who are sexually attracted to people who are both the same as and different than their own gender
• Cisgender: people whose gender identity aligns with the sex they were assigned at birth, i.e., the opposite of transgender or gender diverse
• Gay (G): a person who is attracted to someone of the same gender; historically, refers to men who are attracted to men, but may also be used by women to refer to themselves
• Gender diverse (also gender nonconforming, gender variant, and gender creative): a person who embodies gender roles and/or gender expression that do not match social and cultural expectations
• Gender expression: the way a person presents their gender in society, through social roles, clothing, makeup, mannerisms, etc.
• Gender identity: a person’s internal sense of being male/a man, female/a woman, both, neither, or another gender
• Genderfluid or genderqueer (also called nonbinary): people who do not strictly identify as male or female; a mix of male and female (genderqueer/genderfluid); neither male nor female (nonbinary); or no gender at all
• Intersex (I): people with an indeterminate mix of primary and secondary sex characteristics, such as a person born appearing to be female “outside” who has mostly male anatomy “inside,” a person born with genitals that are a mix of male and female types (a female born with a large clitoris or without a vaginal opening, or a male born with a small penis or a divided scrotum that has formed like labia); may identify as either cisgender or gender diverse
• Lesbian (L): women who are attracted to women
• MSM: men who have sex with men
• Queer: an umbrella term for all who are not heterosexual or who are not 100% clear about their sexual orientation and/or gender identity
• Questioning (Q): a person who is in the process of discovery and exploration of their sexual orientation, gender identity, or gender expression
• Sexual orientation: how a person identifies their sexuality, including who they are physically and emotionally attracted to and with whom they choose to have sex; a person may not have a sexual attraction to others (asexual)
• Transgender (T): People with gender identities that do not align with their assigned sex at birth; some transgender individuals may alter their physical appearance and often undergo hormonal therapy or surgeries to affirm their gender identity. However, medical intervention is not required for a person to identify as transgender. Some transgender people do not undergo the medical transition process for a variety of reasons, including cost or other health concerns.
• Transgender female/woman, trans woman: a transgender person who was assigned male at birth (AMAB) but who identifies as female; formerly referred to as male-to-female (MTF)
• Transgender male/man, trans man: a transgender person who was assigned female at birth (AFAB) but who identifies as male; formerly referred to as female-to-male (FTM)
• WSW: women who have sex with women
  (AECF, 2023; APA, 2022; PFLAG, 2025)

Terms that marginalize and stigmatize people who are LGBTQ+ are still common. Also, some words previously used and accepted in the medical community may no longer be in common usage or considered acceptable/respectful today. Examples include:

• Homosexual
• Sexual preference
• Transvestite
• Male-to-female (MTF) transgender
• Female-to-male (FTM) transgender
  (PFLAG, 2025; GLAAD, 2025)

Examples of concepts that may contribute to societal stigmas for LGBTQ+ patients include:

• Heterosexism: the general presumption that everyone is straight or the belief that heterosexuality is a superior expression of sexuality; prejudice against nonheterosexual behaviors, relationships, or communities
• Homophobia: negative attitudes and feelings toward people with nonheterosexual sexualities; may include discomfort with expressions of sexuality that do not conform to heterosexual norms
• Internalized oppression: the belief that straight and cisgender people are “normal” or better than LGBTQ+ people, as well as the often-unconscious belief that negative stereotypes about LGBTQ+ people are true
• Transphobia: negative attitudes and feelings toward transgender people or discomfort with people whose gender identity and/or gender expression do not align with traditionally accepted gender roles
  (PFLAG, 2025; APA, 2023; Westfield, 2025)

Health Disparities and Health Risk Factors

The LGBTQ+ population is diverse in terms of race, ethnicity, disability, and socioeconomic status. Therefore, risk factors and disparities in each patient will vary depending on these individual factors. (See discussion below on specific population groups.)

Research has uncovered that LGBTQ+ individuals often face health disparities related to societal stigma, discrimination, and denial of civil and human rights in some manner. Discrimination has been linked to higher rates of psychiatric disorders, substance abuse disorders, and suicide. Violence and victimization are also more common and have lifelong consequences to the individual and the community as a whole. Personal, family, and social acceptance of an individual’s sexual orientation and gender identity often affects these individuals’ mental health and personal safety (Franklin, 2023).

Individuals who identify as LGBTQ+ may also experience minority stress. Minority stress theory connects health disparities among individuals to stressors induced by a hostile, homophobic culture in society as a whole. This often results in experiences of prejudice, internal expectations of rejection, concealment, and internalized stigma. Aspects of minority stress, including the perception of prejudice, stigma, or rejection, are associated with higher rates of depression and dysfunctional coping strategies (Fehling, 2024).

