Embracing intersectionality in qualitative research: exploring how women with a chronic illness or disability experience discrimination within healthcare

Introduction 

Evidence shows that health inequities are shaped by structural and interpersonal forms of discrimination, such as sexism and ableism. However, there is a lack of qualitative evidence exploring experiences of intersectional discrimination, which would be valuable for informing equitable health policies and practice.

Goals and methods 

This presentation explores the utility of intersectionality in qualitative research processes (e.g., question design, sampling, recruitment and topic guide development), analysis and reflexivity, exemplified through a multi-method study on discrimination and health. The sample consisted of four focus groups (n=14) with women of all ages and 28 semi-structured interviews with young women aged 16-25. We used intersectionality as a theoretical and applied framework to examine the unique experiences of those at the gender/disability intersection, illuminating other axes of inequality such as ethnicity and socioeconomic position, where relevant. We used thematic analysis and intersectional reflexivity to interpret structural and interpersonal modes of discrimination and generate our themes. The presentation will also outline the ways this work influenced policy via the Women’s Health Plan at the Scottish Government.

Results 

Our analysis is structured around three key themes: (1) Participants highlighted that dominant understandings of "health" were embedded in ableist and sexist assumptions, which shaped healthcare access and contributed to discriminatory treatment; (2) Weight blame emerged as a neoliberal logic within healthcare settings, restricting disabled women’s access to referrals, diagnoses, treatments, and support, while also undermining their dignity; (3) In response to these inequities, participants often engaged in self-advocacy and adapted their behaviour to secure appropriate treatment. This required them to navigate discriminatory systems by managing contradictory self-presentations.

Conclusions 

This study highlights gendered ableism that women encounter in healthcare settings. Embracing intersectionality means uncovering potentially unseen experiences of marginalised groups and allows the researcher to maintain a focus on social justice and health equity.