A critical discourse analysis of selected health services sector access and equity documents, using a gender-based diversity framework, was conducted to offer insight into dominant and counter discourses underlying organizational access and equity initiatives. As a method of social science research, critical discourse analysis is useful for probing underlying philosophical assumptions, ideological commitments and implicit knowledge-power dynamics underlying organizational texts . CDA centres the role of language in organizational texts to "establish identities, social relationships and systems of knowledge and belief" . Critical discourse analysis can reveal structures of domination and control including, for example, how dominant groups in contemporary organizations may inadvertently control diversity issues in a way that privileges some groups while marginalizing others . In this regard, social practices within organizational settings are discourse-led practices that "can set the parameters and the conditions of possibility, for what can be perceived, articulated, and experienced" . This has important implications for which access and equity issues are identified as relevant to care and the strategies that are created in response to them.
The term "gender-based diversity analysis" highlights the importance of examining intersections among racialization and other social processes such as sexuality and gender identity which are simultaneously implicated in the way relations of care are structured and experienced [32–34]. It offers insight into the contradictory and complex dynamics which shape the lives of differently situated women and men, including transgender women and men [35, 36]. Gender and diversity are thus linked to access to meaningful and responsive programs and services  and offer a deeper insight into discourses that operate in the textual documents.
A keyword search was conducted of medical, psychology, health sciences, social science, and sociological electronic databases to locate peer reviewed literature on health services access and equity. A 'funnel-approach' to the search was taken that began with the use of single and combined broad-based terms such diversity, cultural competency, access, equity, equality, health services, social services, health policy, social policy and public policy. Next, in an effort to narrow the search LGBT- specific single and combined terms were used including sexual diversity, sexual orientation, sexual minority, sexual identity, gender identity, and homosexual. In addition to the search of electronic databases, Canadian, US and international health-oriented internet sources were searched to identify relevant health services sector access and equity grey literature. The search included health care organizations' and LGBT health and social services' web sites; heath research institutes, health service provider associations, colleges and unions and/or affiliated LGBT working groups or caucuses; and LGBT health and social services' grassroots activist groups, coalitions and LGBT-specific health and social care professional associations. In an effort to capture the impact of recent legislative changes (e.g., same sex marriage and employment legislation in Canada, UK, Europe and select US states) on health services policy and practices, the search covered 1995-2009.
The literature search yielded: 1) Peer-reviewed empirical research and theoretical papers from medical, psychology, health sciences, social science, and sociological academic journals that reported on health disparities, health services access barriers and experiences, and experiences associate with self-disclosure during care interactions for LGBT people; 2) health service organization (e.g., hospitals, public health) health equity reports and access and equity frameworks and measures related to diversity; 3) health research institute discussion papers exploring health equity and diversity; and 4) LGBT group, association and network-developed LGBTQ-specific health service access and equity frameworks.
The health services access and equity literature related to diversity included in this analysis is largely limited to Ontario- and Toronto-based health equity position papers, reports and frameworks that articulate a vision of enhancing equitable access to health services and how to achieve it in practice. The decision to limit inclusion to Ontario- and Toronto-based health equity documents was based on their proliferation as a result of an increased awareness, over the past several years, of health disparities and the need to account for diversity in health policy and care delivery in Ontario [26, 27].
The health services access and equity literature related to sexual and gender diversity included in the analysis is broader in geographical scope than the health services access and equity literature related to diversity in general. The decision to expand the inclusion criteria to include Canada-wide, US and international literature is largely based on the limited availability of 'home grown' LGBT-specific health services access and equity literature. Canada generally, and Ontario specifically, has offered significant contributions to dialogues towards the advancement of equitable access and good quality care for LGBT communities. For example, policy bodies and professional associations such as the Ontario Public Health Association [14–16], RNAO  and CPATH have called for system-level reform to improve LGBT access to care. Additionally, in 2008, the Ontario Ministry of Health and Long-Term Care funded Rainbow Health Ontario, whose mandate is to improve the health and well-being of lesbian, gay, bisexual and transgender people in Ontario through education, research, outreach and public policy advocacy . However, we include significant international work related to LGBT health services access and equity where relevant.
Selected documents were read and re-read by two research team members (AD, JM) using the following elements to guide the analysis: 1) representations of health, access, culture and diversity; 2) representations of gender, sexuality, race, class and ability; and, 3) absences or silences related to gender, sexuality, race, class and ability. In terms of 'representations' documents were reviewed for the ways in which particular language and/or terms were used to identify population-based health disparities and barriers to health services; determine and demarcate populations and communities based on social identities and locations; and articulate potential solutions towards increased access to good quality health care. 'Absences or silences' refers to the identification of the omission of language and/or terms for some health disparities and access barriers to health services for some populations and communities. Based on this process, organizational assumptions, knowledge and commitments underlying access and equity documents, as reflecting multiple and competing dominant and counter discourses within and across texts were identified.