LGBT Discrimintion in Health Care by Melissa Munoz

Running head: LGBT Discrimination 1
LGBT Discrimination in Health Care
Melissa A. Munoz
Grand Canyon University
Marianne Jankowski
January 13, 2016

LGBT Discrimination 3
Table of Contents
Abstract………………………………….……………………........……………………………3
Part 1: Introduction
I. The problem statement ………………………………….……………………........…3-4
II. The evidence-based question ………………………………………..……….……….…5
Part 2: Literature Review………………………………………..……….……….………….…5-7
Part 3: Implementation of the intervention
I. Solution ……...…………………………………………………………………...…....7-9
II. Change Model ………………….………………………………….…………………9-10
III. Implementation ……………………………………….…………….……….…….....10-12
Part 4: Conclusion ………………………………………………...…………………………….12
Part 5: References…………………………………………………………….………………13-14
Part 6: Appendices …………………………………………………………..…………….……15
A. Critical Appraisal Checklist…………………………………… ……………………15-18
B. Articles Evaluation Tables ……………..…………………………………………….19-21
C. ARCC Conceptual Model……………………………………………...………………22
D. Project Timeline …………..……………………………………………………….…23-24
E. Attitude toward Homosexual Scale ………………………………………….…….…25-26
F. Budget …………..…………………………………………………………………….…27
G. Memo…………..…………………………………………………………………..….…28

Abstract
The LGBT community has received lots of attention over the past few years. From
having the Supreme Court of the United States decide that same-sex couples can get married to
more high profile individuals coming out as part of the LGBT community or in support of it.
Despite the growing amount of acceptance, those who are part of this community still face
discrimination. Within the health care field is no different. IT is not uncommon to hear stories of
individuals being turned away or having their providers make remarks about their sexual and/or
gender orientation. By implementing a mandatory cultural competence training program, the
goal is to reduce the rate of perceived discrimination against LGBT patients, increase the
knowledge and sensitivity to the needs and issues of the LGBT community, as well as increase
the number of LGBT individuals seeking medical care. A 3 month training program will be
implemented at a local medical center; the training will be conducted by a third-party source. A
pretest and posttest will be given to determine their attitude on homosexuality. In addition,
observational data on the topics discussed, methods of teaching, staff participation, and
interactions will be recorded and analyzed after the completion of these courses.
Problem Statement
The LGBT community has faced many types of discrimination. This topic is important
because the LGBT community has faced so much discrimination that they often do not seek
necessary medical treatment. Patients and physicians alike have reported feeling uncomfortable
with the current standing of the healthcare system and coming out as LGBT. Patients, ranging in
ages from infants and children to the elderly, justly fear seeking any needed medical attention as
they are often turned away, misdiagnosed, or completely ignored by medical professionals.

This problem is one that not only affects those who identify as part of the LGBT
community, but also for health care professionals and health care centers. The LGBT community
gain the confidence needed to seek medical attention and feel comfortable and at ease to form a
trusting relationship with their health care provider. Health care professionals will also gain more
diversity education and be able to engage a community that has kept its distance. Other interested
parties in this will include health care centers, social service programs, and training agencies.
The purpose is to determine whether there will be a decreased rate of perceived
discrimination if health care professionals are required to take diversity training courses that are
specifically geared toward working with the LGBT community, compared to the physicians who
take the current diversity courses. The objectives are to (1) increase the diversity training of
heath care professionals, (2) to decrease the perceived rate of discrimination based on being
LGBT, and (3) increase the rate of LGBT community members seeking out health care services.
According to Brotman, Ryan, Collins, Cormier, Julien, Meyer… & Richard (2007), those
who identify at LGBT feel the need to keep their sexual orientation quiet for “…fear of service
refusal, caregivers unsure of how to handle discrimination, lack of support groups for the
caregivers, non-blood family caregivers often left out of major decisions, etc.” Often times,
same-sex partners are left out of important decisions regarding their partner’s care, and
information is often kept from them. Rounds, McGrath, & Walsh (2013) found that LGBT
patients who felt their health care provider was willing to learn more about the specific issues of
the LGBT community were more likely to perceive a higher quality of care compared to those
who’s medical provider showed little to no interest.
Question

