Introduction
The “Don’t Ask, Don’t Tell” policy has been terminated, yet the effects of the framework continue to impact LGBTQ+ veterans and service members. Namely, the policy would prevent individuals who openly disclose their non-heterosexual sexuality from enrolling in the military. As a result, people in the military were faced with the choice to either hide it or make it public, yet face major repercussions. The policy has since been abolished, yet its homophobic agenda has remained one of the reasons why LGBTQ+ veterans experience more barriers. One of those barriers is access to adequate, patient-centered healthcare. The aim is to conduct qualitative research to determine the experiences of non-heterosexual veterans with healthcare access in regard to aspects such as discrimination, health outcomes, and reluctance to access medical help.
Problem Statement
The proposed study is relevant due to the severity of the issue. According to researchers, more than one million veterans identify as a part of the LGBTQ+ community (Candrian & Hinrichs, 2021). The same study mentions that past discriminatory societal policies and prejudice faced by non-heterosexual individuals in the military. As mentioned prior, the “Don’t Ask, Don’t Tell” policy, despite being dismissed, remains one of the reasons why veterans experience inequalities. On the other hand, this particular demographic is vulnerable due to their sexuality as well as their military status. According to researchers, sexual minorities, as well as veterans, are more likely to have higher health needs while having less access to services (Hinrichs & Christie, 2018). The higher needs are linked to both physical and psychological conditions, which are reportedly more common among LGTBQ+ service members. Specifically, the demographic is vulnerable to conditions such as post-traumatic stress disorder, depression, and negative outcomes as a result of increased smoking and alcohol use risk (Carey et al., 2022a). While the negative circumstances related to health are more critical, healthcare cannot be easily accessed due to discrimination, reluctance, and a lack of support.
Needless to say, LGBTQ+ veterans can, indeed, receive medical assistance both through non-military hospitals and the Veteran Health Administration (VHA). Nonetheless, researchers report that non-heterosexual minorities are more likely to be dissatisfied with the services they access (Carey et al., 2022b). Several circumstances correlate with the phenomenon. As a result of negative barriers, veterans are reluctant to access healthcare through VHA (Lange et al., 2020). One of the elements that negatively impact care is perceived discrimination. The prejudice results in the lack of desire to disclose LGBTQ+ statuses, which impairs healthcare provision as well as patient-centered care (Ruben et al., 2019). Moreover, veteran women specifically have reported feeling unwelcome when seeking assistance through VHA (Shipherd et al., 2018). The aforementioned evidence highlights that the topic selected for the research is, indeed, vital to examine due to its importance. Namely, evidence shows that veterans are, indeed, discriminated against when accessing healthcare because they are non-heterosexual. Moreover, the existing prejudice negatively affects their health outcomes and is to be assessed and addressed through evidence-based intervention.
Currently, the circumstances that result from the discrimination include avoidance of seeking health support, inability to access high-quality services, and vulnerability. Furthermore, the subject is relevant to the field of psychology as the current phenomenon examines discrimination in healthcare both from the psychological outcomes experienced by veterans as well as the perception of LGBTQ+ patients through the viewpoint of healthcare providers. Thus, on the one hand, the minority stress and isolation that follows discrimination is the psychological aspect that correlates with reluctance to seek medical assistance (Lange et al., 2020). On the other hand, since veterans experience discrimination, medical providers themselves are less welcoming, which is another psychological element that is to be assessed during the research.
Purpose Statement
The problem that has been exemplified prior, namely, healthcare inequality experienced by LGBTQ+ veterans, can be addressed through the proposed study employing a qualitative approach. The qualitative method is to be applied as it is used to comprehend the nature of a phenomenon (Busetto et al., 2020). As a result, the outcomes will be a deep and detailed examination of discrimination in healthcare experienced by minorities among veterans and service members. The goal is to highlight the nuances of the problem rather than the direct variables, such as the number of people affected and the statistical significance. Instead, the proposed study will assess qualitative variables such as perceptions, subjective and objective overviews, as well as opinions of veterans and healthcare providers. The method will facilitate the generation of a conclusion that takes into consideration the psychological aspects of the barrier experienced by the LGBTQ+ community that has served in the military. Moreover, by employing the design, the issue can be examined from multiple perspectives, which addresses potential gaps in understanding both the significance and the factors that impact the lack of healthcare access and lower-quality medical services.
