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Hofmann MC, Mulligan NF, Bell KA, Condran C, Scarince HJ, Gulik E, He V, Hill F, Wolff E, Jensen G. LGBTQIA+ Cultural Competence in Physical Therapy: An Exploratory Qualitative Study From the Clinician's Perspective. Phys Ther 2024; 104:pzae010. [PMID: 38302087 DOI: 10.1093/ptj/pzae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/14/2023] [Accepted: 11/22/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The purpose of this study was to understand the lesbian, gay, bisexual, transgender, queer, intersex, agender, and other gender and sexually diverse identities (LGBTQIA+) health care experience and associated cultural competence from the physical therapist perspective (physical therapist and physical therapist assistant). METHODS An exploratory qualitative approach implementing semi-structured focus groups and private interviews was utilized. To further anonymity, researchers allowed subjects to keep their camera off on Zoom. An interview protocol included questions guided by Campinha-Bacote domains of cultural competence (cultural awareness, skill, knowledge, encounter, and desire) to collect individual experiences, stories, discussions, thoughts, and opinions. Physical therapist clinicians were recruited from the clinical education affiliation lists of Regis University and Thomas Jefferson University. Seventy-one practicing physical therapists from the USA agreed to be part of the study. RESULTS Themes were organized using the Social Ecological Model Framework. Themes are in parentheses following each level of the Social Ecological Model and include intrapersonal level (psychological stress and implicit and explicit biases), interpersonal (acceptance and competency), organizational (experience), community (advocacy), and society and policy (explicit biases and policy). CONCLUSION Cultural competence in physical therapy is influenced by intrapersonal, interpersonal, organizational, community, and social and policy factors. Themes of psychological stress, limited awareness, decreased acceptance, and competency as well as limited exposure and experience, and a lack of advocacy and broader societal and policy issues prevent adequate LGBTQIA+ cultural competency of physical therapist providers. Further research in the physical therapist profession is needed to elaborate on the student, educator, and patient perspectives and how this information informs the LGBTQIA+ cultural competence of clinicians. IMPACT This project may have a significant impact on suggestions for the delivery of content for health profession education to best impact health equity goals and save lives. Implementation of this content may have a direct impact on health disparities in LGBTQIA+ populations by reducing stigma and discrimination from health care providers, thus improving quality of health care and decreasing rates of patient mortality for LGBTQIA+ individuals.
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Affiliation(s)
| | - Nancy F Mulligan
- School of Physical Therapy, Regis University, Denver, Colorado, USA
| | - Karla A Bell
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Chris Condran
- Harrisburg University of Science and Technology, Harrisburg University, Harrisburg, Pennsylvania, USA
| | | | - Eileen Gulik
- School of Physical Therapy, Regis University, Denver, Colorado, USA
| | - Vivian He
- School of Physical Therapy, Regis University, Denver, Colorado, USA
| | - Felix Hill
- School of Physical Therapy, Regis University, Denver, Colorado, USA
| | - Erin Wolff
- School of Physical Therapy, Regis University, Denver, Colorado, USA
| | - Gail Jensen
- School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, USA
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Hickey PM, Best LA, Speed D. Access to Healthcare and Unmet Needs in the Canadian Lesbian-Gay-Bisexual Population. JOURNAL OF HOMOSEXUALITY 2023:1-19. [PMID: 38019536 DOI: 10.1080/00918369.2023.2287034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Individuals who identify as a sexual minority, including those who are lesbian, gay, or bisexual (LGB), face barriers to healthcare as well as increased discrimination, stigmatization, and negative experiences during healthcare use. Further, few healthcare providers have education and training focused on the specific healthcare needs of individuals who are part of a sexual minority group. Given the limited research on Canadian healthcare access for sexual minorities, our purpose was to use data (n > 2,800) from the 2015-16 Canadian Community Health Survey (CCHS) to investigate the perceptions of healthcare access for LGB and non-LGB Canadians. Although non-LGB and LGB participants reported comparable access to a regular care provider and were equally likely to have consulted with a general practitioner in the past 12 months, LGB respondents were more likely to have seen a specialist and reported more unmet health needs. Although we expected the linear effects of both race and sex to vary by LGB status, this effect only occurred in one model. Current results have implications for addressing health inequalities for sexual minorities, including poorer health outcomes and greater discrimination.
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Affiliation(s)
- Patrick M Hickey
- Department of Psychology, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Lisa A Best
- Department of Psychology, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - David Speed
- Department of Psychology, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
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3
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Mitchell LA, Jacobs C, McEwen A. (In)visibility of LGBTQIA+ people and relationships in healthcare: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 114:107828. [PMID: 37301011 DOI: 10.1016/j.pec.2023.107828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/16/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To identify and map research into the visibility of LGBTQIA+ people and their relationships in healthcare, with the view to inform future research and practice. METHOD Five databases were systematically searched for published and grey literature. Primary research reporting on visibility of LGBTQIA+ people in healthcare was included. Two reviewers independently screened the studies until an acceptable level of agreement was reached. A narrative synthesis was conducted and findings mapped to a taxonomy of microaggressions involving three sub-categories: microinsults, microassaults and microinvalidations. RESULTS The microaggressions identified included Microinsults: 'Perception of health professionals' knowledge and comfort' and 'Disclosure'; Microassaults: 'Discrimination and stigma'; Microvalidations: 'Accessing and navigating through services', 'Encounters of assumptions and stereotypes', 'Validating identities and including relationships', and 'Reading the environment'. CONCLUSION Despite growing societal acceptance, microaggressions still exist within healthcare. Groups within LGBTQIA+ communities have varying levels of visibility in research and healthcare based on the studies included. PRACTICE IMPLICATIONS The limited visibility of LGBT and lack of visibility of QIA+ people and their relationships in healthcare highlight the need to include the views of all LGBTQIA+ communities in research, and to ensure health professionals and clinical services are equipped to address this (in)visibility gap.
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Affiliation(s)
- Lucas A Mitchell
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia; Clinical Translation and Engagement Platform, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Australia.
