Cultural Adaptations of Health Interventions for Sexual and Gender Minorities, a Grounded Theory Model

Sexual and gender minorities (SGM) face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Available data suggests sexual orientation and gender identity have been important demographic factors associated with higher risk for several unhealthy outcomes such as cancer, cardiovascular disease, and stroke. Some of the major inequities affecting SGM include tobacco use, alcohol and illicit drug use, being overweight/obese, psychiatric disorders, and violence. The SGM health disparities created by the use and abuse of various substances, overeating, and violence have required researchers, community partners, and other relevant entities to identify culturally relevant practices and approaches to diminish these inequities. Thus, this study narrowed in on culturally relevant intervention approaches for the health of SGM.

This research investigated how various health interventions have been culturally adapted to fit the needs of SGM. The purpose of this study was to develop an adaptation model through the examination of the targeted modifications that researchers, community partners and others make to existing interventions. Heretofore, explorative studies with the specific intent to build an adaptation model of this type for SGM have not been conducted. The data presented in this study came from 13 semi-structured in-depth interviews with a sample of researchers as well as community practitioners from different fields who had a major role in adapting and/or implementing a health intervention for SGM. All data were transcribed and imported into QSR NVivo 10 for analysis. In addition to coding, a heuristic form of analysis was used to triangulate during the data analytic phase. Specifically, after reviewing and coding each transcript, the process described by each participant was drawn into an individual model. This heuristic form was used as a tool to facilitate discovery and further investigate the data. Each individual model presented a visual alternative to the transcript data. Side by side, the individual models were used to help generate additional codes and begin to connect axial codes. Triangulation with documents, member checking, triangulation with data analysis, and clarifying my credibility was used to validate the quality and accuracy of my research.

A semi-structured interview and qualitative analysis using constructivist grounded theory revealed three main themes (cultural considerations, adaptation process, and lessons learned) and a process model. Additionally, the data brought to light emergent cultural elements that can alternately be categorized as inclusive to and/or exclusive for SGM in particular health interventions. The final results from the data are presented in two ways: (1) in a diagram that depicts the central phenomena, (2) and a narration of the diagram.

The health disparities faced by SGM from the burdens of tobacco, substances, obesity, violence, and potentially other health problems will be ameliorated by a culturally relevant intervention. In some cases, an exclusive intervention is appropriate, while in others an inclusive intervention may be the better option. This study initiates an exploratory discourse regarding SGM populations and relevant cultural adaptations for their health. The results are intended to provide more accessible and relevant routes to intervention adaptations for SGM.