A Social Ecological Approach to Identifying Barriers and Proposing Interventions at Multiple Levels to Improve Healthcare for LGBTQIA+ Youths in the United States.

Young people who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other sexual and gender minorities (LGBTQIA+) in the United States experience poorer health than US youths overall. A social ecological approach that recognizes the multidimensional and multilevel influences on healthcare was used to identify barriers and propose interventions to achieve health equity for LGBTQIA+ adolescents and young adults. Database searches were conducted for original articles published within the last decade (2014-2024) that identified healthcare barriers for LGBTQIA+ individuals with participants aged 10-24 years and/or their family members or healthcare providers. The 36 studies included in this evidence-based, integrative review were conducted in 6 healthcare environments. Thirty-five barriers at the 6 levels of the Social Ecological Model were identified as follows: 5 individual, 10 interpersonal, 9 organizational, 6 community, 3 public policy, and 2 societal. The most frequently cited barrier was anti-LGBTQIA+ stigma at the societal level (21 studies). Findings point to interventions at multiple levels that would improve healthcare for LGBTQIA+ youths and youths overall: updating clinical education to address the needs of LGBTQIA+ youths, expanding Medicaid to cover costs of services in all US states, forming partnerships among LGBTQIA+ groups and healthcare organizations, and implementing inclusive intake forms.