Developing Nursing Resources for LGBTQ+ Older Adult Care Using Human-Centered Design (2022-2023)


Approximately 6.5 million Americans aged 50 and older identify as lesbian, gay, bisexual, transgender or queer (LGBTQ+), and this number is projected to increase to more than 20 million by the year 2060. As LGBTQ+ adults age, they will need options for long-term care by skilled healthcare providers who can address their needs. Yet, health care workers employed in long-term care and skilled nursing facilities have reported not feeling prepared to care for LGBTQ+ older adults and request more training in order to meet the needs of this marginalized population.

The Duke Population Health Management Office (PHMO) leads the Health Optimization Program for Elders (HOPE) Skilled Nursing Facility Collaborative. The HOPE Collaborative is group of approximately 25 long-term care and skilled nursing facilities across seven local counties in North Carolina that work closely with PHMO to improve care for older adults. Currently, there are no resources for the HOPE Collaborative that incorporate care guidance for LGBTQ+ patients. There is a need to develop these resources in collaboration with key stakeholders to improve health care worker knowledge of long-term care practices for the LGBTQ+ population.

Project Description

To help the members of PHMO’s HOPE Collaborative increase their knowledge of long-term care practices for LGBTQ+ older adults, this project team will use Human-Centered Design (HCD) to develop an LGBTQ+ Older Adult Resource Box. HCD is a process that incorporates human input in the creation of a particular solution and is driven by four main phases: discover, define, develop and deliver. To ensure the effectiveness of the LGBTQ+ Resource Box, this team will also add an additional phase centered around evaluation. 

First, the team will recruit an advisory board of approximately 20 members to participate in focused design sessions to define the goals of the resource box, examine LGBTQ+ needs and propose a robust list of care resources. The advisory board will include key stakeholders, such as LGBTQ+ older adult community members, long-term care and skilled nursing facility administrators within the HOPE Collaborative, and LGBTQ+/older adult advocacy leaders.

In partnership with the advisory board, team members will then develop the LGBTQ+ Resource Box prototype, which, once completed, will undergo user testing for 12 weeks by employees of the 25+ long-term care facilities in the HOPE Collaborative. To evaluate their resource, team members will develop, deploy and analyze the results of a survey examining the acceptability (satisfaction and perceived benefit) and usability (frequency and ease of use) of the LGBTQ+ Resource Box prototype. The team will then develop a list of priority updates to address feedback and design the next iteration.

Anticipated Outputs

LGBTQ+ Resource Box prototype; data collection to inform future research; manuscripts for publication; poster presentations


Fall 2022 – Spring 2023

  • Fall 2022: Train and add team members to IRB protocol; refine project goals; form subgroups; recruit and meet with advisory board; develop draft of LGBTQ+ Resource Box prototype; prepare manuscript of protocol for publication
  • Spring 2023: Finalize and deploy LGBTQ+ Resource Box prototype; develop and distribute evaluation survey; prepare second manuscript; analyze survey data; develop improvements to LGBTQ+ Resource Box for future iterations; submit abstracts for conference

This Team in the News

Meet the Members of the 2022-2023 Student Advisory Council

Holding hands.

Team Leaders

  • Jennifer May, School of Nursing
  • Devon Noonan, School of Nursing
  • Jason Wheeler, Duke Connected Care

/graduate Team Members

  • Alexis Domeracki, Medicine MD Third Year
  • Glaucia Nascimento Salgado, Global Health - MSc

/undergraduate Team Members

  • Perisa Ashar, Biomedical Engineering (BSE)
  • Foxx Hart, GCS in Literature Program (AB)
  • Melanie Wang, Computer Science (BS)