Date of Award

January 2022

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)


Yale University School of Nursing

First Advisor

LaRon E. Nelson

Second Advisor

Joanne D. Iennaco


The LGBTQIA+ community has long faced disparities in healthcare which have had significant consequences including increased cancer risk factors and poorer health outcomes when compared to the cisgender, heterosexual community. Interventions are needed to increase the knowledge and cultural competency of providers, to create welcoming and safe spaces for LGBTQIA+ patients, and to encourage disclosure of sexual orientation and gender identity (SOGI).

The purpose of this DNP project was to adapt, implement, and evaluate an evidence-based model for creating an affirming, inclusive, culturally competent, and safe primary care environment for LGBTQIA+ patients within a family practice center. This quality improvement project involved care protocol adjustments including modifications to clinic physical/digital infrastructure, revised intake procedures and documentation, and provider/staff trainings. Evaluation included pre-implementation chart review, staff self-efficacy and implementation outcome surveys, and post-intervention demographic assessment of intake forms. Analysis included paired t-tests for comparison of survey responses, and descriptive statistics and chi square analysis for patient intake form responses.

Results suggest that a majority of staff were supportive of the interventions, and overall showed improved self-efficacy. A majority of patients engaged well with the new intake protocol, willingly disclosing SOGI information and providing valuable information not previously known or documented.

By adapting a multimodal model for implementation in a family practice setting, this project offers a roadmap for any practice to create a welcoming and safe healthcare environment for LGBTQIA+ patients. Through consistent, positive, and affirming engagement with this population, these healthcare disparities can be addressed in concrete and meaningful ways.


This is an Open Access Thesis.

Open Access

This Article is Open Access