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Pratiwi AB, Padmawati RS, Mulyanto J, Willems DL. Patients values regarding primary health care: a systematic review of qualitative and quantitative evidence. BMC Health Serv Res 2023; 23:400. [PMID: 37098522 PMCID: PMC10131468 DOI: 10.1186/s12913-023-09394-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 09/15/2022] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Accessible and high-quality primary health care (PHC) is fundamental to countries moving towards universal health coverage. In order to improve the quality of patient-centered care provided in PHC, a comprehensive understanding of patients' values is crucial to address any gaps in the health care system. This systematic review aimed to identify patients' values relevant to PHC. METHODS We searched primary qualitative and quantitative studies about patients' values related to primary care in PubMed and EMBASE (Ovid) from 2009 to 2020. The studies' quality was assessed using Joanna Briggs Institute (JBI) Critical Appraisal Checklist for both quantitative and qualitative studies and Consolidated Criteria for Reporting Qualitative Studies (COREQ) for qualitative studies. A thematic approach was used in the data synthesis. OUTCOME The database search resulted in 1,817 articles. A total of 68 articles were full-text screened. Data were extracted from nine quantitative and nine qualitative studies that met the inclusion criteria. The participants of the studies were mainly the general population in high-income countries. Four themes emerged from the analysis: patients' values related to privacy and autonomy; values associated with the general practitioners including virtuous characteristics, knowledge and competence; values involving patient-doctor interactions such as shared decision-making and empowerment; and core values related to the primary care system such as continuity, referral, and accessibility. CONCLUSIONS This review reveals that the doctor's personal characteristics and their interactions with the patients are critical considerations concerning the primary care services from the patients' point of view. The inclusion of these values is essential to improve the quality of primary care.
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Affiliation(s)
- Agnes Bhakti Pratiwi
- Department of Ethics, Law, and Humanities, Faculty of Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Retna Siwi Padmawati
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center for Bioethics and Medical Humanities, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Joko Mulyanto
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
- Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick L Willems
- Department of Ethics, Law, and Humanities, Faculty of Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
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5
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Braybrook D, Bristowe K, Timmins L, Roach A, Day E, Clift P, Rose R, Marshall S, Johnson K, Sleeman KE, Harding R. Communication about sexual orientation and gender between clinicians, LGBT+ people facing serious illness and their significant others: a qualitative interview study of experiences, preferences and recommendations. BMJ Qual Saf 2023; 32:109-120. [PMID: 36657773 PMCID: PMC9887369 DOI: 10.1136/bmjqs-2022-014792] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Healthcare organisations have legal and ethical duties to reduce inequalities in access to healthcare services and related outcomes. However, lesbian, gay, bisexual and/or transgender (LGBT+) people continue to experience and anticipate discrimination in health and social care. Skilled communication is vital for quality person-centred care, but there is inconsistent provision of evidence-based clinician education on health needs and experiences of LGBT+ people to support this. This study aimed to identify key stakeholders' experiences, preferences and best practices for communication regarding sexual orientation, gender identity and gender history in order to reduce inequalities in healthcare. METHODS Semistructured qualitative interviews with LGBT+ patients with serious illness, significant others and clinicians, recruited via UK-wide LGBT+ groups, two hospitals and one hospice in England. We analysed the interview data using reflexive thematic analysis. RESULTS 74 stakeholders participated: 34 LGBT+ patients with serious illness, 13 significant others and 27 multiprofessional clinicians. Participants described key communication strategies to promote inclusive practice across three domains: (1) 'Creating positive first impressions and building rapport' were central to relationship building and enacted through routine use of inclusive language, avoiding potentially negative non-verbal signals and echoing terminology used by patients and caregivers; (2) 'Enhancing care by actively exploring and explaining the relevance of sexual orientation and gender identity', participants described the benefits of clinicians initiating these discussions, pursuing topics guided by the patient's response or expressed preferences for disclosure. Active involvement of significant others was encouraged to demonstrate recognition of the relationship; these individual level actions are underpinned by a foundation of (3) 'visible and consistent LGBT+ inclusiveness in care systems'. Although participants expressed hesitance talking about LGBT+ identities with individuals from some sociocultural and religious backgrounds, there was widespread support for institutions to adopt a standardised, LGBT+ inclusive, visibly supportive approach. CONCLUSIONS Person-centred care can be enhanced by incorporating discussions about sexual orientation and gender identity into routine clinical practice. Inclusive language and sensitive exploration of relationships and identities are core activities. Institutions need to support clinicians through provision of adequate training, resources, inclusive monitoring systems, policies and structures. Ten inclusive communication recommendations are made based on the data.
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Affiliation(s)
- Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Liadh Timmins
- Columbia Spatial Epidemiology Lab, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Anna Roach
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | | - Paul Clift
- Patient and Public Involvement member, London, UK
| | - Ruth Rose
- Patient and Public Involvement member, Brighton, UK
| | - Steve Marshall
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK,Palliative Care, Cicely Saunders Institute, King's College Hospital NHS Foundation Trust, London, UK
| | - Katherine Johnson
- School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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McNeill SG, McAteer J, Jepson R. Interactions Between Health Professionals and Lesbian, Gay and Bisexual Patients in Healthcare Settings: A Systematic Review. JOURNAL OF HOMOSEXUALITY 2023; 70:250-276. [PMID: 34292130 DOI: 10.1080/00918369.2021.1945338] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The ways in which health professionals (HPs) interact with individuals from sexual minorities can impact their perception of the health service and influence engagement. This systematic literature review aimed to identify and synthesize the qualitative literature exploring interactions between HPs and lesbian, gay and bisexual (LGB) patients in healthcare settings. A search strategy was developed and applied to CINAHL and Medline, inclusion criteria were then applied to results by two screeners with good agreement. Thematic analysis was carried out on papers meeting the inclusion criteria in three stages, beginning with coding the text line-by-line, developing descriptive themes and finally, analytical themes. Electronic searches identified 348 papers with 20 of these meeting the inclusion criteria. Thematic analysis found five themes; HPs' lack of knowledge regarding LGB specific issues, identification of sexual orientation, discomfort in interactions, LGB patients' experience of heteronormative attitudes and perceived judgment or other negative attitudes.
