Support relationships and service systems for LGBTQ+ people with intellectual disability: Implications for health education and promotion

Objective: To examine how LGBTQ+ people with intellectual or developmental disability experience support relationships across disability, LGBTQ+ community and mainstream service settings, and consider the implications for settings-based health education and promotion. Design: Participatory action research project incorporating researcher-led qualitative analysis. Setting: Disability, LGBTQ+ community and mainstream service contexts in Australia. Methods: Eleven co-design meetings involved 23 LGBTQ+ people with intellectual or developmental disability and 24 subject-matter experts. Discussions addressed participants’ experiences of support and services and informed a dual-read supported decision-making guide. Transcribed discussions were analysed using interpretive within-case and cross-case comparison. Results: Four themes concerned accumulated experiences of discrimination; conditional safety across settings; trust and affirmation within professional support relationships; and organisational authority, accountability and recourse. Participants actively assessed supporters’ trustworthiness and challenged, withdrew from, or worked around disaffirming support. Access to affirming support frequently depended on particular workers, while organisational arrangements affected participants’ capacity to obtain information, exercise autonomy and contest mistreatment. Conclusion: Although health-education engagement was not examined directly, the findings identify relational and organisational conditions likely to shape whether the settings through which health education is delivered are experienced as credible and safe. Settings-based interventions should combine accessible content with identity-affirming support, clear practice expectations and accessible mechanisms for recourse.