Equal experiences

Do LGBT families have the same experiences using health services as heterosexual families? What impact does this have on their children? UQ Honorary Professor of Medicine Linda Shields is working to find the answer.

Over the last 20 or so years, I have worked at many universities in Australia and overseas, but UQ has always been my “home”. I did my PhD and master’s in the School of Medicine, and in 2011 was awarded a Higher Doctorate in Medicine – to the best of my knowledge, I am still the only nurse in Australia with a Higher Doctorate. At present, I am the Professor of Rural Health at Charles Sturt University in Bathurst, and, very importantly for me – I hold the position of Honorary Professor of Medicine at UQ. One of these days I‘ll stop moving around and settle back in Brisbane, but in the meantime, my son, Kirril Shields, carries on the academic banner at UQ as a cultural studies lecturer.

I am a paediatric/child health nurse, and my research over the last 20 years has been about how to be sure that children and their families are given the best, most supportive experience possible if they are using a health service. I have always seen myself as an advocate for parents, and from that, their children. That grew out of an episode many years ago, when I saw some very disadvantaged parents, who were doing their best for their sick baby, inappropriately taken to task by a judgemental health professional.

My work is about what is known as “family-centred care”, and has included several systematic reviews on that topic, including a Cochrane review. Because of this, I know that there is very little evidence as to whether or not family-centred care is effective. However, health services around the world have “family-centred care” policies in place because they sound good. I constantly argue that having an untested model of care as policy is unethical, not to mention unnecessarily costly. To try to see what is actually happening in health services when children are brought for care, I have developed several questionnaires about family-centred care.

My research about family-centred care has been done in many countries, both wealthy and developing, and in many different health care settings. Some of my questionnaires have been translated into 15 different languages.

When a child is admitted to, or visits, a health service, for any condition or event, the child is at risk of emotional upset. All health professionals who work with children are aware of this – or should be. But I always have an eye out for those who are at particular risk.

I wondered that if LGBTQI parents brought their child to a health service, would they be made to feel uncomfortable?

And would this in turn make them hesitant to bring their child to health services, with children then missing out on health care? I set up a series of studies of two questions:

1. What have LBGT (we didn’t include QI) parents experienced when they brought their children to a health service for care?
2. What are the attitudes/skills/knowledge of health professionals about LGBT parents?

We investigated the second question in a range of settings: a large, specialist paediatric tertiary referral hospital; two hospitals that had separate children’s wards; community health services; and also nursing and medical students. Our results showed that many health professionals held negative attitudes, skills and knowledge about LGBT people, and this was disturbing.

However, we needed solid evidence about whether or not parents themselves feel uncomfortable, and we had a terrific sample of some LGBT people who were more than happy to help us and participate in our research. Overall, they had positive experiences and felt they had been treated well. While this was a pleasing result, we are very well aware of a huge limitation on this research. Our participants were all highly educated, articulate and could navigate the health services to get the best care for their children. Despite a large campaign via gay pride, gay organisations, websites etc, we could not recruit LGBT parents who were not highly educated and articulate – they just would not respond. In other words, we have missed the parents who might need our help most.

We have applied for several grants since this baseline research was done, with no luck. I think it could be related to the fact that we need to investigate parents who need help, so we can find out if their children are in danger of missing out on health care. We found that health professionals were not always welcoming, and we believe that parents who do not know their way around health services may be seriously disadvantaged. If, when they reveal their sexual orientation, they are made to feel uncomfortable, are they going to bring their children to those health services? We need to try to find these LGBTQI parents, so we can answer these questions, and if necessary, work towards solutions.

Find out more about Professor Shield’s work at her website, ResearchGate profile, Linked-in or twitter, @Lshields50.