Sexual and gender minorities face higher health risks, worsened by discriminatory care and healthcare professionals’ lack of cultural competence. The study developed and validated a Cultural Competence Matrix to guide including equitable healthcare practice.Describe aspects of a Cultural Competency Matrix in healthcare for working with Sexual and Gender Minorities and its contributions to professional practice and training.he participatory study used the Nominal Group Technique to validate a cultural competency matrix for healthcare with Sexual and Gender Minorities. Six online groups with 21 participants—LGBTQIA+ users, experienced health professionals, and faculty—generated, discussed, and voted on ideas. The matrix was then revised and reformulated based on consensus and systematic analysis.The results consisted of the development of a cultural competency matrix composed of four domains, organized into knowledge, skills, and attitudes. The first domain addresses gender identities and sexual orientations, emphasizing core concepts, inclusive language, and respect for difference. The second focuses on the biopsychosocial aspects of LGBTQIA+ health, grounded in the Social Determination of Health and promoting non-reductionist clinical practice. The third domain concerns the professional–user relationship, highlighting nonviolent communication, welcoming practices, and the recognition and mitigation of biases. The fourth domain encompasses health care networks, support systems, and territory, reinforcing integral, intersectoral care and the defense of the rights of Sexual and Gender Minorities.The cultural competency matrix supports marginalized populations, strengthens collective health, and upholds the principles of Brazil’s health system. It guides professional practice, informs training curricula, and fosters the education of sensitive, critical, and inclusive healthcare professionals.The cultural competency matrix aims to train professionals who are culturally sensitive, open, and self-aware, going beyond technical skills. It emphasizes adaptability to cultural changes and fosters critical, flexible, and transformative practice.

Les personnes transgenres ou en non-conformité de genre (incluant non binaire, genderfluid, agenre) sont sujettes à des discriminations entraînant un stress minoritaire lié au genre, des inégalités en matière de santé et des difficultés d'accès aux soins. L’objectif de l’étude était d'explorer les attentes et les besoins des personnes transgenres dans leur relation avec tous∙tes les professionnel∙les de santé, en recueillant leurs ressentis et vécus en situations de soins.Une étude qualitative utilisant des entretiens individuels semi-dirigés a été menée auprès de 9 adultes transgenres. Le recrutement est passé par des associations LGBTQIA+ de la région XXX par mail, réseaux sociaux et contacts personnels. L'analyse des données a été basée sur une analyse thématique avec construction d'un modèle explicatif, inspirée de la phénoménologie interprétative. Une triangulation des données a été réalisée conjointement par les deux investigatrices.Les personnes transgenres rapportaient des difficultés d'accès aux soins dans un système de santé jugé discriminatoire et violent envers les minorités de genre. Pour surmonter ces freins aux consultations, les personnes transgenres élaboraient des stratégies d'adaptation, notamment le recours à l’automédication. Elles attendaient des professionnel∙les de santé une prise en charge bienveillante et individualisée et un accueil adapté. Enfin, la formation de tous∙tes les acteur∙rices de la santé  aux questions de santé des personnes transgenres semblait nécessaire pour améliorer leur santé et leur intégration dans le système de santé.Les critères COREQ ont été suivis. Le mode de recrutement via des associations LGBTQIA+ a pu sélectionner des personnes plus militantes . La grande majorité des participant∙es vivaient en zone urbaine. La littérature retrouve des difficultés d’accès aux soins liées à un manque de professionnel∙les formé∙es et compétent∙es, ainsi qu'un frein financier. Elle retrouve également des stratégies d’adaptation : réseaux de pairs et automédication. Enfin, la nécessité de formation apparaît dans la littérature internationaleLes personnes transgenres vivent dans une société et un système de santé où elles se sentent discriminées, touchées par les inégalités de santé et obligées de s'adapter. Une meilleure formation de tous∙tes les professionnel∙les de santé pour améliorer l'accueil et la qualité des soins est attendue par les personnes transgenres.

