Building health promotion capacity for sexual and gender-diverse women: insights from staff at community-based organizations in Canada

Sexual and/or gender-diverse women in Canada experience considerable barriers to accessing culturally-competent, affirming healthcare, leading to adverse health outcomes. Community-based organizations play a critical role in delivering health promotion services tailored to diverse women’s needs. This study aimed to explore the requirements for developing and supporting health promotion capacity among community agencies serving sexual and/or gender-diverse women. We conducted a qualitative study using virtual semi-structured interviews with ten community-based staff members from six Canadian provinces. Participants were purposively recruited through 2SLGBTQ+ networks, social media, and community outreach. Data was collected between August and October 2024 through Zoom interviews, which were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis. The research team used NVivo 15 to support systematic coding and developed themes through an iterative, consensus-driven process. Interviews with 10 participants included 5 healthcare promoters, 2 executive directors, 1 therapist, 1 nurse practitioner and 1 program coordinator at various career stages. We identified three overarching themes: (1) participant experiences delivering care, (2) barriers and challenges to providing health promotion services, and (3) strategies to improve care. Participants emphasized the importance of delivering essential health services, including gender-affirming care, mental health, and sexual and reproductive health education, all within culturally and linguistically appropriate frameworks. Leadership development, inter-agency partnerships, and addressing social determinants of health were also cited as crucial components of service delivery. Major barriers included inadequate and unstable funding, shortages of trained providers, lack of formal integration with the broader healthcare system, information gaps, language barriers, healthcare waitlists, and persistent discrimination. Participants recommended enhancing resources, staffing, education and training, advocacy efforts, research engagement, and inclusive policy development to support organizational capacity. This research identified key factors that may strengthen the health promotion capacity of community-based agencies serving sexual and/or gender-diverse women including sustainable funding, workforce development, education, and research infrastructure. Future research should examine their broader applicability and effectiveness across diverse contexts through prioritizing structural change, intersectional approaches, and community-led solutions.