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      Working Through Stigma: A Constructivist Grounded Theory of Delivering Health Services to Diverse 2SLGBTQ Populations

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          Abstract

          Previous research inadequately explores processes and factors influencing the delivery of health services to sexual and gender minorities in ways that equitably attend to the infinite diversity held by these groups. This study employed Intersectionality and Critical Theories to inform Constructivist Grounded Theory methods and methodology; social categories of identity were strategically adopted to explore domains of power operating across multiple forms of oppression, think through subjective realities, and generate a nuanced rendering of power relations influencing health service delivery to diverse 2SLGBTQ populations in a Canadian province. Semi-structured interviews were conducted and the co-constructed theory of Working Through Stigma, with three interrelated concepts, depending on context, resolving histories, and surviving the situation, was generated . The theory depicts the concerns of participants and what they do about power relations influencing health service delivery and broader social contexts. While the negative impacts of stigma were widely and diversely experienced by patients and providers, ways of working within power relations emerged that would be impossible if stigma was not present, highlighting opportunities to positively impact those from stigmatized groups. As such, Working Through Stigma is a theory that flouts the tradition of stigma research; it offers theoretical knowledge that can be used to work within power relations upholding stigma in ways that increase access to quality health services for those whose historical underservicing can be attributed to stigma. In doing so, the stigma script is flipped and strategies for working against practices and behaviours that uphold cultural supremacies may be realized.

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          Most cited references79

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          Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.

          Ilan Meyer (2003)
          In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.
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            Outline of a Theory of Practice

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              Constructing Grounded Theory

              <p>Lecturers, request your electronic inspection copy<br> <br> Kathy Charmaz presents the definitive guide to doing grounded theory from a constructivist perspective. This second edition of her groundbreaking text retains the accessibility and warmth of the first edition whilst introducing cutting edge examples and practical tips.<br> <br> This expanded second edition:<br> <br> - explores how to effectively focus on data collection<br> <br> - demonstrates how to use data for theorizing<br> <br> - adds two new chapters that guide you through conducting and analysing interviews in grounded theory <br> <br> - adds a new chapter on symbolic interactionism and grounded theory<br> <br> - considers recent epistemological debates about the place of prior theory<br> <br> - discusses the legacy of Anselm Strauss for grounded theory.</p> <p>This is a seminal title for anyone serious about understanding and doing grounded theory research. </p>
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                Author and article information

                Journal
                Qual Health Res
                Qual Health Res
                spqhr
                QHR
                Qualitative Health Research
                SAGE Publications (Sage CA: Los Angeles, CA )
                1049-7323
                1552-7557
                18 April 2023
                June 2023
                : 33
                : 7
                : 624-637
                Affiliations
                [1 ]School of Nursing, Ringgold 70338, universityDalhousie University; , Halifax, NS, Canada
                Author notes
                [*]Jennifer Lane, School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, NS B3H 4R2, Canada. Email: jennifer.lane@ 123456dal.ca
                Author information
                https://orcid.org/0000-0002-5832-6017
                Article
                10.1177_10497323231167828
                10.1177/10497323231167828
                10259085
                37070574
                dbf8d1f6-0774-4898-92cc-dac3b0d5e644
                © The Author(s) 2023

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Funding
                Funded by: Canadian Nurses Foundation, FundRef https://doi.org/10.13039/100009271;
                Funded by: Killam Trusts, FundRef https://doi.org/10.13039/501100004073;
                Funded by: Faculty of Graduate Studies, Dalhousie University, FundRef https://doi.org/10.13039/501100000087;
                Categories
                Research Articles
                Custom metadata
                ts10

                Medicine
                constructivist grounded theory,intersectionality theory,critical theory,stigma,sexual minorities,gender minorities,2slgbtq,health equity,structural inequalities,power,identity

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