LGBTQ+ populations experience a greater prevalence of mental health distress and diagnosis, such as:

• Anxiety and depression
• Suicidal ideation and attempts
• Other forms of emotional, physical, and sexual trauma (such as intimate partner violence)
  (The Trevor Project, 2024; Coleman et al., 2022)

Gay, lesbian, and bisexual adolescents and young adults have higher rates of tobacco and alcohol use, substance abuse, eating disorders, and risky sexual behaviors. This may be due to a higher level of psychological distress (The Trevor Project, 2022).

MEN WHO HAVE SEX WITH MEN (MSM)

The most researched health disparity among MSM is HIV/AIDS incidence and prevalence. Worldwide, the risk for MSM to acquire HIV is 26 times higher than that for the general population (WHO, 2025). In the United States, the lifetime risk for HIV for MSM is approximately 1 in 6 (CDC, 2022). Gay, bisexual, and other MSM have also been found to be at increased risk of other sexually transmitted infections (STIs), including:

• Syphilis
• Gonorrhea
• Chlamydia
• Human papillomavirus (HPV)
• Hepatitis A, B, and C
• Mpox
  (WHO, 2025)

Gay men are also at an increased risk of cancers, including prostate, testicular, anal, and colon, which may be related to limited cancer screening and prevention services for this population (Domogauer et al., 2022). Moreover, MSM are also at higher risk for tobacco and drug use and depression (Lagojda et al., 2025).

When providing care for MSM, clinicians and case managers should not assume that the individual is engaged in actions that increase the risk for certain disorders; a history should first be performed to understand the individual’s risk. Understanding the risk factors and health disparities for MSM, it is important to address the unique clinical concerns for this population through:

• Regular assessment and screening for STIs and HIV
• Postexposure prophylaxis and preexposure prophylaxis (PrEP) for HIV prevention, as appropriate
• Routine vaccination for hepatitis A, hepatitis B, and HPV
• Prevention and screening for prostate, testicular, anal, oral (head and neck), and colon cancers
  (CDC, 2022)

WOMEN WHO HAVE SEX WITH WOMEN (WSW)

Studies show that lesbian and bisexual women have a higher risk for cervical cancer, substance use, STIs, and mental illness. WSW are at increased risk for depression and anxiety disorders and are less likely to receive routine reproductive care. Lesbian women are also less likely to access cancer screening and prevention services (Arantes & Da Costa, 2024; ACS, 2025).

Clinicians and case managers working with WSW should carefully assess and address the multiple risks that this population faces by providing:

• Preventive and wellness care to prevent or treat tobacco use/abuse and alcohol use/abuse
• Screening and early identification of behavioral health concerns such as depression or anxiety
• Regular preventive care and screening for uterine, breast, cervical, endometrial, and ovarian cancers
• Resources for programs that promote healthy weight and exercise
  (ACS, 2025)

TRANSGENDER AND GENDER DIVERSE

Transgender individuals often face victimization, violence, and minority stress, and they are less likely to have access to health insurance for a variety of reasons. Transgender individuals have a higher prevalence of:

• HIV
• Sexually transmitted infections (STIs)
• Substance use
• Homelessness
• Behavioral health disorders
• Suicide (approximately 40% of transgender individuals have attempted suicide, as opposed to less than 5% of the general U.S. population)
  (Centre for Suicide Prevention, 2025; NAMI, 2025; Goldsmith & Bell, 2022)

Caring for transgender patients therefore includes screening for the following risks, as appropriate:

• Access to appropriate health insurance
• Violence
• Minority stress
• HIV
• STIs
• Suicide
• Behavioral health disorders
  (Centre for Suicide Prevention, 2025; NAMI, 2025; Goldsmith & Bell, 2022)

Care for transgender patients should also focus on challenging discrimination around the care of these individuals, since discriminatory behavior leads to poor health outcomes. Healthcare professionals should educate themselves on their organizations’ policies and procedures in order to challenge any discriminatory behavior that they observe in their professional environment (Gilmore et al., 2024).

ADOLESCENTS AND YOUNG ADULTS

Many concerns may impact the health and well-being of an LGBTQ+ individual. This is especially true for adolescents, who are in the process of navigating developmental milestones along with sexual orientation and gender identity.

