Navigating Heteronormative Health Systems: A Rich Picture Exploration of the Challenges of 2SLGBTQ + Older Adults and Implications for Community Engagement in Research

With an aging global population, 2SLGBTQ + older adults encounter systemic challenges in healthcare systems that are largely shaped by heteronormative and cisnormative assumptions. In this paper, we present and describe our use of Rich Picture methodology to visually depict barriers and facilitators encountered by 2SLGBTQ + older adults, providing an understanding often obscured by text-based approaches. Guided by Minority Stress Theory, our research illustrates how historical trauma, persistent discrimination, and anticipatory stress intersect to undermine healthcare access and outcomes. Incorporating principles from community-based participatory research, participants engaged in co-design workshops to craft an educational toolkit for caregivers and healthcare professionals (HCPs). Qualitative data were gathered through the workshops with 2SLGBTQ + older adults, community organizations, and HCPs, who identified sources of resilience and strategies for dismantling microaggressions, legal hurdles, and HCP insensitivity. Findings from these workshops shaped both the Rich Picture elements and the toolkit under development. Our findings underscore the urgent need for systemic reforms, including policy changes, enhanced cultural humility training for HCPs, and the adoption of inclusive service-delivery models. By situating these insights in a single, visually compelling representation, the Rich Picture method invites stakeholders to grasp the interconnected nature of personal experiences, organizational practices, and societal norms. Ultimately, this work highlights how action-oriented, systems-based approaches can catalyze more inclusive and equitable healthcare environments, offering insights for researchers, policymakers, and practitioners committed to supporting the health and well-being of 2SLGBTQ + older adults.