Appendix 1. Search strategy and method

The strategy for the literature search for this research overview is based on the approach for systematic reviews. The aim of a systematic overview is to give an account of all the collected research on a specific research question. This method involves reporting in detail how the search and selection of literature has been conducted to ensure reproducibility and transparency, and to reduce bias during the process.

The search strategy was developed in consultation with the authors/researchers Anna Siverskog and Janne Bromseth, and librarians Elina Nybergh and Louise Preinitz Gärdinge. The librarians are responsible for the searches and referencing. The authors of the report are responsible for drawing up the selection criteria and for the selection. The searches were conducted in both international article databases and national search services covering the Nordic countries. All the references from the database searches were reviewed independently at the title and abstract level by the two researchers. The searches were mainly documented out by the librarians.

In addition to the database searches, the literature search was supplemented by searches for grey material – documents produced outside the academic sphere – to investigate what knowledge exists among practitioners, public authorities and other relevant actors for the topic. The results from the grey material searches were divided up between the authors of the report and were assessed in full-text directly. The reviews and selection of Finnish and Icelandic-language publications was carried out by external reviewers.

Since the two research questions differed in part, it was decided that two different searches should be carried out for the overview. Search query 1 aimed to find literature on the living conditions of older LGBTI people in the Nordic countries. Search query 2 aimed to find literature on the competence of healthcare and social care staff in their interactions with LGBTI people, or knowledge about the situation of LGBTI people in healthcare and social care study programmes, in the Nordic region.

Four key terms were developed for the searches:

Each term was expanded with synonyms and related terms with the support of subject matter experts and reviews of already known relevant literature, along with the databases’ thesauruses where available, and other controlled vocabularies in the subject area. Thesauruses and controlled vocabularies are lists of subject words with descriptions and hierarchical classification of terms. The references in a database that has a thesaurus are assigned subject words based on their content, which facilitates re-finding the literature. A search block was formed using the Boolean operator OR for all the words within a term. The blocks were combined into a search string using the Boolean operator AND. For search query 1, terms 1 + 2 + 3 were used, and for search query 2, terms 2 + 3 + 4 were used. The search string for query 1 in English in the PubMed database was:

((aged[TIAB] OR aged[MESH] OR Ageing[TIAB] OR ageis*[TIAB] OR aging[TIAB] OR elder*[TIAB] OR frail elderly[MESH] OR frail elder*[TIAB] OR geriatric*[TIAB] OR geriatrics[MESH] OR gerontol*[TIAB] OR "later life"[TIAB] OR older[TIAB] OR pension[TIAB] OR retiree*[TIAB] OR retired[TIAB] OR retirement[TIAB] OR senior*[TIAB]) AND (Denmark*[TIAB] OR danish[TIAB] OR Faroe Islands[TIAB] OR Faroese[TIAB] OR finnish[TIAB] OR Finland*[TIAB] OR Greenland*[TIAB] OR Iceland*[TIAB] OR nordic[TIAB] OR Norway*[TIAB] OR norwegian*[TIAB] OR scandinavia*[TIAB] OR "Scandinavian and Nordic Countries"[Mesh] OR Sweden[TIAB] OR swedes[TIAB] OR swedish[TIAB] OR Åland[TIAB])) AND (Bisexual*[TIAB] OR bisexuality[Mesh] OR butch[TIAB] OR crossgender[TIAB] OR femme*[TIAB] OR gay[TIAB] OR gays[TIAB] OR "gender change"[TIAB] OR "gender dysphoria"[TIAB] OR gender dysphoria[Mesh] OR "gender expression"[TIAB] OR "gender identit*"[TIAB] OR gender identity[Mesh] OR "gender minorit*"[TIAB] OR "gender nonbinary"[TIAB] OR "gender nonconfirming"[TIAB] OR "gender transformation"[TIAB] OR "gender transition"[TIAB] OR genderqueer*[TIAB] OR GLB[TIAB] OR GLBQ[TIAB] OR GLBT[TIAB] OR GLBTI[TIAB] OR GLBTQ[TIAB] OR GLBTQI[TIAB] OR GQNB[TIAB] OR heteronorm*[TIAB] OR heterosexis*[TIAB] OR homonegativ*[TIAB] OR homophob*[TIAB] OR homosexual*[TIAB] OR homosexuality, female[Mesh] OR homosexuality, male[Mesh] OR intergender*[TIAB] OR intersex*[TIAB] OR intersex persons[Mesh]OR lesbian*[TIAB] OR lesbigay*[TIAB] OR LGB[TIAB] OR LGBQ[TIAB] OR LGBT[TIAB] OR LGBTI[TIAB] OR LGBTQ[TIAB] OR LGBTQI[TIAB] OR "men loving men" [TIAB] OR MSM[TIAB] OR "men who have sex with men" [TIAB] OR "nonbinary gender" [TIAB] OR "non-heterosexual*"[TIAB] OR pansexual*[TIAB] OR Queer*[TIAB] OR "same sex couples*"[TIAB] OR "same sex relation*"[TIAB] OR sexual and gender minorities[Mesh] OR "sexual minorities" [TIAB] OR "sexual orientation" [TIAB] OR SOGI[TIAB] OR Transgender*[TIAB] OR transgender persons[Mesh] OR transnegativ*[TIAB] OR transphob*[TIAB] OR transsexual*[TIAB] OR transsexualism[Mesh] OR transvesti*[TIAB] OR "trans female*"[TIAB] OR "trans male*"[TIAB] OR "trans man" [TIAB] OR "trans men*" [TIAB] OR "trans woman" [TIAB] OR "trans women*" [TIAB] OR "trans people*"[TIAB] OR "trans person*"[TIAB] OR "women loving women"[TIAB] OR "women who have sex with women"[TIAB]) Filters: from 2012 – 2022

