Session: System Dynamic Methodologies to Engage Sexual and Gender Minority Communities in Health Research (Society for Social Work and Research 27th Annual Conference - Social Work Science and Complex Problems: Battling Inequities + Building Solutions)

In 2021 over 250 anti-LGBTQ bills were introduced in state legislatures. This trend has continued in 2022 with a wave of harmful legislation particularly targeting the transgender community and limiting the rights of transgender and gender diverse individuals to receive gender-affirming physical/mental healthcare. LGBTQ+ individuals continue to face significant and cumulative barriers to accessing high quality, affirming, and holistic care in all sectors of the health/mental health system.

Grounded in Community-Based System Dynamics (CBSD) and queer epistemologies, this symposium highlights community-engaged work to change healthcare systems for SGM individuals. CBSD is a participatory research method involving communities to understand the underlying structures of systems. CBSD utilizes the insights and experiences of community members to elicit an emic understanding of social systems and structures, and identify advantage points for change. CBSD uses endogenous system factors and a feedback perspective to improve our understanding of the system and design interventions that are more effective. The studies presented in this symposium used Group Model Building (GMB) to elicit insider perspectives on healthcare issues experienced by SGM communities. This approach helps people with varied perspectives and expertise visualize the more extensive system around an issue by identifying constituent components and relationships through feedback mechanisms, consensus, controversy, and knowledge gaps, and pinpointing leverage points as intervention targets.

CBSD has not been historically used within marginalized communities with facilitators from within the same community. Our critical approach to conducting research within a queer epistemological frame recognizes and accounts for researcher subjectivities and lived experiences as part of the research methodology.

Paper one presents findings from a CTSC-funded translational health pilot study, Rainbow Connections, conducted by an interdisciplinary research team (social work, nursing, and medicine) in partnership with the LGBT Center of Greater Cleveland to understand lapses, disconnections and reconnections to physical/mental healthcare for sexual and gender minorities across the life course. Group Model Building was applied to build a model of key factors influencing disconnections from care, and highlights two interventions to facilitate (re)connection.

Paper two presents the unique barriers and facilitators experienced by transgender and gender diverse (T/GD) community participants in the Rainbow Connections pilot study. T/GD individuals face unique barriers to care connection based on gender identity, expression, and varied desires/need for gender-affirming treatments. This paper focuses on the unique challenges experienced the by T/GD community along with the community resilience and support within the community. Structural, institutional, and interpersonal facilitators and barriers for and within the T/GD community are discussed.

Paper three presents findings from four Group Model Building sessions that addressed PrEP adoption and sustainment among young men who have sex with men, and young transgender and nonbinary individuals across Colorado. In partnership with Colorado Health Network (a statewide, community-based HIV service agency), we conducted two sessions with current and former PrEP consumers and two groups with PrEP providers and program administrators. A casual loop diagram and action ideas for improving PrEP adoption and sustainment generated by participants will be presented.