LGBT healthcare disparities: What progress have we made?

A content analysis on the perceptions of LGBTQ+ (centred) health care on Twitter

BACKGROUND

LGBTQ+ individuals have experienced many barriers to receiving quality health care, but the worldwide implementation of person-centred care should make a positive change. However, as forthright disclosures are difficult to find using traditional methods, novel approaches should be utilized to uncover opinions and experiences on LGBTQ+ health care. Twitter could be a place where people post on this topic.

AIM

This study aimed to explore tweets mentioning LGBTQ+ (centred) health care.

METHODS

The methods consisted of an explorative qualitative content analysis of tweets. The tweets were collected between 26 February and 30 March 2021, resulting in 2524 tweets of which 659 were relevant for content analysis.

RESULTS

The results showed an excess of political tweets involving LGBTQ+ health care. Many tweets included general statements on the need for LGBTQ+ health care. The few tweets on personal experiences in LGBTQ+ health care showed the overwhelming need for quality care that has been made difficult by political developments.

CONCLUSION

Most tweets were made to inform others of the necessity of quality health care for LGBTQ+ individuals, but the utilization of person-centred care is hardly noticeable.

PUBLIC CONTRIBUTION

This study was conducted with the involvement of a public partner (second author) who contributed to the design, data analyses and writing of the paper. Moreover, this study involves the analysis of data provided by the public and published on social media.

They "Don't Know How to Deal with People Like Me": Assessing Health Care Experiences of Gender Minorities in Indiana

Purpose

Within the LGBTQ+ community, the transgender and nonbinary (TGNB) population experience a disproportionate amount of discrimination when seeking health care. Such disparities may arise from lack of proper medical training and resources for providers or biases. In this study, we examine the health care experiences of TGNB individuals living in Southern Indiana.

Methods

We analyzed responses from TGNB respondents to an LGBTQ+ health care needs assessment survey in Southern Indiana. Respondents were asked about demographic data, their self-assessed health status, quality of health care received, whether they have a provider with whom they feel comfortable sharing their gender identity with, and if they have to commute to see their provider. Finally, respondents were asked an open-ended question about their health care experiences while living in Southern Indiana. Responses were coded and several themes emerged and were analyzed.

Results

Eighty-five TGNB individuals completed our survey. Less than half of respondents indicated that they had an LGBTQ+-welcoming provider (44.7%). Individuals with an LGBTQ+-welcoming provider were more likely to report their self-assessed health as excellent/good (p=0.02) and quality of health as excellent/very good (p=0.03) compared to individuals without an LGBTQ+-welcoming provider. Five themes emerged from the write-in responses (n=64): discrimination (34.4%), invalidation (32.8%), distrust (28.1%), logistic concerns (35.9%), and positive experiences (35.9%).

Conclusion

The TGNB community living in Southern Indiana reports numerous barriers related to provider attitudes when obtaining health care. Additional training is needed to address provider biases and improve LGBTQ+ community health disparities.

Medical Students' Attitudes Towards, and Knowledge of LGBT Persons in Guyana

Evidence from industrialized countries show that discrimination and experienced and/or perceived negative encounters with healthcare workers affect frequency and type of healthcare sought by lesbian, gay, bisexual and transgender (LGBT) persons. In Guyana, and the wider English-speaking Caribbean region, there is a dearth of research on how healthcare workers and students perceive and interact with LGBT patients. This study investigated the attitudes and knowledge with regards to LGBT health among students at a medical school in Guyana by using quantitative, self-administered online surveys. We analyzed data using SPSS for descriptive and analytic calculations, and results showed that students held moderately prejudiced attitudes toward LGBT persons. Religiosity and heterosexual orientation were the main factors found to be associated with negative attitudes. Knowledge levels were also moderate with pronounced deficiencies in certain areas, and almost all students had not received LGBT-specific medical education, but most indicated a desire for such education.

Coping with the stress of providing mental health-related informal support to peers in an LGBTQ context

Many lesbian, gay, bisexual, trans or gender diverse, or queer-identifying (LGBTQ) people provide informal support to peers experiencing mental ill health. This reflects both the high prevalence of mental ill health in their communities - often a product of discrimination - and barriers to accessing formal services. In this article, we explore how LGBTQ people who help peers with their mental health seek to cope with the stress of providing such support. Drawing on interviews with 25 LGBTQ people in Melbourne, Australia, we consider how community members being 'leant on' engage in self-care practices and seek help from their communities to cope with the stress of their support roles. We demonstrate that participants' ways of coping, even when similar, can vary in effectiveness and often come with limitations. Thus, we conclude that LGBTQ people providing informal support to peers should be better assisted to do so, in ways that acknowledge the diversity of support provided in LGBTQ communities.

Transgender people in the nursing discourse: An integrative review

OBJECTIVE

To integrate and analyse the literature produced by nurses in terms of care, education and understanding of the reality of transgender (trans) people.

DESIGN

An integrative review methodology guided by the framework proposed by Whittemore and Knafl.

DATA SOURCES

The search strategy was applied in the following databases: Medline, Embase, Scopus, Web of Science and CINAHL, as well as in Biblioteca Virtual de Saúde, during February and March 2021, with no time frame.

REVIEW METHODS

The references found were assessed according to the eligibility criteria established. The information of the articles included was extracted, and a thematic analysis was performed to synthesize the review findings.

RESULTS

The searches in the databases yielded 2859 articles; 985 after removing duplicates, and 33 articles were included in this review. Three major themes were identified: (1) Understanding the trans universe through the trans perspective; (2) Understanding health and nursing care for trans people; and (3) Trans women as the focus of health and nursing care. The themes evidenced in the lens of nurses and clients the importance of nursing training at all levels to prepare professionals on how to provide culturally competent nursing care for this population and reduce healthcare inequities.

CONCLUSION

Nurses must work to provide a space for convergence and enhancement of the rights of trans people and cease to be a verticalized care model. To such end, it is necessary to devise places and possibilities to teach and learn, to construct and reconstruct a culturally competent nursing care.

IMPACT

This review highlighted the current knowledge and identified gaps in the understanding of nurses, health professionals and students about the experience lived by trans people, resulting from the lack of training and continuing education of these professionals.

