Barriers to Comprehensive Sexual and Reproductive Care for LGBTQ+ Individuals in Primary Healthcare: A Mixed-Methods Study Protocol

Background/Objectives: Members of the LGBTQ+ community often have poorer health outcomes and less access to health services than cisgender and heterosexual populations, and many healthcare professionals remain insufficiently aware of the barriers faced by these patients. Community nurses, given their skills and competencies, can help patients overcome barriers and achieve greater inclusion. The aim of this project is to identify the barriers and facilitators detected by the primary care nursing team of the Málaga-Valle del Guadalhorce Health District (MVGHD) when providing holistic care to LGBTQ+ individuals. Methods: A sequential explanatory mixed-methods design (DEXPLIS) will be employed to robustly combine a quantitative baseline of professional attitudes with an in-depth qualitative exploration of institutional discourses. Phase I consists of a pilot cross-sectional study with cluster allocation of questionnaire versions in which primary healthcare nursing staff in the MVGHD will complete the validated Sexuality Attitudes and Beliefs Survey (SABS) with one group completing a version framed around LGBTQ+ patients and the other around the general population. Phase II consists of a qualitative descriptive study based on discourse analysis (DA) using in-depth semi-structured interviews, analyzed with ATLAS.ti 23. Conclusions: This study protocol is expected to provide an empirical framework to identify potential institutional barriers and attitudinal biases in nursing care, highlighting the potential need for targeted training programmes in sexual and reproductive health. The resulting protocol aims to contribute to health equity by offering practical resources to optimize ongoing clinical education in primary care settings.