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Affiliation(s)
- Sarah G McNeill
- Centre for Public Health, Royal Victoria Hospital, Belfast, United Kingdom
- Scottish Collaboration for Public Health Research and Policy (SCPHRP), School of Health in Social Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - John McAteer
- Grow Public Health Research and Consultancy, Edinburgh, Scotland, United Kingdom
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy (SCPHRP), School of Health in Social Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
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Poupon C, Poirier M, Blum Y, Lagarrigue S, Parléani C, Vibet MA, Winer N. Difference in Pap test uptake between women who have sex with women and other women in France: A comparative survey of 2032 women. Prev Med Rep 2022; 30:101990. [PMID: 36193090 PMCID: PMC9525892 DOI: 10.1016/j.pmedr.2022.101990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 10/26/2022] Open
Abstract
The elimination of cervical cancer has been a priority of the World Health Organization since 2018. The number of these cancers induced by the human papillomavirus (HPV) could be drastically reduced through vaccination and regularly screening by Pap tests. Guidelines for cervical cancer screening apply to all women, including those who have sexual relations with women (WSW), as HPV can be transmitted during sex between two women. As far as we know, our study is the first that compare the Pap test rate between WSW and other women in France. We developed an 18-item questionnaire available on the internet for 15 days and finally analyzed the responses of 2032 women. Based on their responses about their self-definition of their sexual orientation and their sexual behavior, we classified them into three groups of women: exclusive WSW, mixed WSW, and non-WSW. For each question, we tested the statistical differences in responses between these three groups. Our study shows in a large sample representative of the French population that exclusive WSW undergo Pap tests significantly less often than either mixed WSW or non-WSW. Among the exclusive WSW, 28.9 % had never had a Pap test, compared with 9 % of the mixed WSW and 3.1 % of non-WSW (p < 0,001). The responses to our questionnaire contribute to an understanding of this disparity and thus help to envision solutions for better care of all women, regardless of their sexual orientation; this point is crucial for prevention of cervical cancer.
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Affiliation(s)
- Camille Poupon
- Medico-psychosocial Obstetrical and Gynecology unit (UGOMPS)
| | - Maud Poirier
- Medico-psychosocial Obstetrical and Gynecology unit (UGOMPS)
| | - Yuna Blum
- Univ Rennes, CNRS, INSERM, IGDR (Institut de Génétique et Développement de Rennes) - UMR6290, ERL U1305, 35000 Rennes, France
| | | | - Cécile Parléani
- Medico-psychosocial Obstetrical and Gynecology unit (UGOMPS)
| | - Marie-Anne Vibet
- Methodology and Biostatistics Platform, Direction of Research and Innovation, University Hospital of Nantes, France
| | - Norbert Winer
- Medico-psychosocial Obstetrical and Gynecology unit (UGOMPS).,Department of Gynaecology and Obstetrics, University Hospital of Nantes, NUN INRAE PhAN, UMR 1280, F-44000, France
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8
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Primary Healthcare Nurse’s Barriers and Facilitators to Providing Sexual and Reproductive Healthcare Services of LGBTQI Individuals: A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10112208. [DOI: 10.3390/healthcare10112208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/18/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
In most cases, we only hear Lesbians, Gays, Bisexuals, Transgender, Queer, and Intersex (LGBTQI) patients complaining about nurses being the reason for not accessing and utilizing healthcare services; for example, studies reports on the different attitudes of healthcare providers including nurses against LGBTQI patients. However, factors influencing the behavior of South African Primary Healthcare (PHC) Nurses toward LGBTQI patients are rarely reported. The study aimed to explore how PHC nurses experienced and perceived sexual and reproductive health services for LGBTQI individuals in Tshwane, Gauteng Province, South Africa. The study followed qualitative research using an exploratory design approach. The sample included 27 PHC nurses from Tshwane, Gauteng Province, South Africa. In-depth face-to-face interviews were coded and analyzed using Thematic Content Analysis (TCA) which included five interrelated steps. The results revealed three main themes: barriers to the provision of LGBTQI-related SRHS, facilitators for the provision of SRHS to LGBTQI individuals, and strategies to improve LGBTQI individuals’ SRHS accessibility and availability. Common barriers were related to the institutions, PHC nurses, the general public, and LGBTQI patients themselves. Regardless of the challenges faced by PHC nurses, there were some enabling factors that pushed them to continue rendering SHRS to LGBTQI patients who came to their clinics. Almost all PHC nurses suggested the importance of awareness, transparency, collaboration, and the need for training related to LGBTQI healthcare issues.
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9
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Gregory KB, Mielke JG, Neiterman E. Building Families Through Healthcare: Experiences of Lesbians Using Reproductive Services. J Patient Exp 2022; 9:23743735221089459. [PMID: 35372679 PMCID: PMC8966110 DOI: 10.1177/23743735221089459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The use of assisted human reproduction (AHR) represents a meaningful and important life event for lesbians wishing to create biologically related families. Despite increasing numbers of lesbians utilizing AHR services, barriers to access persist. This qualitative study investigated the experiences of lesbians and their interactions with reproductive services in Ontario, Canada, where limited public funding is available for all AHR patients and where the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community makes up to 30% of clientele. Eleven semi-structured interviews were conducted, and findings revealed a wide range of experiences. Lesbian patients expressed a desire for more support from their care providers in navigating a complex and costly medical journey through a system largely designed for the needs of heterosexual patients. Additionally, private fertility clinics, as the environment for accessing publicly funded services, were felt to contribute pressure to pay out-of-pocket for add-on medical procedures. To improve the quality of care, participants recommended providing more high-level information on the medical journey and taking an individual approach with lesbian patients, in particular, assuming a patient has sufficient fertility until proven otherwise.
