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Researchers must work with south London LGBTQ+ communities

dr dan bailey

We spoke to King's College Hospital NHS Foundation Trust's Consultant Geriatrician, Dr Dan Bailey. Dan is also a co-chair of King's College Hospital LGBTQ+ Employee Resource Group (King's and Queers). He talked about the need for NIHR research to be shaped by, reflective of and inclusive of the needs of LGBTQ+ communities in south London.

What brought you to NIHR CRN South London's Inclusivity Panel?

Recent census data shows that parts of south London have a much higher percentage of lesbian, gay, bisexual, transgender and queer (LGBTQ+) residents than other parts of England and Wales. As a jobbing geriatrician and a co-chair for King's and Queers, I felt it was an opportunity to raise awareness of two intersecting groups that may be underrepresented in research.

The intersection of LGBTQ+ identities and older age leads to profound disparities in physical and mental health and welfare. The disparities are even more significant if one considers additional characteristics like ethnicity. Members of LGBTQ+ communities experience significantly worse health outcomes than their heterosexual counterparts, and older people often experience discrimination and disadvantage in a youth-centric society that does not value or celebrate them. Whilst there is research involving LGBTQ+ people or older people, there is a need to build on the growing body of research for older LGBTQ+ people to establish why these inequalities occur and how we can address them.

The demographics of people living in south London mean this is a relevant area for local researchers to investigate. My hope in talking to the NIHR CRN South London Inclusivity Panel was to generate enthusiasm for research in this area; I was delighted by the enthusiasm my talk generated among attendees at the meeting.

Why is it important to promote equality, diversity and inclusion across healthcare services, including in research?

The NHS Constitution states that "[it] belongs to the people" and that "The NHS provides a comprehensive service, available to all…irrespective of…age, sexual orientation…gender reassignment…". It also talks of a social duty to promote equality and to "…pay attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population." It is not possible to meet these objectives unless we promote equality, diversity and inclusion (EDI). I believe that healthcare workers and researchers do not go into the field to discriminate directly against diverse groups. Still, a service set up to "treat everybody the same" may not appear inclusive to minorities. The impact of this, for members of the LGBTQ+ communities, is that people are less likely to access healthcare services that can help them, either because they fear receiving discrimination or have experienced it.

Promoting EDI across healthcare services will make them more inclusive, giving people the confidence to engage with them and obtain the benefits they provide. Doing the same in research is essential, as it will help us to generate questions about why there are differential outcomes for minorities and to provide solutions. Finally, we should acknowledge that the workforce in healthcare services and research is highly diverse and working in an inclusive environment is better for staff, too.

What is your advice to CRN South London on working with partners to champion EDI?

Many health and social care organisations have Employee Resource Groups (ERGs). Whilst these have a primary focus on staff, they may also focus on service users. These groups are culturally competent about their community members and will have vital insights into areas lacking in inclusivity and needing improvement. There are opportunities for reciprocal benefits from this relationship. The CRN can use the ERG to establish new research questions and to advertise and endorse research initiatives, increasing the diversity of their participants. Members of the ERG may be able to get involved in research, with another benefit of increasing the diversity of the CRN.

What do you think of CRN South London's Inclusivity Panel?

The Inclusivity Panel is an excellent group. South London is a highly diverse area, and we need to ensure that the research conducted in the region reflects this and improves outcomes for all people.

What are potential barriers to the LGBTQ+ community regarding research participation?

There are two main barriers. The first is reaching the LGBTQ+ communities, and the second is reassuring them that they will be treated inclusively. The latter is a significant issue for health and social care already. We need our health, social care, and research organisations to demonstrate that they are inclusive towards the communities in a way that goes beyond "tokenistic" rainbow-washing.

The first step is to educate CRN members to be culturally competent about LGBTQ+ communities, to know their histories, and to use inclusive language that is both LGBTQ+ affirming and avoids heteronormative terms. Publicising that this education is taking place and using inclusive language in general communications will also make the CRN a more attractive place for LGBTQ+ people interested in research. Researchers will be more likely to frame their calls for research, and the research itself, in terms that invite people to take part.

The CRN should share information about LGBTQ+ researchers and research that is being undertaken as widely as possible. Engaging with LGBTQ+ community groups, ERGs, and community leaders is a good way for the CRN to expand their reach more widely.

The NIHR Evidence website has guidance on how to improve communication with LGBTQ+ people in healthcare settings.

The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR or the Department of Health and Social Care.