For LGBT patients, would specialized diversity training aimed towards working with the LGBT
community, compared to the current generic diversity training, reduce the perceived rate of
discrimination within health care?
Review of Literature
The 2014 Human Right Campaign reports that 56% of the gays, lesbians, and bisexuals
surveyed experienced discrimination in the healthcare field. In addition, 73% of transgender
individuals survey respondents felt they would face discrimination and/or be treated differently
(Hanneman, 2014). The avoidance of regular health care attention is a problem within the
lesbian, gay, bisexual, and transgender (LGBT) community. Even if they are not seeking care for
themselves, LGBT persons are often reluctant to disclose their sexual orientation and/or gender
identity for fear of rejection (Nicol, Chapman, Watkins, Young, & Shields, 2013).
Being able to be open and honest with one’s health care provider and know that care will
be given is something many heterosexuals take for granted. Whether a patient feels they can
disclose their sexual orientation and/or gender identity to their primary care physician (PCP), or
other medical provider, can influence what information is revealed and the perception of care
quality (Rounds, McGrath, & Walsh, 2013). Rounds, McGrath, & Walsh (2013) conducted a
study on the quality of care of sexual and gender minorities. The study sought to collect
narratives from LGBT patients about the behaviors they’ve encountered from health care
providers. One common theme between the participants’ narratives was that they felt their care
providers were not aware of LGBT community needs. Another common issue discussed were the
behaviors of health care providers that made the patients feel they were being negatively judged
(p.104). Feeling negatively judged can make current LGBT patients stop seeking care and/or
convince others to stop seeing the physician or using the medical facility.

Schwinn & Dinkel (2015) found that elder LGBT patients felt anxious about their long
term care due to perceived and experienced rejection and neglect by their medical provider,
based on the client’s sexual orientation and/or gender identity. One of the reasons for this was
the heteronormative culture – this means that heterosexuality is taught at the norm and should be
expected, and anything else is different and looked down upon. This is a subconscious condition
many people have. Gendron, Maddux, Krinsky, Lockeman, Metcalfe, & Aggarwal (2013) found
that those who were open about their sexuality have a more positive psychosocial adjustment
than those who prefer to not reveal their sexuality. Gendron, et al., (2013) found that many of the
LGBT patients did not feel comfortable disclosing their identity because they feel their providers
lack the proper knowledge about the needs of the community, as well as knowledge on how to
deal with LGBT patients. Gendron, et al., felt a cultural competence training program was
necessary to help health care providers learn how to interact with LGBT patients. A training
video was showed and discussion was held to learn what the professionals felt. Many of the
participants explained that they did feel uncomfortable dealing with same-sex relationships and
that the training sessions helped to become more comfortable dealing with situations involving
same-sex couples. Given that many medical providers do not receive any training (or little
training) on working with the LGBT community, these types of cultural competence training
programs are becoming more common.
Walhert & Fiester (2014) found that one of the issues that comes from not understanding
the needs of the LGBT community is that health care providers often infantilize LGBT patients.
Walhert & Fiester (2014) provide an example of a patient who wished not to inform his mother
and sister about his medical conditions. Instead of listening to the patient’s wishes, the physician
wanted to include the biological family. It is unfortunately common for health care providers to

try and include a LGBT patient’s family members, even if they are estranged. When a
heterosexual adult does not want others to know about their medical condition, their medical
providers do not question their patient’s want. There is an overwhelming amount of case studies
written that describe this type of behavior by medical professionals.
Solution Description
Currently there is a perception that health care facilities do not accommodate people within
the lesbian, gay, bisexual, & transgender (LGBT) community. There is a fear within the LGBT
community that they will be misdiagnosed or simply dismissed when attempting to receive
medical care. To help alleviate this fear, it will be proposed that health care professionals and
administration receive training with an emphasis on working with the LGBT community.
The proposed solution is to require staff to attend diversity training that has a focus on
working with sexual minorities. Health care professionals, such as physicians and nurses, as well
as administration and other staff, will be required to attend and complete a training seminar
session. The training will be expected to be completed within three months from program start
date to allow all staff a chance to attend a training session without affecting the facilities work
load and to avoid staffing conflicts. Sessions may be broken into multiple segments to
accommodate those that are unable to commit to a lengthy training session. Every health care
facility requires staff to complete a certain amount of continuous training. There are already
advocated of the LGBT community that offer assistance with acceptance of sexual and gender
minorities. Reaching out to one of these programs will be necessary to assist with the training
portion of the program.
The hopeful outcome from the completion of training would be an increase in the
knowledge and sensitivity of health care professionals toward the LGBT community and a