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Affiliation(s)
- Kelly B Gregory
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - John G Mielke
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Elena Neiterman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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10
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Tabaac AR, Sutter ME, Haneuse S, Agénor M, Bryn Austin S, Guss CE, Charlton BM. The interaction of sexual orientation and provider-patient communication on sexual and reproductive health in a sample of U.S. women of diverse sexual orientations. PATIENT EDUCATION AND COUNSELING 2022; 105:466-473. [PMID: 34023174 PMCID: PMC8594287 DOI: 10.1016/j.pec.2021.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Our goal was to examine associations among provider-patient communication, past-year contraceptive use and lifetime sexually transmitted infection. METHODS Data were analyzed cross-sectionally from 22,554 women in the Growing Up Today Study and Nurses' Health Study 3 between the follow-up period of 1996-2020. We used multivariable Poisson regression models adjusted for race/ethnicity, age in years, study cohort, and region of residence to obtain risk ratio (RR) associations and 95% confidence intervals (CI). RESULTS Provider-patient communication was associated with higher likelihood of using all methods of past-year contraceptive use (RRs ranging from 1.11 to 1.63) and lifetime STI diagnosis (RRs ranging from 1.18 to 1.96). Completely heterosexual women with no same-sex partners (referent) were 13% more likely than lesbians and 4% less likely than other groups to report a provider ever discussed their SRH. Significant interactions emerged between sexual minority status and provider-patient communication. Sexual minority women whose providers discussed their SRH were less likely to report contraceptive non-use in the past year (p < .0001). CONCLUSION Provider-patient communication may benefit sexual minority women's contraceptive practices and engagement with STI testing. PRACTICE IMPLICATIONS Differences in provider-patient SRH discussion by sexual orientation indicate lesbian women are not receiving the same attention in clinical encounters.
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Affiliation(s)
- Ariella R Tabaac
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Megan E Sutter
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA.
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Madina Agénor
- Department of Community Health, Tufts University, Medford, MA, USA; Department of Obstetrics/Gynecology, Tufts University School of Medicine, Boston, MA, USA.
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Carly E Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Brittany M Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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11
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Silva ADN, Gomes R. Access to health services for lesbian women: a literature review. CIENCIA & SAUDE COLETIVA 2021; 26:5351-5360. [PMID: 34787224 DOI: 10.1590/1413-812320212611.3.34542019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/04/2019] [Indexed: 11/21/2022] Open
Abstract
This study explores access to health services for lesbians in the light of current literature. A literature search was conducted using various databases and an interpretive synthesis of the findings of the selected articles was produced anchored in the concepts of habitus and symbolic violence developed by Pierre Bourdieu. Two main themes and their respective units of meaning were identified: (a) barriers and difficulties experienced by lesbians in accessing healthcare (issues related to coming out as a lesbian and difficulties experienced by health services and professionals in dealing with lesbian women); and (b) lesbian women's experiences in health services (unequal care, invisibility, and feeling uncomfortable). We conclude that, despite advances in policy and care protocols, sexual and gender diversity needs to be widely discussed in social, educational, and health settings.
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Affiliation(s)
- Adriane das Neves Silva
- Instituto Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | - Romeu Gomes
- Instituto Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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12
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Lyons T, Krüsi A, Edgar E, Machat S, Kerr T, Shannon K. The Impacts of Intersecting Stigmas on Health and Housing Experiences of Queer Women Sex Workers in Vancouver, Canada. JOURNAL OF HOMOSEXUALITY 2021; 68:957-972. [PMID: 31774383 DOI: 10.1080/00918369.2019.1694337] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The objective of this study was to qualitatively explore how queer women sex workers' experiences of stigma impacted health and housing access in Vancouver, Canada. In-depth semi-structured interviews were conducted with 56 queer women sex workers in Vancouver, Canada between June 2012 and May 2013. Participants described sexual stigma in the form of discriminatory comments about their sexuality, and in the form of barriers to housing and complexities in maintaining their relationships in supported housing environments. Enacted stigma was also experienced, particularly drug use-related stigma, in healthcare settings. Consequently, some participants reported felt stigma in the form of hiding their sexuality and relationships to mitigate stigma and to gain access to services. Participants experienced a variety of stigma related to drug use, housing insecurity, and sexuality; thereby demonstrating the intersecting dimensions of stigma and structural oppressions in the lives of the queer women sex workers.
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Affiliation(s)
- Tara Lyons
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Department of Criminology, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
| | - Andrea Krüsi
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sylvia Machat
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Thomas Kerr
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Tzur-Peled S, Sarid O, Kushnir T. Nurses' Knowledge and Attitudes toward Lesbians Seeking Perinatal Care in Israel. JOURNAL OF HOMOSEXUALITY 2021; 68:157-172. [PMID: 31194920 DOI: 10.1080/00918369.2019.1627130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Sharona Tzur-Peled
- Dina Academic School of Nursing, Rabin Medical Center , Petah Tikva, Israel
| | - Orly Sarid
- The Spitzer Department of Social Work, Ben-Gurion University of the Negev , Beer-Sheva, Israel
| | - Talma Kushnir
- Department of Psychology, Ariel University , Ariel, Israel
- Department of Public Health, Ben-Gurion University of the Negev , Beer-Sheva, Israel
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Rodrigues JL, Falcão MTC. Vivências de atendimentos ginecológicos por mulheres lésbicas e bissexuais: (in)visibilidades e barreiras para o exercício do direito à saúde. SAUDE E SOCIEDADE 2021. [DOI: 10.1590/s0104-12902021181062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Embora lésbicas e mulheres bissexuais tenham sido incluídas nas políticas de saúde, na busca por uma atenção integral e que inclua o reconhecimento da diversidade sexual, a discriminação persiste nos espaços de atenção à saúde, especialmente nas consultas clínicas. Este trabalho, de vertente qualitativa, teve por objetivo discutir, a partir das percepções e vivências dessas mulheres, as relações estabelecidas nas consultas ginecológicas, abordando especificamente a (não) revelação da condição de lésbica/bissexual, as experiências com exames e orientações pertinentes à sexualidade e as dificuldades de negociação de condutas. A produção dos dados empíricos deu-se por meio de entrevistas semiestruturadas com doze lésbicas e cinco mulheres bissexuais. Os resultados apontam para a invisibilidade bissexual no contexto clínico, para as dificuldades na consulta ginecológica tanto para lésbicas quanto bissexuais e para o temor das mulheres quanto à exposição da orientação sexual, bem como o não reconhecimento de sua sexualidade. Nesse sentido, as consultas em ginecologia continuam centradas em pressupostos heteronormativos, preponderando aspectos reprodutivos em detrimento dos aspectos sexuais da vida.
