LGBTQ+ individuals' experiences of initial identity disclosure in primary healthcare services: a qualitative scoping review.

Background: Primary healthcare is central to equitable and high-quality care; however, access and utilisation remain uneven across population groups. LGBTQ+ individuals continue to experience discrimination, stigma and non-affirming practices within primary care settings. These experiences undermine trust, discourage identity disclosure and contribute to reduced engagement with services, delayed care and poorer health outcomes. Objective: To explore LGBTQ+ individuals' experiences of their initial identity disclosure encounters with primary healthcare professionals and how these influence their future engagement with care services. Design: Qualitative scoping review. Information sources: The PubMed, CINAHL, and SCOPUS databases were systematically searched using a PICo-based strategy. Methods: A scoping review followed PRISMA-ScR guidelines, including qualitative studies. Articles were appraised, and the findings were synthesised to identify recurring themes across the reviewed literature. Results: Four thematic units emerged, namely: (a) Factors Shaping the Experiences of Identity Disclosure, (b) The Impact of Discriminatory Attitudes, (c) The Structure and Symbols of Health Institutions, (d) Navigating the Healthcare System. Conclusions: Initial identity disclosure encounters are pivotal in shaping LGBTQ+ individuals' long-term engagement with primary healthcare services, which depends on both anticipated and experienced trust. Establishing trust is predicated on individual qualities of healthcare providers and the structural/organisational context of primary care settings. Enhancing both individual and system-wide trust is crucial in fostering equitable and sustainable healthcare relationships. Registration: A study protocol was developed and registered with the Centre for Open Science (COS) as a scoping review and is publicly accessible under registration DOI 10.17,605/OSF.IO/ZXWGS - registered 24/10/2025. Implications for the profession and/or patient care: The triptych of developing self-aware, empathetic health professionals, educated within a culturally sensitive environment, and being capable of (re)structuring the primary care setting to become more inclusive are key implications of the review. This triptych is founded on developing a new scholarship of reflective practice, grounded in the science of the unique. Impact: Provide a mapping of the current literature's understanding of LGBTQ+ individuals' experiences of initial identity disclosure, highlight the roles that individuals and context play in these experiences, and argue for a new educational and practice approach tailored to each individual's uniqueness. Reporting method: This study adheres to the EQUATOR guidelines and PRISMA-ScR checklist. Patient or public contribution: Τhis study did not include patient or public involvement.