Enablers and inhibitors to the utilization of healthcare services by members of the LGBTQ+ community in Accra, Ghana

Abstract

Background Globally, lesbian, gay, bisexual, transgender and queer (LGBTQ+) individuals experience higher rates of men tal health disorders, sexually transmitted infections and substance abuse compared to their heterosexual counterparts. This implies that this special population requires tailored healthcare services. However, their practice is criminalized in most countries and abhorred by many, including some health professionals leading to isolation and poor health-seeking behaviors. We explored the enablers and inhibitors to the utilization of healthcare services by members of the LGBTQ+ community in Accra, Ghana. Methods In this cross-sectional study. We collected qualitative data through snowballing sampling technique. Fifteen (15) self-reported persons claiming to be sexually diferent and being members of the LGBTQ+ community in Accra were recruited for this study. The participants were involved in an in-depth interview using a pre-tested interview guide and the interviews were recorded and transcribed verbatim. We adopted Braun and Clarks’ refexive thematic analysis approach in analyzing the data with the aid of NVivo 10.0 Results The results identifed the facilitators of health seeking as community-friendly health services, afordable and accessible services, and provider-awareness of LGBTQ+ community members’ status. Specifcally, privacy, anonymity, confdentiality, inclusivity, positive attitudes, welcoming and supportive environment, and gender-appropriate com munication, were identifed as community friendly attributes that enhance health-seeking. On the barriers militating access to health care, the following factors were identifed: negative provider attitude, fnancial constraints, and stigma tization among health providers. Participants frequently recounted instances where provider attitudes made them feel dismissed, disrespected, or judged. Instances of discrimination, accusations, poor healthcare largely based on ignorance of unique health needs related to LGBTQ+ and judgmental attitudes of health providers were identifed as major barriers to health seeking. Conclusion Positive provider attitudes and LGBTQ+ community-friendly health services promote health-seeking behavior among LGBTQ+ individuals. However, members of the LGBTQ+ community in Ghana are stigmatized by health providers and most health workers are ignorant about the special needs of the LGBTQ+ persons. We recommend that in-service training units of hospitals and health training institutions need to provide comprehensive education to health workers particularly nurses and doctors as well as other professionals on the unique health needs of LGBTQ+ persons as well as inclusive care that addresses the needs of members of the LGBTQ+ community