A systematic mapping literature review of education around sexual and gender diversities

Education around sexual and gender identities is highly important to understand diversity and prevent discrimination, violence, and even murder. Nevertheless, educational institutions around the world are lacking a curriculum that explicitly includes diversity and acknowledges the LGBTQ+ community, a minority that over the years has been facing consequences from this exclusion. This study presents a detailed description of the process applied to analyze the studies using a systematic mapping literature review, as well as the positive results found from those educational institutions that started their path to inclusion around sexual and gender diversities through their curricula. The research questions targeted in this work are: What is being taught in educational institutions regarding sexual and gender diversities? What are the approaches used inside the classrooms to teach sexual and gender diversities? Which students are receiving education regarding sexual and gender diversities? Is there a technological approach and/or tool used to teach sexual and gender diversities? After applying the filtering processes, 69 studies were selected from five different online libraries: ACM, DOAJ, Lens.org, SCOPUS, and SpringerLink. The conclusions made from the findings of this review are that those studies that do tackle concerns around the topic have proven to benefit the LGBTQ+ community, the education around sexual and gender diversities predominates within the healthcare field, there are a lack of studies around this topic in Latin American countries, and technological tools are minimally used during the teaching processes.

Affirming Care for Sexual and Gender Minority Prostate Cancer Survivors: Results from an Online Training

Sexual and gender minority people have unique, unaddressed healthcare needs following prostate cancer. The research team along with a group of established subject matter experts developed a training and companion materials for healthcare professionals to address this need. Post-assessment evaluation was reported in frequencies and percentages by combining results from learners who attended an original, live web-based training and learners who completed the same training on-demand via a Learning Management System. Learners from both the live and archived training reported that the training increased their knowledge to effectively work with sexual and gender minority prostate cancer survivors. Learners also reported gaining new resources and strategies they could apply to their work. Results indicate the training fills an educational gap for healthcare professionals and supports the need for additional training of healthcare professionals focused on the healthcare needs of SGM cancer survivors.

Pilot Study: Increasing Medical Student Comfort in Transgender Gynecology

Background: The purpose of this study was to use survey data to better understand medical students’ comfort in taking care of transgender patients and to determine whether this is an area that needs to be expanded upon in their curriculum.

Methods : Eight pre-clerkship medical students participated in a virtual two-week course about gynecologic transgender care which included a mix of self-paced learning combined with two days of interactive faculty-led sessions. Students were asked to complete a pre and post course survey evaluating their comfort in caring for transgender individuals. 

Results: We had an 100% response rate to our pre and post course survey. Students’ knowledge about the gynecologic needs of transgender individuals significantly improved after taking the course with the average student rating before and after the course being 2.38 ± 0.74 (p<0.05) and 4.25 ± 0.46 (p<0.05), respectively. In addition, 100% of students “agreed” or “strongly agreed” that this course built their confidence in taking care of transgender patients in the clinical setting.

Conclusions: This study highlights a potential gap in medical education while also emphasizing that knowledge on this special population can enhance physician confidence when caring for transgender individuals.

Medical students' perceptions of their preparedness to care for LGBT patients in Taiwan: Is medical education keeping up with social progress?

INTRODUCTION

Integrating training on health equity of sexual and gender minorities (SGM) in medical education has been challenging globally despite emphasis on the need for medical students to develop competence to provide adequate care for diverse patient groups. This study elicits Taiwanese medical students' perceptions of their values and preparedness to care for Lesbian, Gay, Bisexual, or Transgender (LGBT) patients using a qualitative approach that considers broader societal changes, and more focused topics such as the provision of relevant training in medical education.

METHODS

Eighty-nine medical students/trainees from two southern Taiwanese medical schools (one public and one private) participated in focus groups (n = 70) and individual interviews (n = 19). Qualitative analysis was conducted using inductive thematic analysis.

RESULTS

Participants (i) expressed wide social acceptance and openness toward LGBT individuals, but were unsure of ways to communicate with LGBT patients; (ii) confirmed that stigmatization and biases might be developed during their training; (iii) recognized gender stereotypes could have negative impacts on clinical reasoning; (iv) considered themselves prepared to care for LGBT patients, yet equated non-discriminatory attitudes to preparedness; (v) acknowledged a lack of relevant professional skills; (vi) implicated curriculum did not address LGBT issues systematically and explicitly.

CONCLUSION

This study has identified the insufficiencies of current medical training and inadequate preparedness of medical students/trainees to provide better care for LGBT patients. It provides insights for medical educators to design and implement effective medical curriculum and training, and faculty development programs to equip medical students/trainees with self-awareness and competencies to more readily provide holistic care for SGM, in keeping up with social progress, and promote health equity for a more diverse patient population.

Sensitivity Toward Gender and Sexually Diverse Populations: Development of a Scale

BACKGROUND

Individuals who are lesbian, gay, bisexual, transgender, queer, intersex, asexual, or nonbinary (LGBTQIA+) experience inequitable access to and utilization of health care services. Nurses' lack of awareness and sensitivity may contribute to this phenomenon.

PURPOSE

This article describes the development and validation of the Gender and Sexual Diversity Sensitivity Scale (GSDSS). A sample of 210 undergraduate nursing students from a large research-intensive university completed the scale online. An exploratory factor analysis was conducted.

RESULTS

Factor analysis illustrated a three-factor construct of the scale (i.e., General Education Experience, Cognitive Awareness, and Comfort With Interactions); Cronbach's alpha coefficients ranged from .66 to .91, and the total scale alpha coefficient was .782.

CONCLUSION

The GSDSS has evidence of construct validity and reliability, and can be used in studies that include nursing and other health professional students. [J Nurs Educ. 2022;61(7):383-389.].

How can the nursing profession help reduce sexual and gender minority related health disparities: Recommendations from the National Nursing LGBTQ Health Summit

BACKGROUND

Lesbian, gay, bisexual, transgender and queer (LGBTQ) people, also commonly referred to as sexual and gender minorities (SGMs), live in every part of the United States and encompass all races and/or ethnicities, religions, and social classes. Major reports from various sources document higher rates of health issues (e.g., substance abuse, depression, suicidality, cardiovascular disease) among SGMs than heterosexuals. Chronic stress related to marginalization and discrimination is a key contributor to these disparities. The nursing profession has paid relatively little attention to SGM health issues.

PURPOSE AND METHODS

To address these gaps, the first National Nursing LGBTQ Health Summit brought together nursing deans, leaders of national nursing organizations, and other participants from across the United States.

FINDINGS

Participants agreed that increasing SGM-specific content in nursing curricula, practice guidelines, faculty development, and research is necessary to improve the health of SGM people.

DISCUSSION

The Summit ended with a call to action for the nursing profession to prioritize SGM health through innovations in education, research, and practice.

Mechanisms of Mental-Health Disparities Among Minoritized Groups: How Well Are the Top Journals in Clinical Psychology Representing This Work?