decrease in the perceived rate of discrimination. This will hopefully allow for more members of
the LGBT community to seek out medical attention without the fear of being turned away,
ignored, or misdiagnosed. To determine the success of this project, the rate of admissions of
LGBT patients will be compared before and after the completion of the training. In addition to
the rate of admission, the self-reported satisfaction of LGBT patients will be taken into
consideration.
By completing the training sessions, health care workers will become more knowledgably
on how to work with those in the LGBT community. This will be expected to help with
misdiagnoses based on assumed lifestyle actions (i.e. AIDs/HIV diagnosis, mental health
disorders, etc.). In addition, it is expected that health care workers will be more sensitive to their
LGBT patients and become more aware of “…political, social, and economic issues that are
unique to the LGBT community, and increased awareness of legal issues regarding LGBT
individuals and couples” (Gendron, Maddux, Krinsky, White, Lockeman, Metcalfe, & Aggarwal,
2013, p.456).
Some of the barriers to achieving the expected outcome are:
• The staff refuses to take part in the training sessions.
• Religious beliefs of workers will hinder attendance
• Lack of financial support from the organization
• Possible protest from other community sects.
To avoid this issues, training will become mandatory. Those who try to avoid the training
sessions will be reprimanded based on the policies of the facility. Although religious beliefs are
important to individuals, the training is a necessity to ensure that all workers understand the
issues and how to work around them. Rounds, McGrath, & Walsh (2013) found that LGBT

patients were more likely to perceive a higher quality of care when they felt their health care
provider was willing to learn more about the specific issues of the LGBT community.
Change Model
Having a theoretical framework to use as a foundation helps to guide change. The
Advancing Research and Clinical Practice through Close Collaboration (ARCC) model is an
ongoing assessment to sustaining evidence based practice (EBP). The first part of the ARCC
model is to make an assessment of the organization’s culture, as well as their readiness for
accepting the EBP change. If the organization is ready for change, they must determine their
strengths and major barriers to implementing the EBP.
The ARCC model will be successful if the organization has EBP mentors, as well as
administration support. In addition, the training sessions and change will be strengthened by
having employees actively participating and wanting to sustain the new changes to the
organization (Melnyk & Fineout-Overholt, 2011, p. 257). Any change will be successful and
more likely to stay implemented when it has the support of the organization and its workers.
Also, another strength of the medical center would be that they will also have support from the
advocate organization chosen to do the training. Having a relationship with other organizations
to keep up morale, provide the necessary training, and to give more support will help the EBP be
more successful.
Potential barriers that would need to be taken care of is lack of EBP mentors and
inadequate knowledge and skills. Potential barriers can also be that not enough people are
participating in the training sessions. People will have their reasons for not wanting to attend the
training sessions – usually personal issues such as religious or personal beliefs. Another possible
barrier is that the organization as a whole does not value evidence based practice and does not

provide support to its employees who wish to practice this (Melnyk & Fineout-Overholt, 2011, p.
255).
Once this first part has been taken care of, there needs to be development and utilization
of EBP mentors. This can increase a clinician’s belief about the value of EBP and how to
implement it. Once this happens, the organization will begin to implement skill building
workshops so that workers can learn about the new practice change. The ARCC model is
successful when employees are motivated to reach the organization goals (Melnyk & Fineout-
Overholt, 2011, p. 260).
Theoretical change models help to provide need foundations for organizations to
implement their wanted change. There are a variety of change models and frameworks that
organizations to pick from – each providing a different way to look at how to solve the same
issue. Using the ARCC model would help implement change in how LGBT patients perceive
discrimination of care from medical professionals because it relies on mentors to help implement
and sustain change.
Implementation
This pilot training program will begin at a local medical center. The participants will be
the center’s staff members, this includes the physicians, nurses, administration, and other staff
working with the patients. A memo will be sent out regarding the reasons for the new training
session and provide information about when sessions will be, how long they will last, and where
in the center they will be held (Appendix H). The training program will last three months to
allow everyone a chance to take part in the training. A pre- and post- assessment will be given to
each employee taking the training. A commonly used test is the “Attitudes of Heterosexuals
Toward Homosexuality” scale (Larsen, Reed, & Hoffman, 1980). This scale consists of 20