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Çakır H, Harmancı Seren AK. Are Nurses Homophobic? A Survey Study in Public Hospitals in Turkey. J Nurs Scholarsh 2020; 52:613-622. [DOI: 10.1111/jnu.12596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Hanife Çakır
- Specialist registered nurse University of Health Sciences Turkey Bakırköy Prof. Dr. Mazhar Osman Mental and Neurological Diseases Training and Research Hospital, and PhD Student Hamidiye Institute of Health Sciences at University of Health Sciences Turkey Istanbul Turkey
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Are Services Inclusive? A Review of the Experiences of Older GSD Women in Accessing Health, Social and Aged Care Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113861. [PMID: 32485874 PMCID: PMC7312223 DOI: 10.3390/ijerph17113861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/02/2022]
Abstract
The review aimed to examine the views and experiences of ageing gender and sexually diverse (GSD) women—a triple minority in relation to their age, gender and sexual orientation—in accessing health, social and aged care services. Eighteen peer reviewed articles identified from seven electronic databases in health and social sciences were evaluated according to predefined criteria and a thematic review methodology drawing upon socio-ecological theory was used to analyse and interpret the findings. Four major themes were identified from the analysis: “The Dilemma of Disclosure”, “Belonging/Connection”, “Inclusiveness of Aged Care” and “Other Barriers to Access Care”. In the dilemma of disclosure, older GSD women consider factors such as previous experiences, relationship with the provider and anticipated duration of stay with the provider before disclosing their sexual identifies. The review also revealed that aged care services lack inclusiveness in their policies, advertising materials, aged care spaces and provider knowledge and attitude to provide sensitive and appropriate care to GSD women. Overall, older GSD women experience multiple and multilevel challenges when accessing health, aged and social services and interventions are needed at all levels of the socio-ecological arena to improve their access and quality of care.
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Yertutanol FDK, Candansayar S, Seydaoğlu G. Homophobia in Health Professionals in Ankara, Turkey: Developing a Scale. Transcult Psychiatry 2019; 56:1191-1217. [PMID: 30484756 DOI: 10.1177/1363461518808166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aims of this study were to develop a sexual orientation attitude scale and use it to investigate the attitudes of psychiatrists, other physicians and first year medical students toward homosexuals and homosexuality in Ankara, Turkey. A cross-sectional study was performed with three groups including psychiatrists (n = 147), non-psychiatric physicians (n = 224) and first year medical students (n = 280). A scale with 43 items consisting of four subscales (heterosexism, homophobia, homonegativity, neutrality) was developed which showed high internal consistency, validity and reliability in this sample of Turkish individuals. The internal consistency coefficients (Cronbach's alpha) for the subscales were 0.85-0.86, 0.95-0.95, 0.95-0.95, and 0.85-0.86, respectively. Being male, single, a graduate of a religious (Imam Hatip) or vocational high school, of rural origin, a student, more religious, heterosexual and studying at university hospitals were found to be related to higher scores (indicating more negative attitudes) on all subscales and the total scale and these differences were significant. Students had the highest scores and psychiatrists had the lowest scores in all subscales and the total scale. The results of this study indicate that physicians and medical students have negative attitudes toward homosexuals and that medical training on sexual health issues should be improved in Turkey.
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Lampalzer U, Behrendt P, Dekker A, Briken P, Nieder TO. The Needs of LGBTI People Regarding Health Care Structures, Prevention Measures and Diagnostic and Treatment Procedures: A Qualitative Study in a German Metropolis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3547. [PMID: 31546719 PMCID: PMC6801863 DOI: 10.3390/ijerph16193547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 12/12/2022]
Abstract
(1) Background: Studies indicate that lesbian, gay, bisexual, transgender and intersex (LGBTI) people constantly face challenges and disadvantages in the health care system that prevent them from getting the best possible patient-centered care. However, the present study is the first to focus on LGBTI-related health in a major German metropolis. It aimed to investigate health care structures, prevention measures and diagnostic as well as treatment procedures that LGBTI individuals need in order to receive appropriate patient-centered health care and health promotion. (2) Methods: Following a participatory approach, five expert interviews with LGBTI people with multiplier function, i.e., people who have a key role in a certain social milieu which makes them able to acquire and spread information in and about this milieu, and three focus groups with LGBTI people and/or health professionals were conducted. Qualitative data were analyzed according to the principles of content analysis. (3) Results: The specific needs of LGBTI individuals must be recognized as a matter of course in terms of depathologization, sensitization, inclusion, and awareness. Such an attitude requires both basic knowledge about LGBTI-related health issues, and specific expertise about sufficient health care services for each of the minorities in the context of sex, sexual orientation and gender identity. (4) Conclusions: For an appropriate approach to LGBTI-centered health care and health promotion, health professionals will need to adopt a better understanding of specific soft and hard skills.
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Affiliation(s)
- Ute Lampalzer
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Pia Behrendt
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Arne Dekker
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
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Tzur-Peled S, Sarid O, Kushnir T. Nurses' perceptions of their relationships and communication with lesbian women seeking perinatal care. J Clin Nurs 2019; 28:3271-3278. [PMID: 31066131 DOI: 10.1111/jocn.14904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVE To examine whether nurses' assessment of their relationships and communication with lesbian women seeking perinatal care is associated with their personal and professional characteristics and knowledge of homosexuality. BACKGROUND Recently, there has been a growing incidence of same-sex parenthood. Nurses administer health care to lesbian women from pregnancy planning through birth, providing consultation. Although there has been a shift in attitudes towards homosexuality, discrimination is still quite common. DESIGN This research is part of a larger cross-sectional study carried out at women's healthcare centres, concerning nurses' perceived quality of perinatal care provided to lesbian women. METHODS The study was conducted from December 2015-April 2016 at women's health centres in Israel encompassing 184 registered nurses who completed self-report questionnaires. They were assessed as to their knowledge of homosexuality and nurse-patient relationships and communication. The Squire checklist was used. RESULTS Most (73.4%) had prior acquaintance with lesbian women; only 17.9% had been educated as to lesbian women's unique health needs; of these, 66.7% thought that they had been given professional tools for working with lesbian women; 60.4% were unaware of the importance of knowing the patient's sexual orientation. The average score on a homosexuality knowledge questionnaire was 10.4 on a scale of 0-17, indicating moderate levels of factual knowledge about homosexuality. A significant positive correlation was found between nurses' knowledge of homosexuality and assessment of their relationships and communication with lesbian women seeking perinatal care. In addition, nurses' personal and professional characteristics, such as place of birth, religiosity and familiarity with lesbian women, were related to their assessment of their relationships and communication. CONCLUSION Nurses' knowledge of homosexuality and personal and professional characteristics were associated with their perceptions regarding relationships and communication with lesbian women seeking perinatal care. RELEVANCE TO CLINICAL PRACTICE Further training might broaden, refine rigid perceptions and contribute to advancing equal perinatal nursing care of lesbian women.