And for search query 2 in English in the PubMed database, the search string was:

(("Academic Medical Center"[Title/Abstract] OR "Academic Medical Centers"[Title/Abstract] OR "Academic Medical Centers"[MeSH Terms] OR "community health service*"[Title/Abstract] OR "community health services"[MeSH Terms] OR "Health Service"[Title/Abstract] OR "Health Services"[Title/Abstract] OR "Health Services"[MeSH Terms] OR "Health services for the aged"[MeSH Terms] OR "Health services for the aged"[Title/Abstract] OR "Homes for the aged"[MeSH Terms] OR "Homes for the aged"[Title/Abstract] OR "Housing for the elderly"[MeSH Terms] OR "Housing for the elderly"[Title/Abstract] OR "hospital"[Title/Abstract] OR "Hospitals"[Title/Abstract] OR "Hospitals"[MeSH Terms] OR "Hospital unit"[Title/Abstract] OR "Hospital units"[Title/Abstract] OR "Hospital units"[MeSH Terms] OR "Nursery"[Title/Abstract] OR "Nurseries"[Title/Abstract] OR "nurseries, infant"[MeSH Terms] OR "Primary care"[Title/Abstract] OR "Primary Health care"[Title/Abstract] OR "Primary Health care"[MeSH Terms] OR "Primary Healthcare"[Title/Abstract] OR "Residential Facilities"[Title/Abstract] OR "Residential Facilities"[MeSH Terms] OR "Residential Facility"[Title/Abstract] OR "University Medical Center"[Title/Abstract] OR "University Medical Centers"[Title/Abstract] OR "caregiver*"[Title/Abstract] OR "caregivers"[MeSH Terms] OR "care worker*"[Title/Abstract] OR "curator"[Title/Abstract] OR "Geriatric nursing"[Title/Abstract] OR "Geriatric nursing"[MeSH Terms] OR "HCS"[Title/Abstract] OR "health and social care professional*"[Title/Abstract] OR "health care professional*"[Title/Abstract] OR "health personnel"[Title/Abstract] OR "health personnel"[MeSH Terms] OR "health care provider*"[Title/Abstract] OR "healthcare worker*"[Title/Abstract] OR "medical staff"[Title/Abstract] OR "medical staff"[MeSH Terms] OR "nurse*"[Title/Abstract] OR "nursing staff"[Title/Abstract] OR "nursing staff"[MeSH Terms] OR "paraprofessional personnel"[Title/Abstract] OR "physician*"[Title/Abstract] OR "physicians"[MeSH Terms] OR "psychologist"[Title/Abstract] OR "psychiatrist"[Title/Abstract]) AND ("bisexual*"[Title/Abstract] OR "bisexuality"[MeSH Terms] OR "butch"[Title/Abstract] OR "crossgender"[Title/Abstract] OR "femme*"[Title/Abstract] OR "gay"[Title/Abstract] OR "gays"[Title/Abstract] OR "gender change"[Title/Abstract] OR "gender dysphoria"[Title/Abstract] OR "gender dysphoria"[MeSH Terms] OR "gender identit*"[Title/Abstract] OR "gender identity"[MeSH Terms] OR "gender minorit*"[Title/Abstract] OR "gender nonbinary"[Title/Abstract] OR "gender nonconforming"[Title/Abstract] OR "gender transformation"[Title/Abstract] OR "gender transition"[Title/Abstract] OR "genderqueer*"[Title/Abstract] OR "GLB"[Title/Abstract] OR "GLBQ"[Title/Abstract] OR "GLBT"[Title/Abstract] OR "GLBTI"[Title/Abstract] OR "GLBTQ"[Title/Abstract] OR "GQNB"[Title/Abstract] OR "heteronorm*"[Title/Abstract] OR "homonegativ*"[Title/Abstract] OR "homophob*"[Title/Abstract] OR "homosexual*"[Title/Abstract] OR "homosexuality, female"[MeSH Terms] OR "homosexuality, male"[MeSH Terms] OR "intergender*"[Title/Abstract] OR "intersex*"[Title/Abstract] OR "intersex persons"[MeSH Terms] OR "lesbian*"[Title/Abstract] OR "lesbigay*"[Title/Abstract] OR "LGB"[Title/Abstract] OR "LGBQ"[Title/Abstract] OR "LGBT"[Title/Abstract] OR "LGBTI"[Title/Abstract] OR "LGBTQ"[Title/Abstract] OR "LGBTQI"[Title/Abstract] OR "MSM"[Title/Abstract] OR "men who have sex with men"[Title/Abstract] OR "nonbinary gender"[Title/Abstract] OR "non heterosexual*"[Title/Abstract] OR "pansexual*"[Title/Abstract] OR "queer*"[Title/Abstract] OR "same sex couples*"[Title/Abstract] OR "same sex relation*"[Title/Abstract] OR "sexual and gender minorities"[MeSH Terms] OR "sexual minorities"[Title/Abstract] OR "sexual orientation"[Title/Abstract] OR "SOGI"[Title/Abstract] OR "transgender*"[Title/Abstract] OR "transgender persons"[MeSH Terms] OR "transnegativ*"[Title/Abstract] OR "transphob*"[Title/Abstract] OR "transsexual*"[Title/Abstract] OR "transsexualism"[MeSH Terms] OR "transvesti*"[Title/Abstract] OR "trans female*"[Title/Abstract] OR "trans male*"[Title/Abstract] OR "trans man"[Title/Abstract] OR "trans men"[Title/Abstract] OR "trans woman"[Title/Abstract] OR "trans women"[Title/Abstract] OR "trans people*"[Title/Abstract] OR "trans person*"[Title/Abstract] OR "women loving women"[Title/Abstract] OR "women who have sex with women"[Title/Abstract]) AND ("denmark*"[Title/Abstract] OR "danish"[Title/Abstract] OR "faroe islands"[Title/Abstract] OR "Faroese"[Title/Abstract] OR "finnish"[Title/Abstract] OR "finland*"[Title/Abstract] OR "greenland*"[Title/Abstract] OR "iceland*"[Title/Abstract] OR "nordic"[Title/Abstract] OR "norway*"[Title/Abstract] OR "norwegian*"[Title/Abstract] OR "scandinavia*"[Title/Abstract] OR "Scandinavian and Nordic Countries"[MeSH Terms] OR "Sweden"[Title/Abstract] OR "swedes"[Title/Abstract] OR "swedish"[Title/Abstract] OR "Aland"[Title/Abstract])) AND (2012:2022[pdat])

For PubMed and PsycINFO which have thesauruses, the free text words in the search string were supplemented with the relevant subject words. The search words we have selected do not reflect the most contemporary use of language in the subject areas, especially given that these are fields where terms are under rapid development. Terms for the searches for both the older and LGBTI people can be perceived as outdated and even derogatory. We used the vocabulary that gave us the best prospects of capturing relevant literature, where we needed to relate to a ten-year-old vocabulary, vocabulary used in fields other than gender research and research about older people, and vocabulary used in databases where there is a certain lag in introducing new concepts or replacing old ones.