questions that are on a Likert-scale, which is a rating scale in which respondents specify their
level of agreement or disagreement with the statements, a copy of this scale has been enclosed in
Appendix E.
The training sessions will be 2 hours each, with 6 sessions, or 4 hours, with three
sessions total. The three month allocation allows time for all to take part in the training, as well
as have time between the sessions to begin integrating what they are learning. The different time
frames will be to accommodate those who may have trouble attending the longer sessions. For
those taking the 2-hour sessions, they will occur every other week for the duration of the 3
months. Those who are doing the 4 hours sessions will only meet once a month.
This project will require outside assistance. An LGBT advocate and/or education
organization will be contacted to help with the training. Each session will have two facilitators,
who will both provide the training as well as take observational notes. Handouts and/or
workbooks will be utilized to help attendees learn the information and challenge any
preconceived notions. The topics that will be covered will be the unique needs of the LGBT
community, how to change the heteronormative assumptions and use more gender neutral terms.
Data will be collected through a pre-test to determine the knowledge, attitudes, and sensitivity;
observational data will include assessments of topics, methods of teaching, participation, format,
and interaction.
This project will cost an estimated $25, 690. This cost includes the amount for materials,
trainers, refreshments and more. Appendix F breaks down the cost. Running a program for 3,500
employees is a challenge. More than one facilitator will be needed to ensure that everyone will
receive the necessary training. In addition, having a 3rd party data analyst will ensure that there is
no unwanted manipulation of the data.

With any type of change these are bound to be barriers. These barriers can consist of
those who do not wish to attend any of the training sessions, as well as barriers from not finding
an organization to help facilitate the training. The training session will be mandatory for all
working within the medical facility. Those who try to avoid the training sessions will be
reprimanded based on the policies of the facility.
This plan will require outside educators to work with the organization to plan a training
session that is tailored to the organization’s needs. In addition workbooks, handouts, and other
training material will be required for each class and person attending the sessions.
Conclusion
Previous world experiences have shown that it is very difficult to remove discrimination
from society. Even with training programs, such as the one proposed, there are many factors that
could hinder the success of alieving perceived discrimination with the most troubling factor
being that one such hindrance are the possible personal beliefs of the intended audience. Past
health care reforms that opted for change in similar fashion required the addition of penalties, yet
still are not perfectly followed. The hope of this proposal is at a bare minimum to raise
awareness of the needs of the LGBT community within the health care system.

References
Boswell, C & Cannon, S. (n.d.). Elements of a Research Critique. Critique Process. Jones and
Barlett Publishers, LLC. Retrieved from
http://www.jblearning.com/samples/0763744379/Critique_Process.pdf
Brotman, S., Ryan, B., Collins, S., Cormier, R., Julien, D., Meyer, E., . . . Richard, B.
(2007). Coming Out to Care: Caregivers of Gay and Lesbian Seniors in Canada. The
Gerontologist, 47(4), 490-503.
Gendron, T., Maddux, S., Krinsky, L., White, J., Lockerman, K., Metcalfe, Y., & Aggarwal,
S. (2013). Cultural Competence Training for Healthcare Professionals working LGBT
Older Adults. Educational Gerontology, 29, 454-463.
Hanneman, Tari. (2014). Healthcare equality index 2014: Promoting equitable and inclusive
care for lesbian, gay, bisexual and transgender patients and their families. Retrieved
from Human Rights Campaign Foundation website: http://hrc-assets.s3-website-us-east-
1.amazonaws.com//files/assets/resources/HEI_2014_high_interactive.pdf
Melnyk, B.M., Fineout-Overholt, E., Gallagher-Ford, L., & Stillwell, S.B. (2011). Models to

guide implementation of evidence-based practice. In Evidence-based practice in nursing
& healthcare: A guide to best practice (2nd ed., pp. 241-275). Philadelphia, PA: Wolters
Kluwer/Lippincott Williams & Wilkins.
Nicol, P., Chapman, R., Watkins, R., Young, J., & Shields, L. (2013). Tertiary paediatric hospital
health professionals' attitudes to lesbian, gay, bisexual and transgender parents seeking
health care for their children. Journal Of Clinical Nursing, 22(23/24), 3396-3405 10p.
doi:10.1111/jocn.12372
Rounds, K. E., McGrath, B. B., & Walsh, E. (2013). Perspectives on provider behaviors: A
qualitative study of sexual and gender minorities regarding quality of care. Contemporary
Nurse, 44(1), 99–110. http://doi.org/10.5172/conu.2013.44.1.99
Schwinn, S. V. & Dinkel, S.A. (2015). Changing the culture of long-term care: combating
heterosexism. Online Journal of Issues in Nursing. 20(2), 1. Doi:
10.3912/OJIN.Vol20No02PPT03
Wahlert, L. & Fiester, A. (2014). Repairing the road of good intentions: LGBT health care
and the queer bioethical lens. Hastings Center Report, 56-63.

