Social Justice Considerations for Lesbian and Bisexual Women's Health Care

Tobacco dependence treatment for special populations: challenges and opportunities

Although smoking rates have declined in most of the countries in the world, there are population groups within these countries whose smoking rates remain significantly higher than the general population. These "forgotten groups" who have not been receiving the needed attention in tobacco control policies and tobacco cessation efforts include people with serious mental illness, substance use disorders, tuberculosis, people living with human immunodeficiency virus (HIV), lesbian-gay-bisexual-transgender-queer people, and pregnant women. A number of steps are needed at the national level in countries where these disparities exist, including modifications to national smoking cessation treatment guidelines that address the special needs of these populations, as well as targeted smoking cessation research, since these populations are often not included in clinical trials. Because of the higher smoking prevalence in these populations, as well as their lower smoking cessation treatment success rates than the general population, more resources are needed if we are to reduce health disparities in these vulnerable populations. Additionally, we believe that more effort should be focused on integrating smoking cessation treatment in the specialized care settings frequented by these subpopulations.

Hearing the Silenced Voices of Underserved Women: The Role of Qualitative Research in Gynecologic and Reproductive Care

In order to provide effective evidence-based health care to women, rigorous research that examines women's lived experiences in their own voices is needed. However, clinical health research has often excluded the experiences of women and minority patient populations. Further, clinical research has often relied on quantitative research strategies; this provides an interesting but limited understanding of women's health experiences and hinders the provision of effective patient-centered care. This article defines qualitative research and its unique contributions to research, and provides examples of how qualitative research has given insights into the reproductive health perspectives and behaviors of underserved women.

Lesbian womens' access to healthcare, experiences with and expectations towards GPs in German primary care

Background

Lesbian women have higher rates of physical and psychiatric disorders associated with experiences of discrimination, homophobia and difficulties with coming out. Therefore, easy access to specialized healthcare in an open atmosphere is needed. We aimed to describe women’s access to and experiences with healthcare in Germany, and to assess the responsibility of the general practitioner (GP) compared to other specialities providing primary health care.

Methods

A questionnaire study was conducted via internet and paper-based sampling. Using current literature, we designed a questionnaire consisting of sociodemographic data, sexual orientation, access to care and reasons for encounter, disclosure of sexual orientation, experience with the German health system (discrimination, homophobia), and psychological burden. Depression was assessed using the depression screening from the Patient Health Questionnaire (PHQ-2).

Results

We obtained responses from 766 lesbian women. Although 89% had a primary care physician, only 40% had revealed their sexual orientation to their doctor. The main medical contacts were GPs (66%), gynaecologists (10%) or psychiatrists (6%). Twenty-three percent claimed they were unable to find a primary care physician. Another 12.4% had experienced discrimination. Younger lesbian women with higher education levels and who were less likely to be out to other physicians were more likely to disclose their sexual orientation to their primary care physician. GPs play an important role in healthcare for lesbian women, even in a non-gatekeeping healthcare system like Germany. Study participants suggested improvements regarding gender neutral language, flyers on homosexuality in waiting areas, involvement of partners, training of physicians, directories of homosexual physicians and labelling as a lesbian-friendly practice.

Conclusions

GPs should create an open atmosphere and acquire the respective knowledge to provide adequate treatment. Caring for marginal groups should be incorporated in medical training and further education. Ideally, physicians address patients’ sexual orientation pro-actively in order to address individual needs accordingly.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-016-0562-4) contains supplementary material, which is available to authorized users.

Promoting health in lesbian and bisexual women: it is not just about behaviour change

AIMS AND OBJECTIVES

To highlight different ways that healthcare professionals can promote health and reduce health inequalities of lesbian and bisexual women using a health promotion framework that focusses on the wider healthcare context.

BACKGROUND

Lesbian and bisexual women experience numerous health disparities that place them at high risk of poor health outcomes. The Frieden health impact pyramid (American Journal for Public Health, 100, 2010 and 590) identifies five tiers of public health interventions. This pyramid could be used to promote health in lesbian and bisexual women in healthcare settings.

DESIGN

A discursive paper.

METHODS

Literature was searched from 2008-2015 using PubMed, ScienceDirect and published grey literature. Individual key words were used to locate articles that focused on lesbian and bisexual women's health inequalities and to identify the interventions to address these.

RESULTS

Examples are presented across the tiers of the health impact pyramid in the context of healthcare settings that healthcare practitioners could action to promote health in lesbian and bisexual women.

CONCLUSIONS

The use of the Frieden triangle offers an alternative way to promote health by conceptualising health promotion interventions that promote lesbian and bisexual women without just focusing on behaviour change. The importance of changing areas of practice in healthcare organisations to be more supportive of lesbian and bisexual women and their healthcare needs is highlighted.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the ways that healthcare professionals can promote health of lesbian and bisexual women within their healthcare practice to help reduce health disparities.

Health promotion of lesbian woman: nursing care

The aim of this study was to analyze national and international scientific literature on nursing care for lesbian women. An integrative approach was adopted to review studies from MEDLINE, LILACS, BDENF and SCOPUS databases and SciELO and Cochrane libraries using the keywords: female homosexuality, nursing care, health promotion and women's health. Studies published between 1990 and 2013 in English, Portuguese or Spanish were considered for analysis. After analyzing data, four international studies were selected, being that three were from the United States and one was from Canada. This study revealed a scarcity of Brazilian and international studies and the importance of increasing scientific literature on this topic.

[The lesbian population in health studies: contributions for a critical reflection]

For decades, lesbian sexuality was associated with pathology in the attitudes to and practices of health sciences and psychology. During the twentieth century that position changed gradually. This article analyzes these changes in a theoretical reflection on the domain of lesbian health, dominated by heteronormative and heterosexist concepts and practices both in research and in health care. By means of a critical contextualization of the literature, specific health needs of lesbians were identified and the interventions of health care professionals and services were questioned. Specific concrete actions are proposed in the fields of health promotion and in the eradication of discrimination and inequality in health care.