Gender is a key determinant of health equity, yet gender stereotypes are still inconsistently considered in clinical reasoning. In military primary care, general practitioners also perform fitness-for-duty assessments and advise command, which may increase the impact of gendered expectations on decision-making.To explore how military general practitioners perceive the influence of gender stereotypes on clinical practice and occupational/aptitude decisions, and to describe the strategies they use to manage this influence.Qualitative study using semi-structured interviews with active-duty military general practitioners from different service branches. Participants were purposively recruited to maximize diversity (age, gender, populations served). Interviews were audio-recorded, transcribed and anonymised, then analysed using grounded theory with open and axial coding. Themes were synthesised and used to build a typology of physician profiles.Twenty-one interviews were analysed. Three main axes emerged: (1) gender sensitivity, (2) clinical fields perceived as influenced by stereotypes, and (3) management strategies. Understanding of the sex/gender distinction was uneven and rarely mobilised explicitly. Stereotypes were framed either as biased generalisations to avoid or as pragmatic reference points. Reported affected fields included sports-related injuries, mental health, sexual health, and fitness-for-duty assessments. Management strategies were mostly individual (standardised templates, deliberate questioning, case-by-case adaptation), with limited collective or institutional support. Five physician profiles were identified; gender sensitivity did not consistently predict whether participants spontaneously recognised stereotype-related influences.Gender stereotypes may shape both care and occupational decisions, but recognition often requires a context that encourages reflexivity. Reliance on individual vigilance can lead to variable practices and uneven equity. Institutional training, structured clinical tools, and peer-reflection spaces could help translate awareness into routine practice.Gender stereotypes influence military general practice across several clinical domains. Embedding reflexivity and gender competence into training and organisational routines may reduce variability and support more equitable care and assessments.

In XXX, an increasing number of individuals identify as transgender, and related health needs are rising. In 2023, the World Professional Association for Transgender Health (WPATH) recommended that primary care professionals, particularly general practitioners (GPs), address these needs. In XXX, GPs play an increasingly central role in transgender healthcare, yet evidence in this area remains scarce. While WPATH outlines health objectives identified by medical professionals, the expectations of transgender people toward GPs remain insufficiently documented, and no review has addressed this to date.The primary objective of this study was to identify, in the scientific literature, the expectations of transgender adults toward their GPs in XXX. The secondary objective was to provide an overview of the current state of research in this fieldA scoping review was conducted by one investigator using PubMed, Cairn, SUDOC, Google Scholar, PsycINFO, LiSSa, and Cochrane. The main MeSH terms used were “primary care,” “general practice,” “transgender,” and “transsexualism.” All studies published before 01/08/2023 were included. Literature reviews and other non-primary sources were excluded. Extracted data were synthesized thematically and included: expectations of transgender individuals toward their GP, study type, study quality (STROBE/SRQR), and publication status.Expectations fell into two categories: “general,” applicable to any patient population, and “specific,” related to transgender health needs. These aligned with core GP competencies. The most frequent were: relational and communication skills (comforting environment, active listening, absence of misgendering), assistance with administrative procedures for long-term condition status, management of hormone therapy, guidance through the care pathway, facilitation of access to healthcare, and ongoing GP training. Primary care research on this topic is substantial but lacks published data and quantification of the relative importance of these expectations.This study is novel in exploring grey literature within French primary care and follows PRISMA-ScR guidelines (22/22), with findings comparable to international studies. Potential selection bias due to a single reviewer and the lack of a dedicated MeSH term for transgender identities was mitigated through multiple search strategies.Transgender patients express realistic expectations aligned with GP competencies, and this review clarifies these expectations while underscoring the need for further quantitative research.

The number of sexual and/or gender minority (SGM) adults in Canada is rising, including among seniors. Many continue to face health inequities such as stigma in care, limited support, unmet health needs, and lasting reluctance to seek help after previous negative experiences. Most available evidence comes from urban settings, leaving little understanding of rural contexts, where reduced anonymity and scarce inclusive services may strongly shape how SGM older adults engage with primary care.(1) To describe how rural SGM older adults experience consultations with family doctors and (2) to examine how rural family physicians and other primary healthcare providers perceive the care they provide.This qualitative descriptive study, approved by a Research Ethics Board, draws on Minority Stress Theory and Bradshaw’s model of need. Semi-structured interviews were conducted with rural SGM adults aged ≥65 (n=15) and with rural family physicians and other healthcare providers (n=12). An inductive–deductive thematic approach informed the analysis.Four themes emerged from the initial interviews. Managing identity in small communities: several participants adjusted or withheld parts of their identity to avoid stigma or unwanted attention. Recognition in clinical encounters: experiences ranged from subtle affirmation to feeling unseen or misidentified, often due to inconsistent documentation of names or pronouns and a gap between clinical neutrality and patients’ sense of erasure. Structural barriers: clinicians reported limited SGM-specific tools and training, while patients avoided certain services out of fear of being recognized in their community. Relational strengths: continuity and long-standing relationships helped build trust and, when present, allowed for more open communication, with clinicians noting that some patients shared aspects of their identity for the first time in this safe relational contextPreliminary insights suggest that rurality intensifies identity-management pressures and that well-intentioned neutrality can inadvertently reinforce feelings of invisibility. Limited resources and visibility concern further hinder access to affirming care, although strong continuity can help counterbalance these challenges.By bringing forward voices rarely heard in small-community health research, this study points to the need for rural-adapted strategies while drawing on the relational strengths of close-knit communities to enhance identity-affirming primary care for SGM older adults.

Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) individuals are at increased risk of mental health issues, substance abuse, sexually transmitted infections, discrimination and suicide attempts. For general practitioners (GP), these topics are difficult to address, even though a better understanding of patients' status could improve prevention, screening and therapeutic alliance.To assess the GPs’ ease of discussing sexual orientation and gender during consultations. Secondary objectives focused on knowledge of health specificities of LGBTQI+ patients and training.Descriptive study using an anonymous online questionnaire distributed in 2025 to GPs and interns in XXXX. The primary endpoint was the level of comfort in addressing sexual orientation and gender issues. The questionnaire explored seven themes. A descriptive and then comparative analysis was performed based on the level of comfort.  The study was validated by an ethics committee.The average age of 305 respondents was 36, with 68.9% being women. The level of ease in addressing sexual orientation and gender issues during consultations was moderate (5.35/10), significantly higher among doctors who had received specific training (p < 0.001). The majority reported knowing the definitions of sexual orientations (81.3%). 81.6% had received no initial or continuing training, and 77.7% wanted it. The majority had not noted the increased risk of chronic diseases in these patients. The frequency with which sexual orientation was discussed was significantly correlated with the level of comfort, specific training and professional status (p < 0.001).The results, in line with the literature, highlight the need to develop specific training to improve the reception and care of these patients. GPs could thus take care of the patient as a whole, better understand their health issues and improve their practices. However, addressing sexual orientation is not a recent issue and difficulties persist over time, even though many guides and tools already exist to help healthcare professionals. Qualitative studies would be useful to explore these barriers.GPs report an average level of ease when discussing patients' sexual orientation during consultations, despite the existence of numerous guides and tools. It would be interesting to explore the persistent barriers to discussion during consultations.

Family physicians, nurse practitioners, and residents increasingly encounter patients experiencing gender incongruence or questioning their gender identity. Yet few provide gender-affirming care directly, often referring patients to tertiary centers. In Québec, long waiting times—up to two years in expertise centers—delay essential interventions that protect mental health. Concentrating such care in tertiary settings reinforces a pathologizing view of gender diversity and leaves primary care teams uncertain about their competencies. Despite the growing importance of gender-affirming services, data on clinicians’ self-efficacy remain scarce, particularly in Canada and Québec. This study addresses this gap by examining factors influencing self-efficacy and the provision of gender-affirming care within community and university-affiliated primary care settings.To identify factors influencing primary care clinicians’ self-efficacy and delivery of gender-affirming care through four aims: (1) describe clinicians’ self-efficacy across care dimensions; (2) identify personal, professional, and organizational factors associated with higher self-efficacy; (3) explore perceived barriers and facilitators; and (4) generate recommendations to improve training, support, and care organization.Following Creswell and Plano Clark’s (2018) framework, a sequential explanatory mixed-methods design (QUAN→QUAL) is being implemented. Data collection is now underway among family physicians, nurse practitioners, and residents working in public and university-affiliated family medicine groups (GMF/GMF-U). The quantitative phase uses a structured online questionnaire assessing general self-efficacy with the General Self-Efficacy Scale (Schwarzer & Jerusalem, 1995), perceived competence in gender-affirming care, and perceived barriers and facilitators. Descriptive and inferential analyses (correlation and multiple regression) will identify associations between self-efficacy and contextual variables. The qualitative phase includes semi-structured interviews to deepen understanding of modifiable mechanisms. Ethical approval has been obtained from the Research Ethics Committee of the CISSS de la Montérégie-Centre.Preliminary analyses suggest overall low self-efficacy among clinicians, with higher confidence associated with prior exposure to transgender and gender-diverse patients, targeted training, and supportive clinical environments.These early trends highlight the need to strengthen training, sustained exposure, and organizational support in academic primary care to better serve transgender and gender-diverse patients.This study will provide actionable, evidence-informed recommendations to enhance education and system design, supporting more humanistic, equitable, and accessible gender-affirming care.