1. Background: No reliable data on how many older lesbian gay, bisexual and trans (LGBT) people are in the UK. Likely to be social, demographic and lifestyle factors that would impact on health, but evidence is not robust. Little data is collected on their specific experiences of health and social care services. May be a reporting bias in data that is available. Universal health services tend to assume all older people have similar needs Virtually no info on older trans people ? But older LGBT service users say…. Heterosexist assumptions History of discrimination and exclusion (homosexuality was listed as a psychiatric disorder until 1992, gender diversity still is) Unsure if it’s OK to talk about family or social life in health settings Low confidence in statutory services Limited data or provider awareness regarding needs Treated as a “risk group”. Worries about care settings Michael Toze. School of Health and Social Care Older LGBT people and efficacy in primary care Research questions What do older LGBT people want from primary care services? Do older LGBT people feel that they can be effective in health settings? How and why do people construct a narrative of themselves as effective (or not effective)? Does the sense of being a part of a community have an impact? Why tell the story of the self as effective/not effective? What about people who find other ways to meet their goals Does “I can’t do that” sometimes mean “I don’t agree with you”? Benefits to older LGBT communities Adding to research literature on a largely overlooked group. Starting by asking what is wanted from health services. Open to considering that what is wanted and how it is pursued may not meet health services expectations Specifically looking to capture complexity, diversity and ambiguity Understanding why people think they cannot act may suggest ways to improve Research can be used to evidence community needs Efficacy as a narrative. Self-efficacy refers to an individual’s confidence in ability to act (Bandura, 1977). It is often applied to health, in contexts such as lifestyle change, self-management of chronic illness and recovery. But standardised approaches to measurement (typically scale based) assume everyone faces the same challenges and in the same way.. It also assumes that talking about overcoming obstacles to achieve a goal is objective fact, rather than a particular cultural convention for explaining events. Collective efficacy has been studied but not given much prominence in health. However, it may be especially relevant to LGBT people (for example, some see being “out” in primary care as a political or community action). Challenges Impossible to have a representative sample – no-one even knows what one would look like Traditionally difficult population to recruit Consider diversity within the LGBT population – tendency for samples not to represent Some members of the population may find talking about their experiences distressing, or feel it would put them at risk. Multiple intersecting issues of gender, sexuality, age, ethnicity, disability religion, class and more… Overcoming challenges Having a clear case as to why research is beneficial Use existing networks (snowball sampling) Purposive sampling to find diverse voices Taking responsibility (strong ethics) Balancing interpretation and participant voice Narrative techniques focus on diversity of stories, and themes within them, not statistical representation Want to know more about older LGBT people and health? Cronin, A. N. N. and A. King (2012). "Only connect? Older lesbian, gay and bisexual (LGB) adults and social capital." Ageing and Society 34(02): 258-279. Heaphy, B., A. K. T. Yip and D. Thompson (2004). "Ageing in a non-heterosexual context." Ageing and Society 24(6): 881-902. McNeil, J., L. Bailey, S. Ellis, K. Morton and M. Regan (2012). “Trans Mental Health Study, 2012.” Edinburgh, Scottish Transgender Alliance River, L. (2011). “Appropriate Treatment Older lesbian, gay and bisexual people’s experience of general practice.” London, Polari/Age of Diversity. Williams, H., J. Varney, J. Taylor, J. Fish, P. Durr and C. Elan-Cane (2013). The Lesbian, Gay, Bisexual and Trans Public Health Outcomes Framework Companion Document, Department of Health.