











































MANUSCRIPT TYPE


PATIENT-CENTERED CARE COMMENTARY 

 

11 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 1 – Issue 1 – June 2018 
 

Creating a LGBTQ+ Inclusive Culture in the Athletic Training 
Facility 
Sean M. Rogers, DAT, ATC

1
; Ashley K. Crossway, DAT, ATC

2
; Patricia A. Aronson, PhD, LAT, ATC3 

1California State University, Northridge, Northridge, CA; 
2
Nazareth College, Rochester, NY; 

3
Lynchburg College, 

Lynchburg, VA 
 

 
Key Phrases 
Emotional Wellness and Mental Health, Pre-
Participation Exams and Screening, Cultural 
Competency, Health Care Disparities 
 
Correspondence 
Dr. Sean Rogers, California State University, Northridge 
Department of Kinesiology, 18111 Nordhoff Street, 
Northridge, CA 91330-8287. 
E-mail: sean.rogers@csun.edu  
Twitter: @DATsearog 
 
Full Citation 
Rogers SM, Crossway AK, Aronson PA. Creating a LGBTQ+ 
inclusive culture in the athletic training facility. Clin Pract Athl 
Train. 2018;1(1):11-14. 
https://doi.org/10.31622/2018/0001.3 
 
Submitted: May 15, 2018 Accepted: May 25, 2018 
 
COMMENTARY 

Lesbian, gay, bisexual, transgender, and queer 
individuals often fall under the umbrella acronym 
LGBTQ+ and are represented as a community. 
However, each individual letter represents a 
distinct population with its own identity, 
challenges, and unique obstacles with regards to 
equity.1 In recent years, there has been significant 
advancements in civil rights legislation and overall 
social acceptance of the LGBTQ+ community. 
Hallmark legislative victories including the right to 
marriage2 and to openly serve in the Armed 
Forces3 have resulted in long overdue legal 
protections for the LGBTQ+ community. Despite 
these advances, LGBTQ+ individuals still 
disproportionately suffer from health disparities 
arising from stigmatization, oppression, and 
discrimination.4,5  One significant societal barrier 
still adversely affecting the healthcare of 
LGBTQ+ individuals is the lack of healthcare 
providers that are both knowledgeable and 
capable of delivering culturally competent and 
inclusive patient care.5 Creating an inclusive 
environment welcoming LGBTQ+ individuals in the 
clinical setting is vital to healthcare of those within 

the community. This paper serves to address 
inclusion of LGBTQ+ patients through patient- 
centered care in the athletic training facility. 
Current literature suggests that one of the most 
predominant health disparities among the 
LGBTQ+ community is dissatisfaction and 
avoidance of healthcare as a whole, which 
directly leads to suboptimal patient outcomes.5,6 
Recent trends in healthcare promote practitioners 
utilizing a patient- centered approach focusing on 
the identity of a patient, and how it relates to 
overall Health Related Quality of Life (HRQOL).7 

Adherence to this approach better serves and 
respects the identity of patient populations.7,8 The 
theoretical framework of contemporary 
disablement models, such as the Nagi Model, 
challenges clinicians to simultaneously address 
multiple aspects of health and wellbeing for 
overall improved patient outcomes.9 In order for 
healthcare practitioners to provide quality patient 
care, and achieve appropriate patient outcomes 
for individuals of many diverse backgrounds, 
cultures, and identities, it is imperative to use a 
patient-centered approach. 
 
The Importance of Identity and Patient- 
Centered Care 

Utilizing a patient-centered approach requires 
the clinician to consider the patient’s identity and 
how it contributes to the overall disability and 
societal implication of the injury or pathology.7,8 
The identity of LGBTQ+ patients, as with all 
patients, is multidimensional and includes the 
interests, goals, dreams, and desires derived from 
the intricacies of patients’ past experiences. 
Utilization of a disablement model in conjunction 
with an understanding of a patient identity helps 
the practitioner create targeted interventions to 
best address the etiology of the injury or illness 
being treated. This practice in healthcare is what is 
known as patient- centered care. Patient-centered 
care is an approach to healthcare that focuses on 
the unique qualities of each individual patient.7,8 

mailto:sean.rogers@csun.edu
https://doi.org/10.31622/2018/0001.3


Creating a LGBTQ+ Inclusive Culture in the Athletic Training Facility 
 

 

12 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 1 – Issue 1 – June 2018 

This approach to healthcare is driven by active 
patient participation and less by clinician-
dominated dialogues.7,8 The patient-centered 
approach creates a clinician-patient relationship 
that is rooted in trust, empathy, understanding, 
and collaboration with respect to the patient’s 
identity.7,8 In practice, a patient-centered 
approach to healthcare has been found to 
increase efficiency of care, improve patient 
outcomes, increase HRQOL, reduce patient 
discomfort, and more adequately address patient 
concerns regarding healthcare.8,10 

 
Healthcare Disparities of LGBTQ+ Individuals 

Specific to the LGBTQ+ community, patient-
centered care can mean the difference between 
an individual feeling comfortable enough to seek 
care and avoiding healthcare all together. A 
recent study published in the, Journal of 
Homosexuality, found that 37% of LGBTQ+ 
young adults do not disclose their identity to 
healthcare providers due to concerns over 
potential discrimination, internalized stigmas, fear 
of rejection, or a belief that health and LGBTQ+ 
identity are not related.6 Apprehension towards 
seeking healthcare either in part by not feeling 
comfortable disclosing personal information, or in 
full by complete avoidance of seeking healthcare 
can be detrimental to the HRQOL of LGBTQ+ 
individuals. 

