LGBTQ+ individuals' experiences of initial identity disclosure in primary healthcare services: a qualitative scoping review

Abstract

Background Primary healthcare is central to equitable and high-quality care; however, access and utilisation remain uneven across population groups. LGBTQ+ individuals continue to experience discrimination, stigma and non-affirming practices within primary care settings. These experiences undermine trust, discourage identity disclosure and contribute to reduced engagement with services, delayed care and poorer health outcomes. Objective To explore LGBTQ+ individuals' experiences of their initial identity disclosure encounters with primary healthcare professionals and how these influence their future engagement with care services. Design Qualitative scoping review. Information sources The PubMed, CINAHL, and SCOPUS databases were systematically searched using a PICo-based strategy. Methods A scoping review followed PRISMA-ScR guidelines, including qualitative studies. Articles were appraised, and the findings were synthesised to identify recurring themes across the reviewed literature. Results Four thematic units emerged, namely: (a) Factors Shaping the Experiences of Identity Disclosure, (b) The Impact of Discriminatory Attitudes, (c) The Structure and Symbols of Health Institutions, (d) Navigating the Healthcare System. Conclusions Initial identity disclosure encounters are pivotal in shaping LGBTQ+ individuals' long-term engagement with primary healthcare services, which depends on both anticipated and experienced trust. Establishing trust is predicated on individual qualities of healthcare providers and the structural/organisational context of primary care settings. Enhancing both individual and system-wide trust is crucial in fostering equitable and sustainable healthcare relationships. Registration A study protocol was developed and registered with the Centre for Open Science (COS) as a scoping review and is publicly accessible under registration DOI 10.17,605/OSF.IO/ZXWGS - registered 24/10/2025. Implications for the profession and/or patient care The triptych of developing self-aware, empathetic health professionals, educated within a culturally sensitive environment, and being capable of (re)structuring the primary care setting to become more inclusive are key implications of the review. This triptych is founded on developing a new scholarship of reflective practice, grounded in the science of the unique. Impact Provide a mapping of the current literature's understanding of LGBTQ+ individuals' experiences of initial identity disclosure, highlight the roles that individuals and context play in these experiences, and argue for a new educational and practice approach tailored to each individual's uniqueness. Reporting method This study adheres to the EQUATOR guidelines and PRISMA-ScR checklist. Patient or public contribution Τhis study did not include patient or public involvement.