We have known for decades that mental health disparities exist among minoritized groups, including race, ethnicity, sexual identities, gender identity and expression, ability, and others. Theories and frameworks that incorporate stressors unique to the experiences of minoritized groups, such as the biopsychosocial model of racism (Clark et al, 1999) and minority stress model (Meyer, 2003), offer testable mechanisms that may help explain, in part, mental health disparities. However, research addressing mechanisms of these disparities is still scarce and is not well represented in our top clinical psychology journals. This review critically examines the extent to which top tier clinical psychology journals publish work examining mechanisms of mental health disparities among minoritized populations. We find very few studies have been published in top clinical psychology journals that address mechanisms of mental health disparities. We examine potential reasons for this and discuss recommendations for future research.

Does Gender Affirming Hormone Therapy Increase the Risk of Kidney Disease?

Kidney health and manifestation of disease in transgender men, women, and nonbinary individuals are not well understood. Transgender individuals commonly receive gender-affirming hormone therapy (GAHT) to align their outward appearance with their gender. Recent attention to the differences in fundamental kidney parameters has identified that transgender individuals may manifest levels of these biomarkers differently than their cisgender counterparts. Improving understanding of the differences in biomarkers and in the development of kidney disease is essential to providing appropriate kidney care to this vulnerable population. In this review, we introduce the current information related to GAHT and kidney health and highlight the significant gaps in our understanding of how GAHT may affect kidney physiology and pathophysiology.

The Binary Order of Things: A Discursive Study of Nursing Students' Talk on Providing, and Learning About, LGBT Patient Care

Against the backdrop of the healthcare inequities and maltreatment facing LGBT patients, recommendations have been made for the inclusion of LGBT health topics in nursing curricula. Based on data collected in focus group discussions with South African nursing students, we complicate the assumption that training focused on health-specific knowledge will effectively reform providers' prejudicial practices. Findings reveal ambivalence: silence and discrimination versus inclusive humanism. Participants drew on discourses of ignorance, religion, and egalitarian treatment to justify their inadequacy regarding LGBT patients; while doing so, however, they deployed othering discourses in which homophobic and transphobic disregard is rendered acceptable, and "scientifically" supported through binary, deterministic views of sexuality and gender. Such "expert" views accord with Foucault's notion of "grotesque discourse." We conclude with a discussion of the findings' implications for nursing education; we call for the recognition and teaching of binary ideology as a form of discursive violence over LGBT lives.

A Novel Curriculum Assessment Tool, Based on AAMC Competencies, to Improve Medical Education About Sexual and Gender Minority Populations

PROBLEM

Medical education aspires to mitigate bias in future professionals by providing robust curricula that include perspectives of and practices for caring for sexual and gender minority (SGM) populations; however, implementation of these ideals remains challenging. Medical school leaders motivated to improve curricula on caring for SGM populations must survey their school's current curricula to identify strengths and opportunities for improvement. In 2014, the Association of American Medical Colleges (AAMC) published 30 SGM competencies that curricula should address. Here the authors describe the development of a tool to efficiently assess whether an undergraduate medical education (UME) curriculum adequately incorporates the AAMC-recommended SGM competencies.

APPROACH

In 2018, Boston University School of Medicine (BUSM) convened a group of faculty and students with experience and expertise regarding SGM health. The group distilled the 30 AAMC competencies into 12 SGM topic areas that should be addressed in any UME curriculum, and they developed a curriculum assessment tool to evaluate the presence and timing of these topic areas in the BUSM curriculum. This tool was distributed to all course and clerkship directors responsible for the required UME curriculum at BUSM to investigate where these topic areas are addressed (May-June 2019).

OUTCOMES

The curriculum assessment tool identified several strengths in the preclerkship and clerkship curricula, including faculty willingness and enthusiasm to include SGM content. The assessment tool also revealed that some SGM topic areas are underrepresented in the BUSM curriculum, particularly during clerkships.

NEXT STEPS

The curriculum assessment tool described here is a straightforward, standardized instrument to map SGM topic areas within any UME curriculum. It is designed to be comprehensible by individuals who are not familiar with SGM health. The tool minimizes barriers to medical curricular change by providing a mechanism to assess and understand how SGM health is incorporated into existing curricula.

Implementation and analysis of a LGBTQ cultural competency module on pharmacy student knowledge

INTRODUCTION

This study describes the implementation and assessment of a cultural competency module on caring for patients who identify as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ). The module was delivered to first professional year pharmacy students, and focused on student knowledge and application of LGBTQ-specific definitions, inclusive language, and health disparities.

METHODS

A mixed-methods design captured data to assess the effect of a LGBTQ module on student knowledge and confidence. For the pre- and post-assessment, descriptive statistics were calculated and mean differences were compared using the paired sample t-test. The number of correct choices for multiple-select questions were compared using the Pearson chi-square test. Post-laboratory (lab) reflections were analyzed via percentages of agreement for Likert-scale questions and thematic analysis of free-response questions.

RESULTS

Average pre- and post-assessment scores (n = 74 students) were 47.84% and 53.51% (P = .02). Sub-analysis of the multiple-select questions indicated statistically significant improvement in student performance on health disparities and culturally-competent communication (P values < .05). Likert-scale questions from 71 student's post-lab reflections indicated agreement of improved knowledge of health disparities (95.77%) and LGBTQ terminology (92.96%). Agreement in student's confidence using inclusive language and competent communication improved from 64.79% pre- to 95.67% post-module. Reflection themes included respect, inclusivity, awareness, and avoiding assumptions.

CONCLUSIONS

The module slightly improved student knowledge via assessment performance; however, student-reported knowledge and confidence regarding LGBTQ competency significantly improved. This module can be utilized by schools of pharmacy as a model educational activity on LGBTQ cultural competency with lab-based application.

LGBT testimony and the limits of trust

In, 'Forever young: the ethics of ongoing puberty suppression (OPS) for non-binary adults,' Notini et al discuss the risks, harms and benefits of treating non-binary patients via identity-affirming OPS. Notini et al's article makes a strong case for OPS's permissibility, and their conclusion will not be disputed here. Instead, I directly focus on issues that their article addressed only indirectly. This article will use a hypothetical case study to show that while Notini et al's ethical conclusion might be spot on, that perhaps the method they took to get there was superfluous. If the medical community is to take LGBT testimony seriously (as they should) then it is no longer the job of physicians to do their own weighing of the costs and benefits of transition-related care. Assuming the patient is informed and competent, then only the patient can make this assessment, because only the patient has access to the true weight of transition-related benefits. Moreover, taking LGBT patient testimony seriously also means that parents should lose veto power over most transition-related paediatric care.