Young adults who “come out” may be faced with bullying from their peers or family rejection. LGBTQ+ youth have high rates of substance abuse, STIs, and homelessness. They have an increased risk of depression, suicidal ideation, and substance use, including tobacco, alcohol, cannabis, cocaine, ecstasy, and heroin (The Trevor Project, 2024).

Research has shown that LGBTQ+ adolescents and young adults with family acceptance have greater self-esteem, more social support, and better health outcomes. This acceptance also reduces the risk of substance abuse, depression, and suicide (Delphin-Rittmon, 2022).

Clinicians and case managers working with this population should pay careful attention to subtle clues and risk factors of each individual, as adolescents and young adults may be especially reticent to discuss their concerns. Careful assessment focuses on:

• Evidence or risk of bullying
• Dysfunctional family dynamics
• Substance abuse risks
• Depression screening
• Suicide risks
• STI screening
• Violence screening
• HPV vaccination
• Home living conditions
  (Bass & Nagy, 2023)

Best Practices for Patient-Centered Care

LGBTQ+ patients, particularly those who identify as transgender or nonbinary, often face barriers to accessing healthcare services due to the lack of provider understanding of their gender identities. Providing high-quality, culturally competent, patient-centered care is a complex process that requires ongoing learning and awareness of the various factors that affect the LGBTQ+ population.

Even healthcare organizations that have taken positive steps toward improving cultural competency for LGBTQ+ patients will find new ways to address barriers to care and engage staff in improvement initiatives. Improving skills and knowledge among healthcare leaders, providers, and staff should be looked at as opportunities rather than as organizational or individual weaknesses.

PHYSICAL SPACE

Best practices start at the front door and extend into the provider’s office and treatment areas. Everything from the hospital website to the front desk and waiting areas should reflect a healthcare setting that is welcoming, open, and inclusive.

• Include gender-neutral restrooms and signage.
• Post signage to affirm nondiscrimination policies that include sexual orientation, gender identity, and gender expression.
• Evaluate environmental factors of potential concern for LGBTQ+ patients and families, such as bathroom designations, artwork, posters, educational brochures, magazines in the waiting room, etc.
  (Bass & Nagy, 2023)

INTERNET AND WEBSITE

Informational, educational, and support materials should be designed to help LGBTQ+ patients feel comfortable and supported in the healthcare setting.

• Include inclusive language on any websites and marketing materials with clear explanations that describe a commitment to high-quality, culturally competent, patient-centered care.
• Ensure that marketing, advertising, and informational materials reflect diverse populations, including same-sex couples and families.
• Create a separate webpage or portal for information and resources related to LGBTQ+ care.
  (Bass & Nagy, 2023; Yu et al., 2024)

SUPPORTIVE COMMUNICATION

An individual may delay or avoid accessing care due to the fear that their provider may not take their gender identity and pronouns seriously or be entirely dismissive of them, causing them to feel “invisible.” There are many ways that a healthcare provider and support staff can communicate with patients to help them feel respected and comfortable.

• Avoid the use of gendered titles such as “Sir” or “Ma’am.” Instead of Mr. or Ms., patients may also wish to be addressed as Mx. (pronounced with a “ks” or “x” sound at the end).
• Introduce yourself with your pronouns. Ask patients for information such as their pronouns, preferred name, and gender identity. Pronouns may include he/his/him, she/hers/her, or a range of options for nonbinary transgender patients, such as they/their/them, ve, xe, ze, per, and ey. Always respect the patient’s pronouns and apologize if the wrong pronouns are used by mistake.
• Always ask for clarification when not clear what a patient would like to be called or how the patient would like to be addressed. Apologize if you refer to a patient in a way that seemed offensive.
• Ask patients what terms they use to refer to their anatomy, and mirror those terms during the patient interaction. Transgender patients may experience gender dysphoria and/or may not be comfortable with traditional terms for body parts.
• Ask the patient to clarify any terms or behaviors that are unfamiliar, or repeat a patient’s term with your own understanding of its meaning to make sure you have a good understanding of what it means to them.
• Do not make assumptions about patients’ sexual orientations, gender identities, beliefs, or concerns based on physical characteristics such as clothing, tone of voice, perceived femininity/masculinity, etc.
• Do not be afraid to tell a patient about one’s own inexperience working with LGBTQ+ patients. Honesty and openness will often stand out to a patient from their previous healthcare experiences.
• Do not ask patients questions about sexual orientation or gender identity that are not material to their care or treatment.
• Do not disclose patients’ sexual orientations or gender identities to individuals who do not explicitly need the information as part of the patients’ care.
• Keep in mind that sexual orientation and gender identity are only two factors that contribute to a patient’s overall identity and experience. Other factors—including race, ethnicity, religion, socioeconomic status, education level, and income—also contribute to the patient’s experiences, perceptions, and potential barriers to healthcare.
  (LGBTQ+ Resource Center, n.d.; Garrett, 2022)

PATIENT INFORMATION AND PRIVACY

Appropriate data collection and privacy policies can lead to improved access, quality of care, and outcomes (Medina & Mahowald, 2022).

