LGBTIQ+ persons’ perception of cultural competence and cultural sensitivity in Maltese in-patient care

Abstract

Background: Malta has advanced LGBTIQ+ rights through progressive legislation, yet inclusive healthcare is not assured. Evidence shows that LGBTIQ+ patients still face stigma, discrimination, and reduced access in hospital settings. Nurses play a crucial role in shaping these experiences, but limited cultural competence and inadequate training can compromise trust and care quality. Objectives: The study explores how LGBTIQ+ individuals experience hospitalisation in Malta. It aims to explore the perceived extent to which (i) nursing care is culturally sensitive; (ii) the structural environment of the health care premises promotes cultural inclusivity; (iii) the local healthcare systems and policies are culturally competent. It also aims to (iv) identify facilitators and barriers to culturally competent care in relation to the local LGBTIQ+ community needs. Methodology: A phenomenological exploratory design employed semi-structured interviews to capture the lived experiences of ten LGBTIQ+ persons hospitalised in Malta, recruited through an intermediary and interviewed between December 2024 and January 2025. The analytic process integrated reflexive thematic approaches to preserve both the individuality of participants’ testimonies and the identification of cross-case meanings. Ethical approval was obtained from the University Research Ethics Committee. Results: Participants highlighted many respectful, supportive interactions while also noting areas for improvement. Findings indicate strong foundations for inclusive care, with clear opportunities to enhance consistency across services. Key barriers included subtle heteronormative assumptions, occasional lack of confidence in discussing sexuality or gender identity, and uneven knowledge of gender-affirming care. Differences in communication styles, documentation practices, and structural supports also contributed to variation in how inclusivity was experienced. Despite these challenges, participants’ experiences show meaningful progress and a strong platform for continued growth in culturally competent, person-centred care. Conclusion: The study recommends embedding cultural competence for LGBTIQ+ patients into healthcare systems rather than relying on individual goodwill. This requires sustained professional education, explicit policy reform, and organisational commitment to inclusive practices and environments. These actions are essential to ensuring more dignified, equitable, and responsive nursing care.