Max Kleijberg

The project PULSAR aims to map the experiences of LGBTQ+ healthcare providers in Portugal. As recent literature shows, LGBTQ+ healthcare professionals are often overlooked as key actors in the promotion and implementation of inclusive healthcare practices. On one side, they face the stigma and discrimination experienced also by LGBTQ+ patients and often choose to conceal their identity or endure additional work-related pressures. On the other, they represent a fundamental key actor in providing expertise and knowledge to improve inclusivity in healthcare settings. In the Portuguese context, the topic has not been explored yet and existing research, even if scarce, is focused on the experiences of LGBTQ+ patients. PULSAR aims at being the first exploration of the experiences of LGBTQ+ healthcare professionals in the country and thus holds strong relevance both to the national and international fields. The choice of the name PULSAR evokes two key aspects of the project. First, in English, a “pulsar” is a small but dense star that emits signals outside of its magnetic poles: metaphorically, although LGBTQ+ professionals may represent only a small part of the overall population of healthcare providers, they have the potential to be key actors in producing practices and trigger change that goes well beyond healthcare settings alone. However, “pulsar” in Portuguese is a verb meaning “pulsate”, or “beat”, and it is often used to indicate the beating of the heart: in this sense, the project aims at exploring a vital, although less known, centre of innovation in healthcare practices and value its potentialities and liveliness. The project emphasizes the symbolic and material leverage of what happens in medical wards and the extent to which those spaces can replicate or reduce discrimination based on sexual orientation, gender identity and sex characteristics. Moreover, it refers to the need to reward LGBTQ+ health professionals with a recognition of their importance as key agents of inclusion in healthcare. The project PULSAR holds a strong exploratory component and aims at producing an enduring impact in the transformation of healthcare, by producing guidelines, involving key stakeholders and valuing embodied experiences. It has three main objectives: Reviewing: to map out the contemporary situation of LGBTQ+ healthcare professionals in Portugal, including their experiences and needs

2. Responding: to design strategies of intervention and guidelines for enhancing inclusivity in the healthcare system

3. Rebuilding: to encourage transversal alliances between healthcare providers and the LGBTQ+ population through the mediating role of LGBTQ+ healthcare professionals. The project is divided into three main phases that reflect the three main objectives. Phase 1, REVIEW, aims to map out the current experiences of LGBTQ+ HPs in Portugal. Considering that no studies so far have collected this data, the exploratory dimension of this phase is crucial. The collection of data will be developed following a mixed-method approach: an online questionnaire and qualitative interviews. Phase 2, RESPOND, aims at elaborating and disseminating guidelines to be implemented in healthcare systems. The objective is to publish a manual of guidelines to improve inclusion for HPs. The main target of the guidelines are healthcare institutions, policy-makers and professional corporations. Phase 3, REBUILD, aims to provide a platform for LGBTQ+ healthcare professionals to dialogue both with professional colleagues and LGBTQ+ activists. A one-day national event, open to LGBTQ+ activists and healthcare professionals, will be organised. The objective is to give visibility to the central role of LGBTQ+ professionals in promoting inclusivity in healthcare

to disseminate the guidelines and the recommendations that emerged from their experiences, and to create a platform of dialogue that can lead to future alliances. Given its ambitious contours, the project PULSAR works to implement innovative practices and value existing embodied knowledge to produce more just, inclusive and diverse healthcare settings.

This project aims to create LGBTQ+ inclusive end-of-life (EoL) care using findings from the applicant’s Forte-funded postdoc research. Despite advances in LGBTQ+ rights, inequities persist in EoL-care for LGBTQ+ people, driven by factors such as limited intergenerational social support, minority stress, and a lack of LGBTQ+ competency among care staff. The concept of “queering the death system” refers to how LGBTQ+ people improve their own EoL experiences, for example by creating informal caring networks. EoL-care staff can contribute to queering the death system by implementing LGBTQ+ inclusive EoL-care practices, yet research shows that they require support to do so. This project responds to these societal needs by bringing together LGBTQ+ and EoL-care stakeholders to create partnerships, exchange knowledge, and implement LGBTQ+ inclusive EoL-care practices and education. “DöBra Rainbow Cafés” will serve as a platform for this work. These cafés were initially developed as part of the applicant’s research to create LGBTQ+ community support around EoL issues. In this impact project, cafés will be spaces in which LGBTQ+ and EoL-care stakeholders come together to develop LGBTQ+ inclusive EoL-care based on research in this field. Two café-formats will be developed: group-format cafés focus on sharing experiences and developing inclusive practices, while roundtable-format cafés concentrate on policy change. The cafés aim to create impact at three levels: personal/group (building partnerships, exchange knowledge, develop ideas for LGBTQ+ inclusive EoL-care), action-oriented (implementing LGBTQ+ EoL-care practices and education), and strategy-oriented (influencing policies). By centering LGBTQ+ voices and using a participatory approach that focuses on resilience and action, the project addresses persistent inequities in EoL-care and aims to create long-term impact towards LGBTQ+ inclusive EoL-care.

Older people are at increased risk for mental health issues and involuntary loneliness. Belonging to a sexual or gender minority is also found to increase these risks. However, there is a lack of knowledge about mental health, social isolation and involuntary loneliness among LGBT+ people (lesbian, gay, bisexual, transgender and other sexual and gender minority identities) in later life.The overall research aim of this project is to investigate mental health, social isolation, and involuntary loneliness among LGBT+ people 65 years or older in Sweden, using both quantitative and qualitative approaches. A second aim is to, in collaboration with the target group and community-based, social and health care stakeholders, identify ways to tailor initiatives to those older LGBT+ people who are found to be most at risk.The aims are addressed through four studies. Study 1 uses already collected data from a population-based survey study to analyze gender identity and sexual orientation disparities in mental wellbeing among older people in Sweden. Study 2 is a survey study directed to the 65+ LGBT+ population to investigate how structural and experiential factors (e.g., openness about LGBT+ identity and stigma-based stress) affect mental health, social isolation and involuntary loneliness in this group. Study 3 is a qualitative interview study with older LGBT+ people who reported loneliness and social isolation, to explore their experiences of relationships, belonging, and community, and facilitators and challenges in strengthening social support networks. Study 4 is a qualitative interview study with community-based, social and healthcare stakeholders to identify ways to tailor initiatives to those older LGBT+ people who are found to be most at risk. An advisory group with representatives from the target group, LGBT+ organizations, and care and policy stakeholders, will be involved throughout the research. This interdisciplinary project is theoretically informed by gerontology, psychology, healthcare science, gender and queer theory. Research results are intended to contribute empirically and theoretically to these fields. Results will be disseminated academically and in contexts where results can inform practice and policy with support from the advisory group. Furthermore, results are intended to form a basis for developing initiatives towards preventing mental health issues, isolation and involuntary loneliness among older LGBT+ people.