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Affiliation(s)
- Sharona Tzur-Peled
- Dina Academic School of Nursing, Rabin Medical Center, Petah Tikva, Israel
| | - Orly Sarid
- The Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Talma Kushnir
- Department of Psychology, Ariel University, Ariel, Israel.,Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Abstract
Lesbian women experience discrimination within the health care system that leads many to cautiously navigate a heteronormative system. This metasynthesis offers a richer contextual understanding about lesbian health care experiences. The 4 overarching themes that emerged are: (a) sizing up the provider and the environment, (b) to say or not to say: "paradoxes of disclosure," (c) reactions to provider's assumptions, (d) and acknowledging my partner. Lesbian women perceive their health care experiences based on the nature of the relationship with the provider. These women are more likely to seek care from health care providers who acknowledge, affirm, and respect a woman's sexual identity, cultural beliefs, and family structures.
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Manzer D, O'Sullivan LF, Doucet S. Myths, misunderstandings, and missing information: Experiences of nurse practitioners providing primary care to lesbian, gay, bisexual, and transgender patients. CANADIAN JOURNAL OF HUMAN SEXUALITY 2018. [DOI: 10.3138/cjhs.2018-0017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Dana Manzer
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, NB
| | - Lucia F. O'Sullivan
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, NB
| | - Shelley Doucet
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, NB
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Disclosure of Sexual Orientation Among Women Who Have Sex With Women During Gynecological Care: A Qualitative Study In Brazil. J Sex Med 2018; 15:966-973. [DOI: 10.1016/j.jsxm.2018.04.648] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 11/24/2022]
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Gregg I. The Health Care Experiences of Lesbian Women Becoming Mothers. Nurs Womens Health 2018; 22:40-50. [PMID: 29433699 DOI: 10.1016/j.nwh.2017.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/07/2017] [Indexed: 11/18/2022]
Abstract
As modern family composition shifts-for many, away from a heteronormative nuclear family-so, too, must the health care that families receive. Lesbian women and their families face particular difficulties with maternity care in the United States and internationally, because many care providers lack an understanding of this population's specific health care needs. In this article, I examine the challenges faced by lesbian women during the transition period to new motherhood and recommend improvements that can be made by individual providers and the health care system as a whole to better provide culturally competent health care for this population.
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Brooks H, Llewellyn CD, Nadarzynski T, Pelloso FC, De Souza Guilherme F, Pollard A, Jones CJ. Sexual orientation disclosure in health care: a systematic review. Br J Gen Pract 2018; 68:e187-e196. [PMID: 29378698 PMCID: PMC5819984 DOI: 10.3399/bjgp18x694841] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/10/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Significant health disparities between sexual minority individuals (that is, lesbian, gay, bisexual, or transgender [LGBT]) and heterosexual individuals have been demonstrated. AIM To understand the barriers and facilitators to sexual orientation (SO) disclosure experienced by LGBT adults in healthcare settings. DESIGN AND SETTING Mixed methods systematic review, including qualitative, quantitative, and mixed methods papers following PRISMA guidelines. METHOD Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and a qualitative synthesis was performed. Studies were included if their participants were aged ≥18 years who either identified as LGBT, had a same-sex sexual relationship, or were attracted to a member of the same sex. RESULTS The review included 31 studies representing 2442 participants. Four overarching themes were identified as barriers or facilitators to SO disclosure: the moment of disclosure, the expected outcome of disclosure, the healthcare professional, and the environment or setting of disclosure. The most prominent themes were the perceived relevance of SO to care, the communication skills and language used by healthcare professionals, and the fear of poor treatment or reaction to disclosure. CONCLUSION The facilitators and barriers to SO disclosure by LGBT individuals are widespread but most were modifiable and could therefore be targeted to improve healthcare professionals' awareness of their patients' SO. Healthcare professionals should be aware of the broad range of factors that influence SO disclosure and the potential disadvantageous effects of non-disclosure on care. The environment in which patients are seen should be welcoming of different SOs as well as ensuring that healthcare professionals' communication skills, both verbal and non-verbal, are accepting and inclusive.
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Affiliation(s)
| | | | - Tom Nadarzynski
- Department of Psychology, University of Southampton, Southampton, UK
| | | | | | | | - Christina J Jones
- Department of Clinical Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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25
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Abstract
OBJECTIVE To explore how often general practitioners (GPs) deal with patients' sexual concerns, what kind of concerns are brought up and how the GPs deal with them. DESIGN Cross sectional observational study. SETTING/SUBJECTS 22 GPs in Southern Norway. MAIN OUTCOME MEASURES The percentage of consultations dealing with sexual concerns during three consecutive working days, as registered by the GPs on a questionnaire. RESULTS Out of 1 117 consultations, 47 (4.2%) dealt with sexual concerns, varying from 1.6 to 10.9% of consultations. The concerns brought up varied widely, with erectile dysfunction and pain related to sexual activity in females as the largest groups. Concerns regarding sexual orientation, preferences or behavior were also dealt with, as were problems due to sexual assaults or rape. In 36 (76.6%) of the consultations, discussion of the problem and/or advice was the only action. Medication was prescribed in one third of the consultations. Patients' mean age was 46.7 years, with a span from 17 up to 75 years and 60% were female. We found no associations between GP characteristics and how frequently they dealt with sexual concerns. CONCLUSIONS In around 4% of consultations, the GPs dealt with a wide variety of sexual concerns.