Development and psychometric properties of the tool for assessing LGBTQI+ health training (TALHT) in pre-licensure nursing curricula

BACKGROUND

There is a lack of comprehensive lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) content in pre-licensure nursing curricula. LGBTQI+ people commonly experience mistreatment from nurses and healthcare providers due to a lack of knowledge or personal biases. To date, few instruments exist to guide LGBTQI+-specific curricular improvement.

OBJECTIVES/DESIGN/SETTING/PARTICIPANT/METHODS

Johns Hopkins School of Nursing LGBTQI+ Health Initiative and Emory University School of Nursing developed the Tool for Assessing LGBTQI+ Health Training (TALHT) to assist in evaluating gaps and redundancies in LGBTQI+ health content within pre-licensure nursing curricula. Face and content validity were evaluated among experts in LGBTQI+ health, curricular development, nursing education, and measure development (N = 22). The TALHT was modified based on expert feedback and a pilot with pre-licensure faculty (N = 13) to evaluate utility and acceptability of the refined measure.

RESULTS

Face and content validity evaluation of the 60-item iteration of the TALHT showed that the majority of items were consistently relevant among external expert reviewers. However, the clarity and readability of items were lacking. We triangulated the quantitative and qualitative data from experts to adapt and reduce the number of items in the TALHT to 20 items. Pilot testing of the revised 20-item measure found that utility and acceptability of the tool were rated highly among pre-licensure faculty.

CONCLUSION

The validation of the TALHT comes at a time when this type of instrument is clearly needed. The Future of Nursing 2020-2030 report calls for nursing education to incorporate competencies in caring for diverse populations to promote health equity. The Essentials: Core Competencies for Professional Nursing Education calls for a transition to operationalization of competency-based nursing education. The TALHT provides faculty and programs with a valid and reliable means to operationalize implementation of those competencies as they pertain to LGBTQI+ health.

Medical student Interest in expanded transgender gynecologic education

Background: The purpose of this study was to use survey data to better understand medical students’ comfort in taking care of transgender patients and to determine whether this is an area that needs to be expanded upon in their curriculum. Methods: Eight pre-clerkship medical students participated in a virtual two-week course about gynecologic transgender care which included a mix of self-paced learning combined with two days of interactive faculty-led sessions. Students were asked to complete a pre and post course survey evaluating their comfort in caring for transgender individuals.  Results: Students’ knowledge about the gynecologic needs of transgender individuals significantly improved after taking the course with the average student rating before and after the course being 2.38 ± 0.74 (p<0.05) and 4.25 ± 0.46 (p<0.05), respectively. In addition, 100% of students “agreed” or “strongly agreed” that this course built their confidence in taking care of transgender patients in the clinical setting. Conclusions: This study highlights a potential gap in medical education while also emphasizing that knowledge on this special population can enhance physician confidence when caring for transgender individuals.

The Nature and Impact of Informal Mental Health Support in an LGBTQ Context: Exploring Peer Roles and Their Challenges

BACKGROUND

Research shows that LGBTQ communities experience high levels of suicidality and mental ill health. They also face significant barriers to accessing adequate mental health treatment in service settings. In response to these factors, it is likely that LGBTQ community members turn to their peers for informal mental health-related support. Such support, however, is largely undefined, the extent of it poorly understood and its impacts on those who perform it underexplored.

METHODS

We explored the nature and impact of informal mental health-related support provided by peers in LGBTQ communities in Melbourne, Australia. Drawing on semi-structured in-depth interviews with 25 LGBTQ adults in 2020, we explored how and why peers provided mental health support to friends, partners, housemates and even strangers and the impact this had on them.

RESULTS

We found that participants performed support roles as extensions of their existing relationships. We demonstrate that the support roles of the safe friend, housemate and partner, among others, represent everyday relationships stretched-even to breaking point-to incorporate informal mental health support. Each of these support roles is distinct, but they can all potentially result in similar impacts on those performing them. One of the more significant of these is burnout.

CONCLUSIONS

LGBTQ community members face a diverse range of challenges when they support peers with their mental health. Informal peer-support roles are a significant responsibility for those performing them. LGBTQ community members stepping up to support others should be better supported to help manage their roles and the impacts of performing them.

POLICY IMPLICATIONS

Findings can contribute to policy that not only addresses high levels of mental ill health in LGBTQ communities, but also seeks to help peers in support roles to prevent them from being negatively impacted.

mHealth video gaming for human papillomavirus vaccination among college men-qualitative inquiry for development

BACKGROUND

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Persistent infection with HPV can cause various cancers; however, HPV vaccination can prevent infections associated with high risk, cancerous strains of the virus. As it relates to HPV, college age men have been identified as one of the catch-up vaccination groups. Among college age men, gaming is an extremely popular extracurricular activity. Further, video games have emerged as a popular public health intervention tool. Therefore, this study aims to collect qualitative data on how to develop, implement and evaluate the effectiveness of a gaming intervention to increase HPV risk perceptions, improve self-efficacy and increase intention to receive the HPV vaccine among male college students (18-26 years old).

METHODS

Four focus group sessions ranging from eight to ten individuals were conducted among male college students from one large research-intensive university in the South. Using grounded theory, data from focus group interviews were coded using NVivo software to identify emergent themes.

RESULTS

Participants emphasized that although customization was not viewed as important by college aged males, the ability to tailor in game experiences or experience different things each time they played (creative freedom) was more important. They encouraged that the digital game be created on a mobile platform, incorporate health messages, and be informative to reach their population. Furthermore, they suggested innovative way to disseminate the game, which included having health department/health care providers prescribe the game to patients as an end of clinical interaction strategy.

CONCLUSIONS

College age men, are natural avid gamers, enjoy game play, and can engage in learning online or offline. While platform preference varies among gamer type, college age men in our study emphasized that mobile based gaming is the most advantageous way to increase knowledge/awareness and encourage positive in game behavior which can impact out of game behaviors such as vaccination. Because of the level of access and natural disposition of mHealth technology seen as an "extension of the self", games for health developers should consider the mobile platform as the ideal for the target demographic.

Proportion of U.S. Clinics Offering LGBT-Tailored Mental Health Services Decreased Over Time: A Panel Study of the National Mental Health Services Survey

Our objective was to characterize the proportion of U.S. mental health clinics that offered LGBT-tailored mental health services between 2014 and 2018. We used data from the National Mental Health Services Survey (NMHSS) to construct a mixed logistic model of availability of LGBT-tailored mental health services over time, by region (Northeast, South, Midwest and West), and by facility type (Veterans Administration, inpatient/residential, outpatient, community mental health centers and mixed). Our results show that the overall proportion of mental health clinics that offered LGBT-tailored services decreased from 2014 to 2018. Our results also indicate that Veteran Affairs clinics and facilities in the West and Northeast were most likely to offer LGBT-tailored mental health services. Given the temporal, regional, and facility gaps in LGBT-tailored mental health services availability, more effort should be dedicated to addressing this disparity.