Appendix A: Critical Appraisal List
Title:
Coming out to
Care:
Caregivers of
Gay and
Lesbian
Seniors in
Canada
Cultural
Competence
Training for
Healthcare
Professionals
Working with
LGBT Older
Adults
Healthcare
Preferences of
Lesbian, Gay,
Bisexual,
Transgender
and
Questioning
Youth
Perspectives
on Provider
Behavior: A
Qualitative
Study of
Sexual and
Gender
Minorities
Regarding
Quality of Care
Attitudes of
Heterosexuals
Toward
Homosexuality:
A Likert-Type
Scale and
Construct
Validity
Author
Credentials
Brotman is a
professor at
McGill
University
Gendron is an
Assistant
Professor at
Virginia
Commonwealt
h University.
Hoffman is an
Associate
Professor of
Clinical
Pediatrics,
Freeman is a
Clinical Social
Worker
Not stated
Larsen was an
Associate
Professor of
Psychology,
Reed and
Hoffman were
PhD candidates
in Counseling.
Purpose of study
Explore the
experiences of
caregivers of
gay & lesbian
elders.
Develop an
LGBT cultural
competence
training
program, as
well as the
process and
evaluation
methods.
Determine the
preference of
LGBTQ youth
regarding
healthcare
issues they
deem
important.
Use focus
groups with
LGBT persons
to determine
how the
behaviors of
health care
providers can
improve or
worsen quality
of care.
Construct a
reliable and valid
measurement of
attitudes of
heterosexuals
toward
homosexuality.
Research
Question
NA NA NA
LGBTQ
“…persons
described
health care
provider
behaviors that
either
enhanced or
inhibited their
quality of care”
(p.100).
NA
Hypothesis NA NA
“Our null
hypothesis was
that there were
no associations
between age,
NA NA

gender and
race/ethnicity,
and social
orientation and
the relative
importance
assigned by
our sample of
youth to
specific
provider/settin
g
characteristics
and health
concerns.
Definitions given
Coming out –
process of
identifying
oneself to
others as
LGBT
NA
LGBTQ –
Lesbian, gay,
bisexual,
transsexual, &
questioning.
Allies – those
who support
LGBTQ
persons &
issues.
NA NA
Tools Reliability
& Validity
Used the
Grounded
Method to
analyze
themes and
relationships
Threats to
internal
validity
included:
attrition and
selection bias
Created
questionnaire
that was pilot
tested and
revised twice
to determine
validity.
Interview
questions were
examined by 2
PhD-prepared
nurses to
confirm
internal
validity.
Retested scale on
a larger
population to
rest the
reliability and
validity.
Sample
17 caregivers
from 3
different
Canadian
cities
199
Participants
from 5 sites.
733, 13-21
year old, self-
reported LGBT
members,
25 responded,
11 participated
80 – 43 males &
37 females, with
a mean age of
21.5 years.
Ethics of study
Consent
Forms
NA
Approved by
Montefiore
Medical
Center’s
Institutional
Review Board
for the
Protection of
Approved by
University of
Washington’s
IRB
NA