All healthcare institutions are encouraged to integrate data related to sexual orientation and gender identity into medical records. Data collection on intake and other forms should allow for appropriate responses that are inclusive of LGBTQ+ patients. Best practices when collecting data include asking questions about gender first, then sexual orientation, followed by relationship status (National LGBTQIA+ HEC, 2022; Yu et al., 2024).

Examples of inclusive data collection are indicated below.

Name

• First and last name on medical insurance:_________________________
• Name you would like our staff to use:_________________________

What are your pronouns?

• She/Her/Hers
• He/Him/His
• They/Them/Theirs
• Please specify: _______________________________________

Gender Identity

Sex/gender marker on medical insurance:

• Female
• Male

What is your current gender identity? (Check all that apply)

• Female/woman/girl
• Male/man/boy
• Nonbinary, genderqueer, or not exclusively female or male
• Transgender female/woman/girl
• Transgender male/man/boy
• Another gender: _______________
• Don’t know
• Prefer not to answer

What sex were you assigned at birth, on your original birth certificate? (Check one)

• Female
• Male
• X/Another sex: _______________
• Don’t know
• Prefer not to answer

Sexual Orientation

Do you think of yourself as: (check all that apply)

• Lesbian or gay
• Straight or heterosexual (that is, not gay or lesbian)
• Bisexual
• Queer
• Pansexual
• Something else: _______________
• Don’t know
• Prefer not to answer

Relationship Status

• Single
• Married
• Partnered/long-term or domestic partnership
• Divorced/separated
• Widowed
• Prefer not to answer

(National LGBTQIA+ HEC, 2022)

It is important to assure all patients that any information collected is considered confidential and subject to established privacy policies. Confidential information may include patient-provider conversations and any data collected and stored in the medical record. Assurance of patient privacy may help LGBTQ+ patients feel more comfortable disclosing information within a healthcare setting knowing that it is protected. A confidentiality and privacy policy should be available in written format and readily available for patients to read and understand.

Elements to include in a privacy policy include:

• What information is covered by the policy
• Who has access to the medical record
• How test results remain confidential
• How information is shared with their insurance provider
• Any instances when maintaining confidentially is not possible
  (GLMA, n.d.)

Institutional Policies and Practices

In order to provide culturally competent care, institutions must assess current organizational practices and identify gaps in policies and services related to care and services for LGBTQ+ patients. This also includes ensuring that policies comply with all federal and state regulations.

Recommendations to build awareness within an organization about the LGBTQ+ community include:

• Hold an open discussion with healthcare professionals and staff about the difference between sexual orientation (lesbian, gay, bisexual, etc.) and gender identity (transgender, nonbinary, intersex, etc.), since this can be confusing to those who are not familiar with such concepts.
• If not already in place, establish a dedicated team leader, point person, office, or advisory group to oversee LGBTQ-related policies and concerns, ideally including members representing the LGBTQ+ community.
• Review codes of conduct and ethics to ensure they include expectations for respectful communication with all patients, visitors, and staff members and that they specify consequences for code violations.
• Collect and share data from LGBTQ+ patients and employees to promote empathy and understanding of the LGBTQ+ population among healthcare staff.
• Provide ongoing training and orientation to professionals and staff on culturally competent care and organizational policies related to conduct, ethics, privacy, nondiscrimination, and antiharassment policies.
  (Bass & Nagy, 2023; Yu et al., 2024)

CONCLUSION

Providing high-quality, culturally competent care to all patients involves understanding the cultural contexts of each individual. In the case of LGBTQ+ patients, it is important to educate oneself on issues related to sexual orientation and gender identity in order to address and understand the spectrum of these patients’ health concerns. This may include addressing any health risks or disparities, with careful attention to any behavioral health needs and transgender care.

When considering best practices for providing culturally competent care, healthcare professionals should carefully evaluate their practice environment; examine, advocate for, and modify practice policies when needed; take detailed and nonjudgmental histories; educate themselves and/or update their knowledge on the health issues of patients; and reflect on any personal attitudes or bias that may prevent them from providing the highest level of care to their patients. By taking these positive steps, healthcare providers can ensure that all patients they care for achieve the best possible health outcomes.