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Affiliation(s)
- Audun Vik
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mette Brekke
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- CONTACT Mette Brekke Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Stewart K, O'Reilly P. Exploring the attitudes, knowledge and beliefs of nurses and midwives of the healthcare needs of the LGBTQ population: An integrative review. NURSE EDUCATION TODAY 2017; 53:67-77. [PMID: 28448883 DOI: 10.1016/j.nedt.2017.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 02/27/2017] [Accepted: 04/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To explore current literature surrounding the knowledge, beliefs and attitudes of nurses and midwives of the healthcare needs of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) patients and their influence on equal and non-discriminatory care for LGBTQ individuals. DESIGN Systematic integrative review. DATA SOURCES CINAHL, MEDLINE, PubMed, InterNurse. REVIEW METHODS This integrative review used Wakefield's (2014) framework to establish the knowledge, beliefs and attitudes of nurses and midwives of the healthcare needs of LGBTQ patients. Qualitative, quantitative and mixed methods primary studies carried out between 2006 and 2015 from 7 countries were included. Four databases were searched and 98 studies were screened for eligibility by two researchers. Level of evidence was assessed by the Scottish Intercollegiate Guidelines Network (SIGN, 2010) criteria and quality was assessed by a screening tool adapted from Noyes and Popay (2007) for qualitative papers and Quality Assessment Tool for Quantitative Studies adapted from the Effective Public Health Practice Project (EPHPP, 2010). Following PRISMA guidelines, this integrative review analysed and synthesised evidence using thematic analysis to generate themes. RESULTS 24 papers were included in the final synthesis which revealed four primary themes: Heteronormativity across Healthcare; Queerphobia; Rainbow of Attitudes; Learning Diversity. CONCLUSIONS Nurses and midwives possess a wide spectrum of attitudes, knowledge and beliefs which impact the care received by LGBTQ patients. Many issues of inadequate care appear to be due to a culture of heteronormativity and a lack of education on LGBTQ health. Further research is needed on interventions which could facilitate disclosure of sexual orientation and interrupt heteronormative assumptions by staff. It is recommended that LGBTQ issues be included within undergraduate nursing and midwifery education or as part of continued professional development.
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Affiliation(s)
- Kate Stewart
- Department of Nursing and Midwifery, University of Limerick, Ireland.
| | - Pauline O'Reilly
- Department of Nursing and Midwifery, University of Limerick, Ireland.
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Baptiste-Roberts K, Oranuba E, Werts N, Edwards LV. Addressing Health Care Disparities Among Sexual Minorities. Obstet Gynecol Clin North Am 2017; 44:71-80. [PMID: 28160894 DOI: 10.1016/j.ogc.2016.11.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is evidence of health disparities between sexual minority and heterosexual populations. Although the focus of lesbian, gay, bisexual, and transgender health research has been human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infection among men who have sex with men, there are health disparities among sexual minority women. Using the minority stress framework, these disparities may in part be caused by individual prejudice, social stigma, and discrimination. To ensure equitable health for all, there is urgent need for targeted culturally sensitive health promotion, cultural sensitivity training for health care providers, and intervention-focused research.
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Affiliation(s)
- Kesha Baptiste-Roberts
- Department of Public Health Analysis, School of Community Health & Policy, Morgan State University, 4530 Portage Avenue Campus, Suite 211, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA.
| | - Ebele Oranuba
- Department of Public Health Analysis, School of Community Health & Policy, Morgan State University, 4530 Portage Avenue Campus, Suite 211, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
| | - Niya Werts
- Department of Health Science, Towson University, 8000 York Road, Baltimore, MD 21252, USA
| | - Lorece V Edwards
- Department of Behavioral Health Science, School of Community Health & Policy, Morgan State University, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
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28
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Bjarnadottir RI, Bockting W, Dowding DW. Patient perspectives on answering questions about sexual orientation and gender identity: an integrative review. J Clin Nurs 2017; 26:1814-1833. [PMID: 27706875 DOI: 10.1111/jocn.13612] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To examine patients' perceptions of being asked about their sexual orientation and gender identity in the healthcare setting. BACKGROUND Health disparities exist in the lesbian, gay, bisexual and transgender population, but further research is needed to better understand these disparities. To address this issue, experts recommend the routine collection of sexual orientation and gender identity data in health care. Nurses on the front line of patient care play a key role in the collection of these data. However, to enable nurses to conduct such assessments it is important to understand the perspective of the patients on being asked about their sexual orientation and gender identity in a healthcare setting. DESIGN An integrative review was conducted using the methodology proposed by Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546). METHODS Six electronic databases were searched, and two reviewers independently reviewed papers for inclusion. Papers were included if they were empirical studies, peer-reviewed papers or reports, assessing patient perspectives on discussing sexual orientation and gender identity in the healthcare setting. RESULTS Twenty-one relevant studies that met the inclusion criteria were identified. A majority of the studies indicated patients' willingness to respond to, and a perceived importance of, questions about sexual orientation and gender identity. However, fears of homophobia and negative consequences hindered willingness to disclose this information. CONCLUSIONS This review indicates that in most cases patients are willing to answer routine questions about their sexual orientation in the healthcare setting and perceive them as important questions to ask. RELEVANCE TO CLINICAL PRACTICE The findings of this review have implications for nurses looking to incorporate questions about sexual orientation into their routine patient assessment. The findings indicate that care providers need to be mindful of heteronormative assumptions and take steps to ensure they are knowledgeable about lesbian, gay, bisexual and transgender health.
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Affiliation(s)
| | - Walter Bockting
- School of Nursing, Columbia University, New York, NY, USA.,Division of Gender, Sexuality, and Health, Columbia Psychiatry at NYSPI, New York, NY, USA
| | - Dawn W Dowding
- School of Nursing, Columbia University, New York, NY, USA.,Center for Home Care Policy & Research, Visiting Nursing Service of New York, New York, NY, USA
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29
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Klaeson K, Hovlin L, Guvå H, Kjellsdotter A. Sexual health in primary health care - a qualitative study of nurses’ experiences. J Clin Nurs 2017; 26:1545-1554. [DOI: 10.1111/jocn.13454] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Kicki Klaeson
- School of Health and Education; University of Skövde; Skövde Sweden
- Oncology Department; Skaraborgs Hospital; Skövde Sweden
| | | | - Hanna Guvå
- Psychiatric Department; Skaraborgs Hospital; Skövde Sweden
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30
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Hirsch O, Löltgen K, Becker A. Lesbian womens' access to healthcare, experiences with and expectations towards GPs in German primary care. BMC FAMILY PRACTICE 2016; 17:162. [PMID: 27871239 PMCID: PMC5117504 DOI: 10.1186/s12875-016-0562-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/14/2016] [Indexed: 12/03/2022]
Abstract
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.
