Outer-context determinants on the implementation of school-based interventions for LGBTQ+ adolescents

Abstract

Background Schools are critical venues for supporting LGBTQ+ youth well-being. Implementing LGBTQ-supportive practices can decrease experiences of stigmatization, discrimination, and victimization that lead to adverse mental health outcomes like anxiety, depression, and suicidality. However, schools are also subject to a wide range of outer-context pressures that may influence their priorities and implementation of LGBTQ-supportive practices. We assessed the role of emergent outer-context determinants in the context of a 5-year cluster randomized controlled trial to study the implementation of LGBTQ-supportive evidence-informed practices (EIPs) in New Mexico high schools. Method Using an iterative coding approach, we analyzed qualitative data from annual interviews with school professionals involved in EIP implementation efforts. Results The analysis yielded three categories of outer-context determinants that created challenges and opportunities for implementation: (a) social barriers related to heterocentrism, cisgenderism, and religious conservatism; (b) local, state, and national policy and political discourse; and (c) crisis events. Conclusions By exploring the implications of outer-context determinants for the uptake of LGBTQ-supportive practices, we demonstrate that these elements are dynamic—not simply reducible to barriers or facilitators—and that assessing outer-context determinants shaping implementation environments is crucial for addressing LGBTQ health equity.