Human
Subjects.
Data collection
Procedures
Snowball
sampling – led
to a
homogenous
group. 1.5 – 2
hour
interview,
which were
audiotaped
and
transcribed
Quasi-
experimental,
nonequivalent
group, Pretest
& posttest,
questionnaire,
observational
data, &
interviews
Placed survey
within an
established
website that
provides
support to
LGBTQ youth
and allies
The focus
groups were
audio recorded,
then later
transcribed.
Comments
were
categorized
based on
whether
actions helped
or impeded
quality of
health care.
Collected
seventy
statements
relating to
homosexuality
and homosexuals
from a variety of
sources and
tested in 3
phases by
volunteer
participants.
Data analysis
Transcripts
analyzed to
find common
themes:
financial
issues,
wanting
providers who
are
understanding,
accepting, and
properly
trained
Participants
felt more
knowledgeable
and culturally
competent
Interpersonal
skills of
providers and
interactions
with patients
were deemed
more important
to LGBT youth
patients
NA
Phase 1 created a
Likert-type
scale; Phase 2
discriminated
between liberal
arts and business
students; Phase 3
tested several
hypotheses and
ensured the
validity of the
scale.
Results,
recommendations
, implications
Can be used to
expand
definitions of
caregivers,
start of
specialized
services,
advocates
2 hour training
sessions were
most effective,
this program
will help
others start
their own
training
programs
The youths
placed more
importance on
provider
qualities and
interpersonal
skills. Paves
the way for
more research
to be done on
healthcare with
LGBT youth.
Develop and
evaluate
interventions
that focus on
LGBT youth
NA
A valid and
reliable Likert-
scale was
developed for
future
researchers to
use. Is used as a
way to measure
individuals;
prejudice.

wellness and
promotion.
Checklist from Boswell & Cannon (n.d.).

Appendix B
ARTICLE EVALUATION TABLE
Authors/Year of
Citation
Year Article Title Research
Design
Sample
Size
Data
Collection
Key Findings
Brotman, S.,
Ryan, B.,
Collins, S.,
Cormier, R.,
Julien, D.,
Meyer, E.,
Peterkin, A., &Richard,
B.
2007 Coming out to Care:
Caregivers of Gay
and Lesbian Seniors
in Canada
Qualitative,
open ended
interview
17
Caregivers
17 caregivers
from 3 different
Canadian cities,
Determined there was a
need for specialized
agencies and providers;
training sessions on the
needs, realities, and the
issues facing lesbian & gay
seniors & their caregivers,
support groups or support
phone lines.
Gendron, T.,
Maddux, S.,
Krinsky, L.,
White, J.,
Lockerman, K.,
Metcalfe, Y.,
& Aggarwal, S.
2013 Cultural Competence
Training for
Healthcare
Professionals
Working with LGBT
Older Adults
Cultural
Competence
Training
199
Participants
from 5
sites.
Quasi-
experimental,
nonequivalent
groups, Pre- &
Post-tests,
Observations
Participants felt more
knowledgeable & culturally
competent; revisions in how
the training and testing is
done;
Hoffman, N.D.
Freeman, K.,
& Swann,, S.
2009 Healthcare
Preferences of
Lesbian, Gay,
Bisexual,
Transgender and
Questioning Youth
Qualitative,
Cross
sectional
Survey
733 13-21 year old,
self-reported
LGBT
members,
internet survey
Providers’ qualities and
interpersonal skills were
place high in importance.

ARTICLE EVALUATION TABLE CONT.
Authors/Year of
Citation
Design
Sample
Size
Data
Collection
Key Findings
Larsen, K.S., Reed, M.,
& Hoffman, S.
1980 Attitudes of
Heterosexuals
Toward
Homosexuality: A
Likert-Type Scale
and Construct
Validity
Quantitative
Survey
80 – 43
males & 37
females
20 question
Likert-scaled
survey,
Females had a more positive
attitude toward
homosexuality overall
compared to males; validity
and reliability determined
through the 3 phases of
testing this likert-scale.
Melnyk, B.M.,
Fineout-Overholt, E.,
Gallagher-Ford, L.,
& Stillwell, S.B.
2011 Sustaining Evidence-
Based Practice
Through
Organizational
Policies and an
Innovative Model
NA NA
Nicol, P., Chapman, R.,
Watkins, R., Young, J.,
& Shields, L.
2013 Tertiary paediatric
hospital health
professionals'
attitudes to lesbian,
gay, bisexual and
transgender parents
seeking health care
for their children.
Descriptive
comparative
study of
health staff
using a
cross-
sectional
survey
646
medical
staff
Validated
anonymous
questionnaires,
Three open-
ended questions
staff working in a tertiary
paediatric hospital setting,
held attitudes and beliefs
that may impact on the
experience of
hospitalization for lesbian,
gay, bisexual and
transgender parents, and the
quality of care received by
their children.

