Understanding the Dynamics of Informal, Community-Based Care Among LGBTQ2+ Young Adults in Southwestern Ontario

Abstract

Background: Historically, North American health care has been developed through predominantly a hetero- and cis-normative, and white, lens which has led to the social exclusion of LGBTQ2+ individuals through institutional heterosexism, racism, homophobia, and transphobia (Brotman, Ferrer, Sussman, Ryan, & Richard, 2015; Gahagan & Colpitts, 2017; Hudson & Romanelli, 2019; Pepper, 2015; Warner, 2002). Non-inclusive health care services have the potential to compromise the well-being LGBTQ2+ young adults and influence their willingness to seek health care services, which can lead to additional adverse health outcomes (Burch, 2008; Gahagan & Colpitts, 2017; Hudson & Romanelli, 2019; Zay Hta et al., 2021). Emerging research presents evidence that a sense of community care develops among marginalized groups struggling with similar adversities; however, there are several uncertainties surrounding the experiences of informal community-based care that LGBTQ2+ young adults provide or receive in the absence of inclusive, professional health care services (Gahagan & Colpitts, 2017; Garcia, 2010; Kleinman & Van der geest, 2009; Sturman & Matheson, 2020). Specific aims: The goal of this research is to explore whether LGBTQ2+ young adults in Southwestern Ontario receive and provide informal community-based care for one another in the potential and/or perceived absence of sexuality-inclusive and trans/non-binary gender competent health care services. My research sought to identify which informal, community-based care practices might be enacted amongst this marginalized population, as well as determining what prompts these young adults to offer and receive this type of emergent care.

Methods: This study included qualitative semi-structured interviews with young adults in Southwestern Ontario who identify as a part of the LGBTQ2+ community. The interviews explored their experiences within the formal health care system and community-based care. Calls for the participation of LGBTQ2+ community members to were advertised via flyers (see Appendix. A) that were distributed online through LGBTQ2+ networks, social media forums, LGBTQ2+ servers (Twitter, Discord, Reddit). Zoom video conferencing software was used to conduct the interviews. Abductive reasoning was applied during the narrative analysis of the participants’ responses to identify potential motivations and ways in which LGBTQ2+ young adults promote well-being amongst themselves. Autoethnographic reflection pieces were utilized throughout the study and during the analysis to provide further experiential insights as well as my own voice in the findings.

Results: Responses garnered from 10 interviews with LGBTQ2+ young adults (24-27) living in southwestern Ontario are included in the results of this study to demonstrate their experiences with formal health care services and informal community-based care. These experiences provide reasonings for the reluctance to rely on formal health care as well as impetuses for turning to informal community-based care. The most common methods of informal community-based care included forms of emotional, physical and epistemic care. Lastly, the results of this study illuminated the existence of a sense of watchfulness and social obligation to care for fellow members of the LGBTQ2+ community that transcend social, economic and geographic differences. Conclusion: The results from the study illustrate how sex, sexuality, trans/ non-binary gender, and variation of gender identity or expression, can shape young peoples’ experiences with or their willingness to seek out health care services. The findings of the study demonstrate the potential reluctance for LGBTQ2+ young adults to solely rely on mainstream health care practices by illuminating the prevalent barriers to inclusive services. This study is one of the first to identity some of the potential approaches that LGBTQ2+ young adults might employ to provide care to, or receive care from, fellow community members (alternatively to, or in tandem with, formal health care). Lastly, the study describes the possible impetuses beyond the unwillingness to pursue formalized health care services, for the utilization of informal community-based care.