Pelvic health physiotherapists’ knowledge of and confidence working with the LGBTQIA+ community: a qualitative survey

BACKGROUND: Inclusive pelvic health care for people with lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other diverse bodies, identities and/or experiences (LGBTQIA+) is essential, yet little is known about physiotherapists' preparedness to provide affirming care. This study explored the knowledge and confidence of pelvic health physiotherapists in Australia when working with LGBTQIA+ patients. METHODS: Qualified physiotherapists practising in pelvic health in Australia were invited to complete an online survey. Qualitative data were analysed using reflexive thematic analysis. RESULTS: Sixty-three participants met eligibility criteria. The median participant age was 38 years (interquartile range 32-47 years), with a median of 9 years' (interquartile range 5-14 years) pelvic health clinical experience. Most participants identified as women (98.4%) and straight/heterosexual (87.3%), and 11.5% self-identified as LGBTQIA+. Although >75% of participants provided care for LGBTQIA+ patients, only 39% had undertaken LGBTQIA+-specific postgraduate education. One overarching theme, relationship between LGBTQIA+ exposure and knowledge and confidence, was identified, comprising two high-level themes: (1) the knowledge that shapes inclusive practice, and (2) pathways to inclusive practice. Participants with LGBTQIA+-specific pelvic health training and/or community connections demonstrated higher levels of knowledge and confidence, and most expressed a need for further training, particularly in gender-affirming language and care for people who are transgender. CONCLUSION: Pelvic health physiotherapists in Australia demonstrate varied knowledge and confidence when treating LGBTQIA+ individuals, shaped by exposure and education. Integrating LGBTQIA+ content into training may enhance pelvic health physiotherapists' capability to deliver inclusive, affirming care.