Experiences of Transgender Participants in Emergency Departments: Findings from the OutLook Study

Purpose: Even in cases of medical emergency, mistreatment and negative experiences in life or in medical settings can deter trans patients from seeking necessary care. The purpose of this study was to identify factors associated with trans persons' emergency department (ED) avoidance in the mixed urban-rural Region of Waterloo, Ontario, Canada. Methods: The OutLook Study was a community-based partnership that created an online, cross-sectional questionnaire for lesbian, gay, bisexual, transgender, and other sexual and gender minority community members. Participants in this analysis were 16 years of age or older, lived, worked, or attended school in Waterloo Region, and identified as trans (n=112). Binary logistic regression was used to test associations between sociodemographic, resilience, and risk variables, and ED avoidance. Sociodemographic variables statistically significant at p<0.05 at the bivariate level were included as controls to explore different combinations of resilience and risk factor in multivariable models. Results: Participants reporting complete or partially complete medical transitions were more likely to report ED avoidance, compared to those who had not initiated medical transition. Elevated transphobia was associated with greater likelihood of avoidance. However, increasing levels of social support decreased the likelihood of avoidance. In multivariable models, social support, support from a special person, and transphobia were always significant, regardless of controlled variables. Conclusion: Transphobia-enacted in the contexts of everyday life and health care-can deter patients from seeking care. Patient-centered care requires careful attention to trans identity and health needs, especially in emergency settings. In the absence of structural changes, providers can take steps to mitigate the erasure and discrimination trans patients experience and anticipate when accessing EDs.

The process of transitioning for the transgender individual and the nursing imperative: A narrative review

AIMS

The objectives of this study were to bring the experience of the transitioning process for the transgender population to the nursing profession and address the lack of knowledge to promote improved patient outcomes.

DESIGN

This study used a narrative review using the literature matrix method. Because of the dearth of trans specific literature, editorials and monologues were included.

DATA SOURCE

A broad search was undertaken across all databases including CINAHL, PubMed, PsycINFO, Ovid MEDLINE, ProQuest Nursing & Allied Health and Google Scholar. Literature from June 1994 to May 2020 was appraised. Non-peer reviewed literature and published texts were procured via Google Alerts.

REVIEW METHODS

Selection for inclusion was based on credibility and relevance from a variety of social science disciplines. A narrative analysis was used to identify common themes, incongruencies in schools of thought and perspectives that require consideration.

RESULTS

Analysis of the literature revealed the following themes: (a) literature and terminology evolution, (b) transitioning as a process, (c) medicalization of transitioning, (d) generational views on transitioning and (e) needs during transition.

CONCLUSION

This review highlights key issues about the transitioning process imperative to nursing when meeting the needs of the transgender population.

IMPACT

This review addresses the lack of trans specific literature and lack of consistency in the literature about the understanding of the transitioning process for the transgender population. Main findings? Terminology to explain the transitioning process is ever evolving. Future studies about transitioning need to go beyond the medical lens. Generational views differ in the approach to transitioning, and there are needs unique to this population required during the process. Where and whom will the research impact? The review has significant implications for change in health delivery, nursing policy and formulating nursing practice and education to improve trans competent care.

An audit of the medical pre-clinical curriculum at an urban university: sexual and gender minority health content

Most medical students receive inadequate preparation to care for sexual and gender minority (SGM) patients. A review of one urban medical school's pre-clinical curriculum was conducted to assess coverage of appropriate SGM health content. Curricula that fully or partially addressed American Association of Medical Colleges (AAMC) core competencies for SGM health were categorized in an Excel spreadsheet. For partially met competencies, content that addressed the competency along with what was needed to fully address the competency were documented. AAMC SGM competencies that were not addressed at all were also noted. As a secondary source for triangulation, curricular topics were compared to SGM health content prioritized by Vanderbilt, a leader in championing inclusion of SGM content in medical curricula. Of the 30 AAMC competencies, 10 competencies were addressed, 11 were partially addressed, and 9 were not addressed. Gaps were noted in the AAMC domains of professionalism, systems-based practice, interprofessional collaboration, and personal/professional development. Among Vanderbilt topics, the George Washington University (GW) curriculum lacked content in intersex health, sexually transmitted infections (STIs) in lesbians, vaginitis in lesbians, efficacy of anal microbicides, anal Pap smears, and anal cancer risk and treatment for men who have sex with men (MSM). Despite these weaknesses, GW clocked greater than the national average at 7.5 hours of SGM content. This study provides a roadmap for curricular enhancements needed at GW as well as a prototype for other institutions to audit and improve curricular coverage on SGM health.

Perception of Unmet Need after Seeking Treatment for a Past Year Major Depressive Episode: Results from the 2018 National Survey of Drug Use and Health

Depression, a leading cause of disability and mortality world-wide that one in five U.S. adults are estimated to experience in their lifetime, presents special complications in treatment. While it is well-recognized that there are several barriers to even obtaining treatment for depression, once an individual obtains treatment they may not receive the type of care that they need. In order to examine common factors of those who experienced an unmet treatment need for depression despite seeking mental health treatment, we examined data from the 2018 National Survey of Drug Use and Health (NSDUH). We cross-sectionally compared two groups of individuals who both met criteria for a past year Major Depressive Episode (MDE) and sought mental health treatment, however one group reported an unmet treatment need and the other did not. Results indicate a variety of personal identity and social factors associated with perceiving an unmet treatment need, including age, race/ethnicity, sexual attraction, marital status, poverty level, health insurance, substance misuse, global health, and role impairment. This study contributes to the literature by providing further support for disparities in depression treatment at the consumer, provider, and systemic levels that have downstream effects for health equity policy and public health promotion.

LGBTQ+ conversion therapy and applied behavior analysis: A call to action

The term conversion therapy refers to any practices intended to alter a person's sexual orientation, gender expression, gender identity, or any combination thereof. The present-day scientific consensus is that such practices are not only ineffective, but highly harmful and fundamentally unethical. However, historical connections exist between applied behavior analysis and the design and dissemination of conversion therapy practices. The purpose of this paper is to highlight these connections and to call for further attention and action from contemporary behavior analysts on this matter. Specifically, we call for continued discussion and review of previously published conversion therapy papers according to present-day guidelines for ethical research, position statements from professional organizations, additional ethics guidelines for behavior-analytic practice, and future behavior-analytic research and practice efforts that support LGBTQ+ people.

What Are the Benefits of Educating Nurses on Transgender Health?