The searches were limited to include scholarly articles published from 2012 onwards because the research question aimed to compile a current knowledge base. Based on the nature of the topic, four international article databases were selected for the search: Gender Studies Database (GSD), PsycINFO, PubMed and Scopus.

Given the geographical limitation for the topic, searches were also carried out in databases from each of the Nordic countries. The selected databases were Det Kgl. Bibliotek (DK), Finna (FI), Opin Visindi (IS), Oria (NO) and SwePub (SWE). In these searches, the search block for the Nordic countries was not used. Material other than scholarly articles was also searched for, such as dissertations and chapters in anthologies. The searches were conducted in each Nordic language and in some cases together with English (see table below)

The searches were carried out in two stages and were delivered to the researchers in the screening program Rayyan. The total of 1671 references were reviewed by the two authors in blind mode, which means that the researchers could not see the other person’s decisions but made decisions on each reference independently. This was to avoid being influenced by the other researcher’s decision, and to base the selection on the selection criteria, thereby ensuring the scholarly quality of the report. After the references where the researchers made different assessments were discussed and decided on jointly, the following remained for question 1: 99 references (75 from Nordic databases + 24 from the second search), and for question 2: 126 references (106 from the Nordic databases and 20 from the second search), the full texts of which were then read. Since the research field is relatively small, the ‘benefit of the doubt’ principle was applied at this stage so as not to miss anything of relevance. The articles were selected based on the following inclusion and exclusion criteria:

After the full text reading, further references were excluded. The reasons were for example that the reference was a conference abstract, that data was presented in in such a way that age was not reported with sexuality/gender identity, and where it was therefore not possible to deduce anything about the group in question.  The number of articles included after full text reading for search query 1 was 25, and for search query 2, it was 19. The review of the hits from the searches in Icelandic and Finnish did not result in the inclusion of any publications.

Grey material
In order to supplement the gaps in the research and look for knowledge on the topic in literature beyond academic production, searches for grey material were also conducted. Reports and other publications published by actors with knowledge of the issue were of particular interest were, and to find this material, customised search engines were used in Google. This tool permits listings of websites where one can then search documents only on the selected websites. The search prefix filetype:pdf was used to only find publications in PDF format and exclude HTML sources. Together with the project’s reference group, the authors identified relevant actors for all the Nordic countries, and also decided on which search words to use. The focus on these actors followed the initially identified focus of the search strategy, where search query 1 aimed to find literature on older LGBTI people’s living conditions in the Nordic region. Search query 2 aimed to find literature on the competence of healthcare and social care professionals in their interactions with LGBTI people, or knowledge about the situation of LGBTI people in healthcare and social care study programmes, in the Nordic region. For each Nordic country, two search engines were created, one for search query 1 and one for search query 2.

It is difficult to export the combined search results because the PDF files lack meta data, which in turn is due to lack of bibliographic records. Therefore, the first screening was used to select publications at full-text level. For each search, the first 50 hits were reviewed and the same selection criteria as for the database searches were applied. External reviewers were engaged for searches and selection in Icelandic and Finnish. In total, the searches for grey material for question 1 resulted in a further eight publications, three of which were from Denmark, two from Sweden, one from Norway, one from Finland, and one from Åland. For question 2, it resulted in five more publications, three of which were from Sweden and two from Norway.

Through recommendations from the reference group, contacts and previously known publications, another 5 publications were included for Part 1 and 14 for Part 2. Finally, citation searches were conducted on a selection of publications in the Scopus and Google Scholar databases, and this search added two more articles for assessment.

A total of 38 + 37 publications formed the basis for the research overview.