Challenges and opportunities for medical referrals at a mobile community health clinic serving sexual and gender minorities in rural South Carolina: a qualitative approach.

BACKGROUND: Sexual and gender minorities (SGM) in the Southern United States face challenges in accessing sexual and gender affirming health care. Alternative care models, like inclusive mobile clinics, help mitigate barriers to care for SGM. There is limited data in the literature on the experience of medical referral processes for SGM individuals accessing services from mobile health clinics. AIMS AND OBJECTIVES: The purpose of this study is to describe the medical referral experiences of SGM clients and their providers at a mobile health clinic in the Southern United States. METHODS: We recruited English-speaking individuals who provided care or received care from the mobile health clinic in South Carolina between June 2019 and August 2020. Participants completed a brief demographic survey and a virtual in-depth, semi-structured individual interview. Data analysis was conducted using an iterative process to generate codes, categories, and themes. Data collection and analysis were terminated once thematic saturation was achieved. RESULTS: The findings from this study indicated that the mobile health clinic had an inconsistent referral process that was largely dependent on providers' knowledge. Furthermore, clients and providers expressed individual barriers to the referral process, such as financial barriers, and opportunities to improve the referral process, such as an opt-in follow-up from the mobile clinic and increased mobile clinic resources. CONCLUSION: The findings in this study underscore the importance of having mobile clinics create a structured referral process that all medical providers are familiar with, and the value of hiring patient navigators that can support and refer clients to care that goes beyond the mobile health clinic setting.

"Little Red Flags": Barriers to Accessing Health Care as a Sexual or Gender Minority Individual in the Rural Southern United States-A Qualitative Intersectional Approach.

ABSTRACT: Sexual and gender minorities (SGMs) experience unique challenges when accessing sexuality and gender-affirming, safe health care services in the rural, southern United States. An identified gap in the literature is an intersectional, community-based approach to assessing the obstacles SGM individuals with intersecting identities experience when navigating comprehensive health services in rural southern communities in the United States; therefore, the present study used qualitative inquiry with an intersectional lens to describe these obstacles. The authors analyzed qualitative data from in-depth, semi-structured individual interviews with SGM individuals (N = 12). Common themes emerged that highlighted the compounding effects of the sociopolitical climate of the geographical area, religious attitudes toward SGMs, and the experience of racism. Findings of this study can inform health professions' academic curriculum, provider and support staff training, and implementation of policy that focuses on creating a diverse and inclusive health care delivery experience.