Transgender people frequently report negative experiences in health care settings. This is often due to a lack of cultural competence from health care staff, resulting in stigmatized and discriminatory attitudes and actions. With nurses having the greatest amount of patient interaction among health care professionals, this article examines the potential benefit of educating nurses in providing culturally competent care in the interest of improving experiences of health care for transgender people. At present, very few nurses are provided with transgender inclusive training whether as students or once registered, restricting the profession from progressing toward a transgender inclusive culture with culturally competent practitioners. The article recommends that nurses are provided with transgender inclusive education both as preregistered student nurses, and as registered nurses.

Does cultural competency training matter? A national study of anti-gay bias among cancer care professionals

PURPOSE

This study examined whether higher levels of self-reported cultural competency training were associated with less anti-gay bias among a cancer healthcare provider sample (n = 404) recruited in January 2017.

METHODS

A factorial analysis of variance (ANOVA) was performed to examine anti-gay bias across professional role, sex and level of cultural competency training using the Index of Attitudes on Homosexuality (IAH).

RESULTS

Females, F(1, 396) = 8.861, p = 0.003, ηp2 = 0.022, and those who reported higher levels of cultural training, F(1, 396) = 6.136, p = 0.014, ηp2 = 0.015 had lower mean IAH composite scores than men or those with lower levels of training, respectively. Females reported statistically significantly lower mean scores than males for Avoidance, F(1, 396) = 14.105, p < 0.001, ηp2 = 0.034. However, those with more cultural training, reported statistically significantly lower mean scores than those with less training for the Approach, F(1, 396) = 5.402, p = 0.021, ηp2 = 0.013, and Acceptance, F(1, 396) = 6.699, p = 0.010, ηp2 = 0.017 factors, regardless of sex assigned at birth.

CONCLUSION

Findings suggest that cultural competency training may moderate some aspects of anti-gay bias.

PRACTICE IMPLICATIONS

Cultural competency training may be one important strategy to improve care for sexual minority patients.

Hermeneutic comprehensions on female vulnerabilities belonging to the collective of lesbians, bisexuals, and transexuals

OBJECTIVE

To reveal the comprehension of women and health professionals about the feminine vulnerability belonging to the collective of lesbians, bisexuals, and transsexuals' women.

METHOD

Qualitative research, carried out from October 2018 to March 2019, in a Basic Health Unit located in Marabá - Pará, Brazil, using the hermeneutic-dialectic circle and inductive hermeneutic analysis. Five lesbians, bisexuals, and transsexuals' women and five health professionals participated, through interviews.

RESULTS

Health care for women, as described by the participants, promoted social and programmatic vulnerabilities structured by taboos and preconception, which endorsed exclusive professional behaviors in the provision of specific care, which consequently amplified risks and threatened the quality of life of this population.

CONCLUSION

The dissemination of this evidence is configured as an indicator to support future decisions regarding priorities, application of resources and professional training in the care of lesbians, bisexuals and transsexuals' women.

Experiences and Perceptions of Trans and Gender Non-Binary People Regarding Their Psychosocial Support Needs: A Systematic Review of the Qualitative Research Evidence

People who identify as trans and gender non-binary experience many challenges in their lives and more interest is being paid to their overall health and wellbeing. However, little is known about their experiences and perceptions regarding their distinct psychosocial needs. The aim of this systematic review is to critically evaluate and synthesize the existing research evidence relating to the unique psychological and social experiences of trans people and identify aspects that may help or hinder access to appropriate psychosocial interventions and supports. The PRISMA procedure was utilized. A search of relevant databases from January 2010 to January 2021 was undertaken. Studies were identified that involved trans people, and addressed issues related to their psychosocial needs. The search yielded 954 papers in total. Following the application of rigorous inclusion and exclusion criteria a total of 18 papers were considered suitable for the systematic review. Quality was assessed using the MMAT instrument. Following analysis, four themes were identified: (i) stigma, discrimination and marginalization (ii) trans affirmative experiences (iii) formal and informal supports, and (iv) healthcare access. The policy, education and practice development implications are highlighted and discussed. Future research opportunities have been identified that will add significantly to the body of evidence that may further the development of appropriate health interventions and supports to this population.

Social-ecological factors associated with having a regular healthcare provider among lesbian, gay, bisexual and transgender persons in Jamaica

Lesbian, gay, bisexual, and transgender (LGBT) people experience a multitude of barriers to healthcare access, particularly in highly stigmatising contexts, such as Jamaica. Access to a regular healthcare source can contribute to uptake of health knowledge and services. Yet social-ecological factors associated with access to a regular healthcare provider among LGBT persons in Jamaica are underexplored. We conducted a cross-sectional survey with LGBT persons in Jamaica to examine socio-demographic and social-ecological factors associated with having a regular healthcare provider. Nearly half (43.6%) of 911 participants reported having a regular healthcare provider. In multivariate analyses, socio-demographic factors (higher age; identifying as a cisgender sexual minority man or woman compared to a transgender woman) were associated with higher odds of having a regular healthcare provider. Socio-demographic (living in Ocho Rios or Montego Bay compared to Kingston), stigma/discrimination (a bad past healthcare experience), and structural factors (insufficient money for housing; reporting medication costs as a barrier; no health insurance) were associated with decreased odds of having a regular healthcare provider. Findings support a multi-level approach to understanding and addressing barriers to having a regular healthcare provider among LGBT people in Jamaica.

Barriers to palliative care in sexual and gender minority patients with cancer: A scoping review of the literature

The Institute of Medicine reports lesbian, gay, bisexual and transgender (LGBT) individuals having the highest rates of tobacco, alcohol and drug use leading to elevated cancer risks. Due to fear of discrimination and lack of healthcare practitioner education, LGBT patients may be more likely to present with advanced stages of cancer resulting in suboptimal palliative care. The purpose of this scoping review is to explore what is known from the existing literature about the barriers to providing culturally competent cancer-related palliative care to LGBT patients. This review will use the five-stage framework for conducting a scoping review developed by Arksey and O'Malley. The PubMed, Scopus, PsychINFO and Cochrane electronic databases were searched resulting in 1,442 citations. Eligibility criteria consisted of all peer-reviewed journal articles in the English language between 2007 and 2020 resulting in 10 manuscripts. Barriers to palliative cancer care for the LGBT include discrimination, criminalisation, persecution, fear, distress, social isolation, disenfranchised grief, bereavement, tacit acknowledgment, homophobia and mistrust of healthcare providers. Limited healthcare-specific knowledge by both providers and patients, poor preparation of legal aspects of advanced care planning and end-of-life care were underprovided to LGBT persons. As a result of these barriers, palliative care is likely to be provided for LGBT patients with cancer in a deficient manner, perpetuating marginalisation and healthcare inequities. Minimal research investigates these barriers and healthcare curriculums do not provide practitioners skills for administering culturally sensitive palliative care to LGBT patients.

