Part 2 Knowledge inventory of healthcare, social care and social sciences study programmes and professions
The purpose of the knowledge inventory in Part 2 is to look at what knowledge and skills concerning LGBTI people’s living conditions and gender and sexuality norms are found in healthcare and social sciences study programmes, and among active professionals in healthcare and social care in the Nordic countries.
The knowledge inventory is based primarily on relevant research from the literature searches conducted for this study, as well as relevant reports and other grey material from supplementary searches. The analysis has been supplemented with contextualising material: policy documents that regulate national intended learning outcomes for relevant professional study programmes at university level, as well as interviews and e-mail interviews with university employees and continuing professional development (CPD) providers. CPD courses are the channel through which many professionals without formal education gain knowledge, for example in the home help service and elderly care.
Norms and knowledge perspectives in healthcare and social sciences study programmes in the Nordic countries
There is relatively little research on what knowledge and knowledge perspectives concerning gender, sexuality, LGBTI people’s living conditions and ageing are available in different study programmes in the Nordic countries. The amount of research also varies greatly between the Nordic countries and the Faroe Islands, Greenland and the Aaland Islands. The biggest lack is in studies that specifically investigate the elderly and ageing, and the studies included here therefore focus mainly on gender and sexuality perspectives.
Despite the fact that there are few studies of how knowledge about gender, sexuality and LGBTI people’s living conditions has been implemented in professional study programmes, there is a clear pattern in the material, regardless of the profession or country concerned: Whether students acquire such knowledge in their study programmes varies greatly and is often dependent on individuals. This is despite the introduction of new common guidelines for healthcare and social sciences study programmes with the aim of ensuring learning exchanges linked to equality in healthcare and social care services, and gender identity, gender expression and sexual orientation, for example.
Teaching materials in Scandinavian languages about sexuality are also important for this area to be included in the teaching according to many of the interviewed teachers. If you search for key publications concerning older LGBTI people’s living conditions, you find that they are included as course literature for some professional study programmes, which indicates a positive development.
Professional practitioners’ experiences in encounters with patients and users
In general, a majority of the studies show that professional practitioners are positive to LGBTI people being treated equally and with respect, and that knowledge is key to making this possible. On the other hand, there are large knowledge gaps in the field, where heteronormative thinking dominates, along with an equality rhetoric where everyone should be ‘treated equally’ with reference to the legislation and guidelines governing the specific service.
Healthcare and social care services are regulated by various laws, central government directives and municipal guidelines, in addition to professional practice guidelines for different professions. In general, today´s welfare policy discourses tend to emphasise that social services should facilitate greater user participation, empowerment and a focus on individual needs. Healthcare and social care services are dominated by person-centred care as a philosophical framework, where an empathetic perspective is to form the basis for meeting the patient’s basic psychological needs in the care of the person. There also seems to be a trend towards gender identity, gender expression and sexual orientation being included more and more often in government agencies’ policy documents that concern equal access to good health and equal healthcare, and in strategies for older people in certain Nordic countries.
All the included studies of professionals in healthcare, social care and social sciences professions highlight a significant lack of knowledge regarding gender, sexuality and LGBTI perspectives. These perspectives have been absent in their study programmes, particularly in compulsory courses. This leads to uncertainty when it comes to raising questions about sexuality and gender identity on one’s own initiative.
CPD for healthcare, social care and social sciences professions
Higher education institutions offer some CPD courses and elective courses for professionals working in healthcare, social care and social sciences occupations that include knowledge about gender, sexuality and LGBTI perspectives. These focus in particular on occupational groups that encounter children and young people. CPD initiatives are also important because many in the elderly care sector do not have higher education, or received their education some time ago, or did not acquire LGBTI perspectives from their study programmes.
CPD is currently provided primarily by civil society organisations, in particular LGBTI organisations and other organisations working with issues related to sexual and reproductive health rights (SRHR). In Sweden and Norway, the national LGBTI organisations have their own education units, and courses are offered in all the Nordic countries and in the Aaland Islands to a greater or lesser extent. These education activities are mainly financed by state and municipal funding in most of these countries, while the Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex Rights (RFSL) offers courses as a limited company, where LGBTI certification comprises a considerable part of its contract education, largely for public sector activities. However, there is no qualitative knowledge base concerning how CPD initiatives actually impact healthcare activities.
Demand for courses and certifications has increased over the past five years according to the trainers interviewed for this study. This is a result of stricter anti-discrimination laws as well as explicit policy to increase competence in this area, and that the knowledge provided in professional study programmes is inadequate. This leads to a significant disconnect between requirements to work to prevent discrimination and being able to do so in practice. Civil society organisations that provide courses with central government or municipal funding talk about the pressures in this context, both in terms of the amount of funding provided and the possibility of continuity.
A positive trend is that LGBTI perspectives appear to be more often integrated into CPD courses or existing knowledge resources for healthcare and social care professionals who encounter the elderly. However, despite positive developments in integrating knowledge of LGBTI perspectives, gender and sexuality into central government and municipal resources for healthcare and social care staff, it is inadequate in relation to the knowledge needed by those working in these fields.