Research Questions
For healthcare discrimination against LGBTQ+ veterans to be researched, it is essential to determine the research questions that are to be assessed through a qualitative design. Initially, it is important to establish the issue itself. Thus, the question is, “Are veterans identifying as LGBTQ+ satisfied with the level of healthcare and the quality of received services they access?”. While the topic will be examined more in-depth, current researchers highlight dissatisfaction with VHA (Shipherd et al., 2018). Based on the first question, the following one is “How do healthcare providers perceive LGBTQ+ veterans?”. This will help determine whether the physicians themselves exemplify discrimination or whether the current system is designed through prejudice. Current research highlights that two-thirds of the medical personnel are open to discussing sexuality with veteran patients, and four-fifths would like defined guidelines for approaching LGBTQ+ topics (Rerucha et al., 2018). Thus, the desire for change is present regarding combating discrimination, yet circumstances highlight issues regarding patient-physician communication and openness.
The next research question will be, “What factors facilitate reluctance to access healthcare services among LGBTQ+ veterans”. It has been mentioned previously that prejudice and discrimination generate a lack of desire to seek medical assistance among veterans. Thus, it is crucial to determine certain circumstances that facilitate this outcome. Moreover, another question that will be answered through qualitative research is “What are the effects of discrimination against LGBTQ+ veterans?”. Based on this subject, both physical and psychological outcomes will be discussed. Last but not least, the following research question to be assessed is “Are perceptions of discrimination different based on the hospital being military vs. non-military?”. The reflection will determine whether the military system is designed to be prejudiced against sexual minorities or the healthcare system.
Methodology and Design
Multiple qualitative studies have been conducted concerning discrimination against sexual minorities among veterans in healthcare. An example is a research by Ruben et al. (2019) exemplifying the perceived discrimination and correlating negative health outcomes. The qualitative design was employed through interviews conducted with the participants. Namely, 47 veterans aged between 33 and 73 identifying as lesbian, gay, bisexual, transgender, and “other” took part in the study. Data was collected through direct interviews and analyzed based on the Discrimination in Medical Settings. The study was approved by Boston VA, which ensured ethical considerations of human protection and data validity. To examine the perception of care, health behaviors, and mental health symptoms, the researchers applied the Communication Assessment Tool, the Alcohol Use Disorders Identification Test-Core, and the PTSD Checklist.
Another study that has assessed the experiences of veterans accessing healthcare services has compared the LGBT and non-LGBT demographics. The qualitative design of the study conducted by Shipherd et al. (2018) employed the descriptive research design through surveys. The sample of 1391 women veterans consisted of 1201 non-LGBT participants and 190 women identifying as LGBT. The researchers have identified women veterans with at least 3 VHA visits in the previous year who were willing to participate in the survey. Data analysis implied comparing the data collected from the two demographics, namely, non-LGBT and LGBT veterans. The human subjects were protected through the explanation of the research methodology and aim, as well as through data security and anonymity.
Both studies that have been mentioned are qualitative, which may correlate with the issue of bias. Namely, qualitative studies may be less trustworthy since the subjects examined during the assessments are more indirect and, hence, more likely to be subjective (Ma et al., 2020). Depending on the subjective perceptions of the participants, results may be compromised. Thus, the challenges correlating with the proposed research method include potential bias, a lack of direct variables, and issues with trustworthiness. On the other hand, the strengths include an in-depth understanding of the issue and an examination of the complexity of discrimination through various elements.
Conclusion
The LGBTQ+ community experiences discrimination in healthcare, an issue that is more prominent among veterans. The proposed research will determine factors affecting the demographic, healthcare providers’ perceptions, impacts on reluctance, and the negative outcomes correlating with the phenomenon. Nonetheless, the severity of the current barriers correlates with the aim of understanding the topic and assessing potential interventions that can minimize the adverse effects of discrimination against LGBTQ+ veterans.
References
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