Apprehension of LGBTQ+ individuals in seeking 
healthcare can be especially problematic for 
athletic trainers (ATs) particularly those practicing 
in traditional sports-focused settings at the 
professional, collegiate, or secondary school 
levels. While organizations such as the National 
Collegiate Athletic Association (NCAA) have 
made a concerted effort to create a more 
inclusive environment in sports, ideologies 
supporting homonegativity are still prevalent in all 
competitive levels of sport subculture in western 
society.11 Athletic trainers, especially in the 
aforementioned settings, are often the point of 
care for a disproportionately large number of 
patients. Given the close proximity with athletics, 
an ideology of homonegativity can either 
intentionally or unintentionally permeate into the 
clinic climate. 

Consciously or unconsciously supporting and 
reinforcing a homonegative ideology in an 

athletic training facility can substantiate lingering 
societal stigmas of LGBTQ+ individuals.9 Such an 
environment can prevent LGBTQ+ patients from 
seeking care from an AT, or disclosing pertinent 
information to the AT. Through being an active 
champion and advocate in identifying and 
addressing blatant bias and discrimination in 
athletic training facilities, ATs can focus on more 
patient-centered and equitable practice. 
 
Creating an Inclusive Facility Environment 

In order for a shift towards more equitable 
patient care to occur ATs must first take inventory 
of their own clinical practice, implicit biases, and 
communication styles in addition to the clinical 
setting in which they practice. One of the most 
difficult and perhaps tedious aspects of affecting 
change is awareness of not only systemic faults, 
but also personal weaknesses and areas of 
improvement. On an individual level, ATs must 
recognize their own verbal and non-verbal 
reactions when interacting with patients of diverse 
backgrounds. Inappropriate or incorrect 
language, body positioning, facial expression, or 
mannerisms, whether intentional or unintentional 
can cause the practitioner to appear as closed off 
or unwelcoming.12,13 These verbal and non-verbal 
cues, when intentionally exhibited towards 
underserved populations such as the LGBTQ+ 
community, are an example of demeaning micro 
aggressions.12,13 Adjustments to personal practice 
should be reinforced through the creation of 
facility or institution-wide policies that ensure 
discriminatory language, micro aggressions, and 
inappropriate behavior are addressed.12 

 
In addition to an analysis of personal practice and 
athletic training facility policies, specific attention 
should be given to maintaining an inclusive clinic 
environment. In order to create a welcoming 
inclusive environment for LGBTQ+ individuals an 
athletic training facility can present visible 
representation supporting equality such as safe 
space ally stickers and posts of non-discrimination 
policies, and provide access to gender neutral 
restrooms as well as brochures or information 
addressing health concerns specific to the 
LGBTQ+ population.12,13 This development of an 
inclusive facility culture is especially pertinent for 
ATs, given the close relationship and proximity 
between practitioner and patient in the multiple 



Creating a LGBTQ+ Inclusive Culture in the Athletic Training Facility 
 

 

13 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 1 – Issue 1 – June 2018 

different settings ATs practice. As such, it is 
important to create an inclusive facility culture 
before the first LGBTQ+ patient seeks care. 

Creating and maintaining an equitable and 
culturally competent practice in athletic training is 
a difficult endeavor for any practitioner. In order 
to facilitate this development of a model practice, 
there are many training programs such as Safe 
Space and Ally training that provide sensitivity 
training to become cognizant of LGBTQ+ 
concerns, while simultaneously learning how to 
identify and address internal bias.5,12,13 These 
types of instructional trainings are an excellent 
way to bridge individual practitioner 
development, while at the same time addressing 
clinic or institutional areas of cultural 
weakness.12,13 

In addition to the aforementioned changes, 
another impactful adjustment that can be made to 
improve a facility’s culture is the creation and 
utilization of inclusive documentation forms. While 
documentation forms, such as a pre-participation 
exam, are important for an athletic training 
facility to gather legal names and biological sex, 
it is equally important that the patient have the 
opportunity to self-report demographic 
information such as preferred name, gender, and 
gender identity. The most effective way to gather 
this information from the patient without being 
insensitive is by simply asking open-ended 
questions.13 This technique allows the patient to 
respond in whatever manner is appropriate, while 
also conveying that the practitioner respects the 
identity of the patient. Furthermore, utilizing an 
open-ended questioning technique allows the 
practitioner to collect pertinent demographic 
information, such as relationship status and 
appropriate pronouns, which are important when 
considering the HRQOL of LGBTQ+ patients and 
can be utilized in future patient interactions.7,12,13 

An inclusive approach to patient interaction and 
documentation sets an important precedence that 
any patient, regardless of his-her-zir identity, is 
welcomed and will be treated with the upmost 
respect and fairness. Special attention, however, 
must be placed on avoiding ambivalent or neutral 
attitudes towards practicing in an equitable 
manner in order to maintain an inclusive athletic 
training facility environment. While not being an 

active participant in creating an equitable 
practice might seem innocuous, inaction in 
addressing areas of weakness related to equity 
can be just as harmful to LGBTQ+ individuals as 
outright discrimination. 

Conclusion 

Major societal advancements in recent years have 
provided recognition and legal protections for 
LGBTQ+ individuals. These advancements, 
coupled with more exposure and access to 
competitive sports, have created a prominent 
need for ATs in all settings to ensure their practice 
is welcoming, inclusive, and culturally competent. 
Through the process of intentional reflection and 
analysis of athletic training facility culture, 
coupled with tangible changes, ATs can create an 
environment in which all patients, regardless of 
their identity, can feel comfortable seeking care. 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 1 – Issue 1 – June 2018 

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