"It Made Me Feel Like I Didn't Know My Own Body": Patient-Provider Relationships, LGBTQ+ Identity, and End-of-Life Discussions

PURPOSE

LGBTQ+ individuals experience multiple challenges receiving quality care at the end of life, such as lack of confidence in the healthcare system to address their needs and lack of knowledge about advance care planning. Important gaps remain about the needs of LGBTQ+ individuals in the provider-patient relationship and how critical discussions about the end of life occur or do not occur in that relationship. The purpose of this study is to explore patients' narratives of their relationship with their provider and their experiences discussing end-of-life care with their providers, among patients who do and do not identify as LGBTQ+.

METHODS

Twenty-nine attendants of an event devoted to LGBTQ+ health, 15 of which identified as LGBTQ+, completed an altered version of the CAHPS® Patient Narrative Elicitation Protocol. We used inductive content analysis to qualitatively analyze the data.

RESULTS

Respondents described wanting to be heard, finding safety and trust, and valuing competency in their relationship with their provider. Respondents who identified as LGBTQ+ additionally 1) valued providers who avoided making assumptions, 2) looked for cues of safety to indicate they would be accepted by the provider, and 3) sought providers competent in LGBTQ+ care needs. Few respondents had discussed end-of-life care with their provider, although some assumed that their provider may or may not be able to meet their needs based on aspects of their provider-patient relationship.

CONCLUSIONS

Strengthening patient-provider relationships may help improve the care of LGBTQ+ populations, particularly for the end of life.

Barriers and Facilitators to Cancer Screening Among LGBTQ Individuals With Cancer

PROBLEM IDENTIFICATION

Cancer screening may reduce mortality and frequency of the disease. Lesbian, gay, bisexual, transgender, or queer (LGBTQ) individuals are less likely than non-LGBTQ individuals to present for cancer screening.

LITERATURE SEARCH

A literature search was performed using CINAHL®, PsycINFO®, and PubMed®. Articles were included if they were published in English from 2008 to 2018 and addressed barriers or facilitators to cancer screening in LGBTQ populations.

DATA EVALUATION

Data were organized by thematic matrix and classified according to the multilevel influences on the cancer care continuum framework.

SYNTHESIS

This integrative review found that the lack of cancer screening data and knowledge about screening guidelines by LGBTQ populations and providers were major barriers to cancer screening adherence. Provider-created welcoming environments and caregiver inclusion were facilitators.

IMPLICATIONS FOR PRACTICE

Determinants of health-seeking behavior included patients' and providers' lack of cancer screening knowledge, as well as perceived discrimination. Nurses are in a unique position to provide cancer screening information and culturally sensitive care for LGBTQ populations with adequate education.

Nurses' Knowledge and Attitudes toward Lesbians Seeking Perinatal Care in Israel

In recent decades, there has been an increasing tendency among lesbians to realize their desire to become parents. Nurses provide perinatal care to lesbians at women's healthcare centres from the pregnancy planning stage until childbirth, serving as a source of information, advice and support. However, little is known about nurses' personal and professional characteristics, including knowledge and attitudes concerning perinatal care of lesbians at women's health centres. The current study was a cross sectional study that assessed a convenience sample of 184 nurses who provide perinatal care to lesbians at women's health centres belonging to the two largest health organizations in Israel. The average score received by participants on a homosexuality knowledge questionnaire was 10.4 on a scale of 0-17, indicating moderate levels of factual knowledge about homosexuality. Of all nurses surveyed, 83.2% had negative attitudes with regard to the treatment of lesbians. Nurses' personal and professional characteristics were found to be associated with these attitudes.

"Sex Can Be a Great Medicine": Sexual Health in Oncology Care for Sexual and Gender Minority Cancer Patients

Purpose of review

Until recently, sexual and gender minority (SGM) people have been largely invisible in health care and health services research. However, understanding the needs and experiences of SGM cancer patients is critical to providing high-quality care, including needs and experiences related to sexual health. In this narrative review, we highlight that the literature on sexual health for SGM people with cancer is lacking, summarize existing literature on disparities affecting SGM patients with cancer, and discuss factors associated with these disparities. We conclude with recommendations and suggestions for future research in this area.

Recent Findings

Emerging evidence suggests that SGM people are at a higher risk for breast, cervical, endometrial, HPV-related, and lung cancers, as well as poor cancer outcomes, due to behavioral risk factors and health care system factors (e.g. lower access to health care insurance, discrimination in non-affirming care settings, negative health care interactions with providers). Additional research suggests that lack of clear guidelines for cancer screening in SGM patients, particularly for transgender and gender diverse patients, negatively impacts cancer screening uptake among SGM people. A growing number of studies have suggested greater sexual challenges following cancer treatment for sexual minority men with prostate cancer, while other studies highlight positive outcomes for sexual minority women following cancer treatment, such as benefit finding and resilience. Research on transgender and gender diverse patients is lacking.

Summary

Collection of sexual orientation and gender identity data across clinical enterprises and population-based surveys, mandatory health care provider training on cultural and clinical competency with SGM patients, and additional research inclusive of and focused on SGM cancer patients are key strategies to advance evidence-based clinical cancer care for diverse SGM populations.

A systematic review of stigma in sexual and gender minority health interventions

Stigma against sexual and gender minorities is a major driver of health disparities. Psychological and behavioral interventions that do not address the stigma experienced by sexual and gender minorities may be less efficacious. We conducted a systematic review of existing psychological and behavioral health interventions for sexual and gender minorities to investigate how interventions target sexual and gender minority stigma and consider how stigma could affect intervention efficacy. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Eligible studies were peer reviewed and published in English between January 2003 and July 2019 and reported empirical results of behavioral or psychological interventions implemented among sexual and gender minorities. All interventions addressed stigma. We identified 37 eligible interventions. Most interventions targeted sexual minority men. Interventions were frequently developed or adapted for implementation among sexual and gender minorities and addressed multiple levels and types of stigma. Interventions most frequently targeted proximal stressors, including internalized and anticipated stigma. HIV and mental health were the most commonly targeted health outcomes. A limited number of studies investigated the moderating or mediating effects of stigma on intervention efficacy. The application of an intersectional framework was frequently absent and rarely amounted to addressing sources of stigma beyond sexual and gender minority identities. A growing number of interventions address sexual and gender minority stigma in an effort to prevent deleterious health effects. Future research is needed to assess whether stigma modifies the effectiveness of existing psychological and behavioral interventions among sexual and gender minorities. Further, the application of intersectional frameworks is needed to more comprehensively intervene on multiple, intersecting sources of stigma faced by the diverse sexual and gender minority community.

