# Constructing Wholeness in LGBTQ+ Healthcare Access: A Grounded Theory Model

## TL;DR

LGBTQ+ individuals navigate healthcare through a dynamic process of affirming care and community support, which helps them achieve a sense of wholeness despite facing discrimination and structural barriers.

## Contribution

The study introduces a novel grounded theory model of 'Constructing Wholeness' in LGBTQ+ healthcare engagement, emphasizing identity integration and community-based resilience.

## Key findings

- Participants described a shared non-linear process of moving toward wholeness through four internal mechanisms.
- Intra-community support is critical for navigating healthcare and fostering resilience in inequitable systems.
- Healthcare systems must adopt wholeness-oriented models that recognize social, emotional, and identity-based dimensions.

## Abstract

What are the main findings?
LGBTQ+ individuals’ engagement with healthcare across the life course is shaped by a dynamic process of reconstructing and deconstructing forces, wherein affirming care, accessible providers, and community support promote wholeness, while discrimination, structural barriers, and dismissal fragment identity and well-being.Despite diverse identities and life stages, participants described a shared, non-linear process of moving toward wholeness through four interconnected internal mechanisms: interconnecting selves (identity integration and authenticity), intra-community support, self-determined care (advocacy, persistence, and pursuit of quality care), and meaning-finding.

LGBTQ+ individuals’ engagement with healthcare across the life course is shaped by a dynamic process of reconstructing and deconstructing forces, wherein affirming care, accessible providers, and community support promote wholeness, while discrimination, structural barriers, and dismissal fragment identity and well-being.

Despite diverse identities and life stages, participants described a shared, non-linear process of moving toward wholeness through four interconnected internal mechanisms: interconnecting selves (identity integration and authenticity), intra-community support, self-determined care (advocacy, persistence, and pursuit of quality care), and meaning-finding.

What are the implications of the main findings?
Healthcare systems and providers must move beyond deficit-based or purely biomedical approaches and instead adopt wholeness-oriented, affirming models of care that recognize the interconnected social, emotional, cultural, and identity-based dimensions shaping LGBTQ+ health experiences.Strengthening LGBTQ+ community infrastructures and peer-based knowledge exchange is critical, as intra-community support functions as a key mechanism for navigating healthcare, mitigating harm, and fostering resilience—particularly in contexts where formal healthcare systems remain inequitable or unresponsive.

Healthcare systems and providers must move beyond deficit-based or purely biomedical approaches and instead adopt wholeness-oriented, affirming models of care that recognize the interconnected social, emotional, cultural, and identity-based dimensions shaping LGBTQ+ health experiences.

Strengthening LGBTQ+ community infrastructures and peer-based knowledge exchange is critical, as intra-community support functions as a key mechanism for navigating healthcare, mitigating harm, and fostering resilience—particularly in contexts where formal healthcare systems remain inequitable or unresponsive.

LGBTQ+ individuals continue to experience substantial barriers to accessing affirming healthcare, including discrimination, structural inequities, and provider-level limitations. This study aimed to develop an emergent grounded theory model of constructing wholeness in healthcare. Methods: This study employed a secondary constructivist grounded theory analysis of qualitative data from The Rainbow Connections Study, a community-based system dynamics project. Data were collected through eight group model-building sessions conducted via Zoom with 28 LGBTQ+ participants, including older adults, youth, transgender and gender-diverse individuals, and staff from the LGBTQ+ community center who also held service and practitioner roles; analytic claims are framed to reflect this mixed-role sample. Sessions were audio- and video-recorded, transcribed verbatim, and analyzed using open, axial, and selective coding procedures. Constant comparative methods, reflexive memoing, and member checking were used to support analytic rigor and trustworthiness. Results: Analysis revealed a dynamic process in which LGBTQ+ individuals encounter external forces within healthcare systems that alternately support or fragment their sense of self. In response, participants engaged in four interconnected internal processes—interconnecting selves, intra-community support, self-determined care, and meaning-finding—that facilitated movement toward wholeness. These processes were non-linear, iterative, and present across diverse identities and life stages. Conclusions: The emergent theory of Constructing Wholeness in Connecting to Healthcare highlights that LGBTQ+ healthcare experiences extend beyond access and utilization to include identity integration, community reliance, and meaning making. Supporting LGBTQ+ health requires healthcare approaches that affirm wholeness, reduce structural harm, and recognize the central role of community in navigating care.