ARTICLE EVALUATION TABLE CONT.
Authors/Year of
Citation
Design
Sample
Size
Data
Collection
Key Findings
Rounds, K.E.,
McGrath, B.B.,
& Walsh, E.
2013 Perspectives on
Provider Behavior: A
Qualitative Study of
Sexual and Gender
Minorities Regarding
Quality of Care
Qualitative,
Focus
Group
25
responded,
11
participated
Questionnaire&
Interview
There is a need for
providers to be more
comfortable,
knowledgeable, and
competent in working with
LGBTQ patients. Better
education, continuing
education, and sophisticated
training is needed.
Schwinn & Dinkel 2015 Changing the Culture
of Long-Term Care:
Combating
Heterosexism
Literature
Review
NA NA Heterosexism is one of the
primary issues with LGBT
health care access
Walhert, L. & Fiester,
A.
2014 Repairing the Road
of Good Intentions:
LGBT Health Care
and the Queer
Bioethical Lens.
NA NA Case Studies LGBT patients’
confidentiality must be
protected; “legally selected”
surrogates need to be treated
the same as heterosexual
partners; heteronormative
culture needs to be
addressed.

Appendix C: ARCC Conceptual Model

Appendix D: Timeline
 1 Month before Program Start
o Reach out to LGBT advocates/educators -
o Gather information on LGBT patient satisfaction and admittance rate -
o Meet with educators to discuss desired topics to be covered -
 3 Weeks before Program Start
o Send out memos and emails/ post fliers -
o Finalize training class schedules
o Begin sign up
 Program Duration – 3 Months
o Give pre-test and interviews to staff
o Training classes – 2 hour training sessions will be held every other week; 4 hour
sessions will be held once a month.
o Begin close up -1 week before end
 Administer post-test and final interviews
 1 Week
o Collect all data
o Send data to be analyzed
o Send out evaluations to staff
o Receive feedback
 Receive data analysis
 Meet with training facilitators to revise topics covered and handouts

 4-6 months after completion – gather information on LGBT patient satisfaction and
admittance rates.

Appendix E: Homosexuality Attitude Scale
1. I would not mind having a homosexual friend.
Strongly Agree Agree Neutral Disagree Strongly Disagree
2. Finding out that an artist was gay would have no effect on my appreciation of his/her
work.
3. I won't associate with known homosexuals if I can help it.
4. I would look for a new place to live if I found out my roommate was gay.
5. Homosexuality is a mental illness.
6. I would not be afraid for my child to have a homosexual teacher.
7. Gays dislike members of the opposite sex.
8. I do not really find the thought of homosexual acts disgusting.
9. Homosexuals are more likely to commit deviant sexual acts, such as child molestation,
rape, and voyeurism (Peeping Toms), than are heterosexuals.
10. Homosexuals should be kept separate from the rest of society (i.e., separate housing,
restricted employment).
11. Two individual of the same sex holding hands or displaying affection in public is
revolting.
12. The love between two males or two females is quite different from the love between two
persons of the opposite sex.
13. I see the gay movement as a positive thing.

14. Homosexuality, as far as I'm concerned, is not sinful.
15. I would not mind being employed by a homosexual.
16. Homosexuals should be forced to have psychological treatment.
17. The increasing acceptance of homosexuality in our society is aiding in the deterioration
of morals.
18. I would not decline membership in an organization just because it had homosexual
members.
19. I would vote for a homosexual in an election for public office.
20. If I knew someone were gay, I would still go ahead and form a friendship with that
individual.
21. If I were a parent, I could accept my son or daughter being gay
Note: Items 1,2, 6, 8, 13, 14, 15, 18, 19, 20, and 21 are reverse scored.
1 2 3 4 5

Appendix F: Budget Proposal
Budget Proposal
Description Amount
Personnel
Interviewer $1,890
Training Facilitator/Trainer $10,000
Data Analyst $3,000
Program Supplies
Workbooks 7,000
Misc. Handouts 300
Refreshments 3500
Administration
Computer Provided by facility
Projector Provided by facility
Sound System Provided by facility
Total $25,690

Appendix H: Memo
MEMO
To: All Employees
From: Melissa Munoz
Date: January 13, 2016
Subject: Mandatory Cultural Sensitivity & Competence Training
We are scheduling several training sessions concerning cultural competency working with our
LGBT patients.
Trainings will be held in two structures, a 2 hour session that occurs once every other week or a
4 hour session that will occur monthly. Sign up for sessions will begin next week.
Everyone is expected to attend these trainings and take notes since the things learned shall be a
huge help to boost the productivity of our organization. Thank you.

LGBT Discrimintion in Health Care by Melissa Munoz

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