Improving the care management of trans patients: Focus groups of nursing students' perceptions

AIM

To know the perspectives of nursing students in trans patients' care and their access to health services and how to improve the quality of care in trans patients, related to the barriers identified by nursing students.

BACKGROUND

Lesbian, gay, bisexual, transgender, queer and plus (LGBTQ+) find barriers related to the health care access, including stigma, discrimination and lack of education. In addition, to the transphobia reported in some health care providers.

METHODS

A descriptive qualitative study was performed through 12 focus group interviews in nursing students. Data analysis was based on content analysis.

RESULTS

124 first-year nursing students participated. The qualitative analysis resulted in three major themes: (a) Exposing an invisible reality, (b) Interprofessional communication: a starting point to arise awareness and (c) Care with pride as a link between individuality and professionalism.

CONCLUSIONS

Our findings suggest that both LGBTQ+ content and institutional resources are the cornerstone for nursing students and professionals' practice in order to develop and provide a well-informed and high-quality care delivery to these patients.

IMPLICATIONS FOR NURSING MANAGEMENT

Policymakers, senior charge nurses and other managers should be aware of the structural-level changes identified and ongoing mentoring needed to guarantee trans patients' privacy and safety.

"Straight Sex is Complicated Enough!": The Lived Experiences of Autistics Who are Gay, Lesbian, Bisexual, Asexual, or Other Sexual Orientations

Autistics are more likely than neurotypicals to be gay, lesbian, bisexual, asexual, and other sexual orientations. Autistics and sexual minorities represent populations at high risk for depression, anxiety, and suicidality. Little is known about the experiences of individuals living at this intersection. In this phenomenology, 67 individuals who identified as autistic sexual minorities participated in online interviews to describe the meaning of their experiences. Six themes emerged, including: self-acceptance is a journey; autistic traits complicate self-identification of sexual orientation; social and sensory stressors affect sexual expression; feeling misunderstood and isolated; challenges finding mutually satisfying relationships; and difficulty recognizing and communicating sexual needs. Autistic sexual minorities experience a "double minority" status that complicates identity formation and increases vulnerability in sexual relationships.

Family relationships in the social network for young male homosexuals

OBJECTIVE

To evaluate the family relationships in the social network for young male homosexuals.

METHODS

this is a qualitative, descriptive, exploratory study anchored in the theoretical framework Social Network and including 20 male homosexuals selected by the Snowball technique through semi-structured script interview. The IRaMuTeQ software was analyzed by Similitude Analysis.

RESULTS

the primary social network was configured in the elements: 1 - Family affective ties: the center of the social network, 2 - Binding family relationship and religiosity.

FINAL CONSIDERATIONS

it was evaluated that the primary social network has been rooted to fragile relationships of socialization and solidarity, and that the social dimension is also rooted on conservatism, sexism/bigotry, and violence. When it comes to address this issue creates the contribution to the visibility of the homosexual youth family dynamics, since it represents the central core and first learning experience that will determine the development and ability to deal with adversities.

Survivors' Perceptions of Quality of Colorectal Cancer Care by Sexual Orientation

OBJECTIVE

The objective of this study was to assess sexual minority and heterosexual survivors' perceived quality of cancer care and identify demographic, clinical, and psychosocial characteristics associated with patient-centered quality of care.

MATERIALS AND METHODS

Four cancer registries provided data on 17,849 individuals who were diagnosed with stage I, II, or III colorectal cancer an average of 3 years prior and resided in predetermined diverse geographic areas. A questionnaire, which queried about sexual orientation and other eligibility criteria was mailed to all cancer survivors. Of these, 480 eligible survivors participated in a telephone survey. Quality of cancer care was defined by 3 measures of interpersonal care (physician communication, nursing care, and coordination of care) and by rating cancer care as excellent. We used generalized linear models and logistic regression with forward selection to obtain models that best explained each quality of care measure.

RESULTS

Sexual minority survivors rated physician communication, nursing care, and coordination of care similarly to heterosexual survivors, yet a significantly higher percentage of sexual minority survivors rated the overall quality of their cancer care as excellent (59% vs. 49%). Sexual minority survivors' greater likelihood of reporting excellent care remained unchanged after adjusting for demographic, clinical, and psychosocial characteristics.

CONCLUSIONS

Sexual minority survivors' ratings of quality of colorectal cancer care were comparable or even higher than heterosexual survivors. Sexual minority survivors' reports of excellent care were not explained by their interpersonal care experiences.

Cancer screening utilization by residence and sexual orientation

PURPOSE

Although few studies have examined screening uptake among sexual minorities (lesbian, gay, bisexual, queer), almost none have examined it in the specific context of rural populations. Therefore, our objective was to assess how cancer screening utilization varies by residence and sexual orientation.

METHODS

Publicly available population-level data from the 2014 and 2016 Behavioral Risk Factor Surveillance System were utilized. Study outcomes included recommended recent receipt of breast, cervical, and colorectal cancer screening. Independent variables of interest were residence (rural/urban) and sexual orientation (heterosexual/gay or lesbian/bisexual). Weighted proportions and multivariable logistic regressions were used to assess the association between the independent variables and the outcomes, adjusting for demographic, socioeconomic, and healthcare utilization factors.

RESULTS

Rates for all three cancer screenings were lowest in rural areas and among sexual minority populations (cervical: rural lesbians at 64.8% vs. urban heterosexual at 84.6%; breast: rural lesbians at 66.8% vs. urban heterosexual at 80.0%; colorectal for males: rural bisexuals at 52.4% vs. urban bisexuals at 81.3%; and colorectal for females: rural heterosexuals at 67.2% vs. rural lesbians at 74.4%). In the multivariate analyses for colorectal screening, compared to urban heterosexual males, both rural gay and rural heterosexual males were less likely to receive screening (aOR = 0.45; 95% = 0.24-0.73 and aOR = 0.79; 95% = 0.72-0.87, respectively) as were rural heterosexual females (aOR = 0.87; 95% = 0.80-0.94) compared to urban heterosexual females. For cervical screening, lesbians were less likely to receive screening (aOR = 0.62; 95% = 0.41-0.94) than heterosexuals, and there were no differences for breast screening.

CONCLUSION

We found that rural sexual minorities may experience disparities in cancer screening utilization associated with the compounding barriers of rural residence and sexual minority status, after adjusting for demographic, socioeconomic, and healthcare utilization factors. Further work is needed to identify factors influencing these disparities and how they might be addressed.