Beyond the rainbow: authenticity, trust, and symbolic inclusion in health and social care

Background: LGBT+ individuals continue to experience marginalisation and exclusion within health and social care systems. In response, organisations increasingly use symbolic markers of inclusion—such as rainbow flags, lanyards, and visual branding—to signal safety and acceptance. While these symbols are highly visible, there is limited empirical evidence examining whether they are perceived as authentic by LGBT+ service users or whether they meaningfully influence trust and engagement.

Aim: This study aimed to explore how symbolic inclusion, specifically the use of rainbow imagery, is perceived by LGBT+ individuals and to examine its relationship with trust, authenticity, recall, and engagement.

Methods: A quantitative cross-sectional survey was conducted using an online questionnaire distributed in the United Kingdom to individuals who self-identified as LGBT+ (n = 157). The survey explored perceptions of organisations that adopt rainbow imagery, focusing on perceived authenticity, trust, recall, and behavioural intention. Data were analysed using descriptive statistics, correlation analysis, ANOVA, and hierarchical multiple regression.

Findings: Results indicated that rainbow symbolism was associated with improved perception and recall of organisations but did not significantly increase behavioural intention on its own. High levels of scepticism were reported, with over 60% of participants perceiving rainbow symbolism as inauthentic unless supported by meaningful organisational action. Perceived authenticity showed a strong positive association with trust and willingness to engage.

Conclusion: Symbolic inclusion alone is insufficient to establish trust among LGBT+ individuals. While visible markers of inclusion may offer reassurance, they risk being perceived as performative when not aligned with organisational practice.

Implications for Practice: Health and social care organisations should ensure that symbols of inclusion are supported by inclusive policies, staff training, and everyday practice. Authentic, sustained commitment—rather than symbolic gestures alone—is essential for culturally safe and equitable care.