Raising voices of 2SLGBTQIA+ patients: The intersection of minority stress and systemic oppression in pharmacy practice.

BACKGROUND: Two-spirit, lesbian, gay, bisexual, trans, queer, intersex, asexual, and other sex, sexual, and gender identities (2SLGBTQIA+) experience minority stress processes in pharmacy settings. Processes may be distal (objective prejudicial events) or proximal (subjective internalized feelings) and lead to delay or avoidance of care. The nature of these experiences in pharmacies and ways to reduce occurrence is largely unknown. OBJECTIVES: This study aimed to characterize 2SLGBTQIA+ individuals' perceived experiences in pharmacies according to the minority stress model (MSM) and to elicit patient-identified individual, interpersonal, and systemic strategies for reducing systemic oppression of 2SLGBTQIA+ individuals in pharmacy practice. METHODS: This was a qualitative phenomenological study using semistructured interviews. Thirty-one 2SLGBTQIA+ individuals from the Canadian Maritime provinces completed the study. Transcripts were coded according to domains of the MSM (distal and proximal processes) and the lens of systemic oppression (LOSO) (individual, interpersonal, and systemic factors). Framework analysis was used to identify themes within each theoretical domain. RESULTS: Distal and proximal minority stress processes were described by 2SLGBTQIA+ individuals in pharmacy settings. Distal processes included direct and indirect perceived discrimination and microaggressions. Proximal processes included expectation of rejection, concealment, and internalized self-stigma. Nine themes were identified according to the LOSO. Two related to the individual (knowledge and abilities, respect), 2 related to interpersonal relations (rapport and trust, holistic care), and 5 related to systemic factors (policies and procedures, representation and symbols, training/specialization, environment/privacy, technology). CONCLUSION: Findings support the notion that individual, interpersonal, and systemic strategies can be implemented to reduce or prevent minority stress processes from occurring in pharmacy practice. Future studies should evaluate these strategies to better understand effective ways to improve inclusivity for 2SLGBTQIA+ people in pharmacy settings.