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Affiliation(s)
- Oliver Hirsch
- Department of General Practice/Family Medicine, Philipps University Marburg, Karl-von-Frisch-Str. 4, Marburg, 35043, Germany.
| | - Karina Löltgen
- Department of General Practice/Family Medicine, Philipps University Marburg, Karl-von-Frisch-Str. 4, Marburg, 35043, Germany
| | - Annette Becker
- Department of General Practice/Family Medicine, Philipps University Marburg, Karl-von-Frisch-Str. 4, Marburg, 35043, Germany
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Faulkner SL, Lannutti PJ. Representations of lesbian and bisexual women’s sexual and relational health in online video and text-based sources. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2016.06.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Malterud K, Bjorkman M. The Invisible Work of Closeting: A Qualitative Study About Strategies Used by Lesbian and Gay Persons to Conceal Their Sexual Orientation. JOURNAL OF HOMOSEXUALITY 2016; 63:1339-1354. [PMID: 26914706 DOI: 10.1080/00918369.2016.1157995] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The last decades have offered substantial improvement regarding human rights for lesbian and gay (LG) persons. Yet LG persons are often in the closet, concealing their sexual orientation. We present a qualitative study based on 182 histories submitted from 161 LG individuals to a Web site. The aim was to explore experiences of closeting among LG persons in Norway. A broad range of strategies was used for closeting, even among individuals who generally considered themselves to be out of the closet. Concealment was enacted by blunt denial, clever avoidance, or subtle vagueness. Other strategies included changing or eliminating the pronoun or name of the partner in ongoing conversations. Context-dependent concealment, differentiating between persons, situations, or arenas, was repeatedly applied for security or convenience. We propose a shift from "being in the closet" to "situated concealment of sexual orientation."
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Affiliation(s)
- Kirsti Malterud
- a Research Unit for General Practice , Uni Research Health , Bergen , Norway
- b Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
- c Research Unit for General Practice in Copenhagen , Copenhagen , Denmark
| | - Mari Bjorkman
- a Research Unit for General Practice , Uni Research Health , Bergen , Norway
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Carrotte ER, Vella AM, Bowring AL, Douglass C, Hellard ME, Lim MSC. "I am yet to encounter any survey that actually reflects my life": a qualitative study of inclusivity in sexual health research. BMC Med Res Methodol 2016; 16:86. [PMID: 27465507 PMCID: PMC4964098 DOI: 10.1186/s12874-016-0193-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heteronormativity describes a set of norms and assumptions pertaining to heterosexual identities and binary gender. In 2015, we conducted our annual Sex, Drugs and Rock'n'Roll study, an online health survey of over 1000 Victorians aged 15-29 years. Feedback from participants suggested that our survey contained heteronormative language. In response to this, we aimed to make inclusive changes to our survey via consultation with young gender and sexually diverse (GSD) people. METHODS We conducted two semi-structured focus groups in Melbourne with a total of 16 participants (age range: 21-28 years). Participants were mostly cisgender women, and there were two transgender participants and one non-binary participant. Participants also had a range of sexual identities including lesbian, queer, bisexual, pansexual, and asexual. Focus group discussions were transcribed verbatim and analysed thematically. RESULTS Most participants indicated heteronormativity affects their lives in multiple ways, noting its impacts on access to sexual healthcare, invalidating sexual experiences and miscommunication in forms and surveys. Overall, participants emphasised the need for sexual health research to avoid assumptions about behaviour, to be clear and eliminate question ambiguity and avoiding treating gender as binary. Participants also discussed how the Sex, Drugs and Rock'n'Roll survey could address a range of sexual behaviours and experiences, rather than focusing on penetrative sex, which many participants found invalidating. CONCLUSIONS Our findings have important implications for future health surveys aimed at general populations. We present recommendations that encourage research to be more inclusive to ensure data collection from GSD participants is respectful and rigorous.
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Affiliation(s)
- Elise R Carrotte
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Alyce M Vella
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Anna L Bowring
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia
| | - Caitlin Douglass
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia
| | - Margaret E Hellard
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia
| | - Megan S C Lim
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
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Graham K, Treharne GJ, Ruzibiza C, Nicolson M. The importance of health(ism): A focus group study of lesbian, gay, bisexual, pansexual, queer and transgender individuals’ understandings of health. J Health Psychol 2016; 22:237-247. [DOI: 10.1177/1359105315600236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study investigated understandings of health among lesbian, gay, bisexual, pansexual, queer and/or transgender people, who are under-represented in research. The study involved 12 focus groups in Aotearoa/New Zealand with 47 participants who identified as lesbian, gay, bisexual, pansexual, queer and/or transgender and responded to an advert inviting participants without chronic illnesses. Three themes were inductively formulated: health is important because education and protection efforts are seen as required to preserve health, health is seen as holistic, and contextual factors are seen as creating health risks. These findings provide insights into how lesbian, gay, bisexual, pansexual, queer and/or transgender people’s understandings of health draw upon notions of healthism.
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Roller CG, Sedlak CA, Draucker CB, Veney A, Leifson MA, Sanata JD. Managing the Conversation: How Sexual Minority Women Reveal Sexual Orientation. J Nurse Pract 2016. [DOI: 10.1016/j.nurpra.2016.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Munson S, Cook C. Lesbian and bisexual women's sexual healthcare experiences. J Clin Nurs 2016; 25:3497-3510. [DOI: 10.1111/jocn.13364] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Siân Munson
- Central Primary Health Organisation; Palmerston North New Zealand
| | - Catherine Cook
- Massey University School of Nursing; Auckland New Zealand
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Young K, Fisher J, Kirkman M. Endometriosis and fertility: women's accounts of healthcare. Hum Reprod 2016; 31:554-62. [PMID: 26759140 DOI: 10.1093/humrep/dev337] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/15/2015] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What do women with endometriosis recall being told about their fertility by their healthcare providers? SUMMARY ANSWER Women recalled being given varied information and advice, and gave examples of empathic and individualized care from doctors but also reported opportunities for enhancing clinical practice. WHAT IS KNOWN ALREADY There is evidence of an association between endometriosis and infertility. However, the strength of this association and the mechanisms that underlie it are not yet known nor are the implications for optimum healthcare. STUDY DESIGN, SIZE, DURATION This study used in-depth cross-sectional qualitative research methods. PARTICIPANTS/MATERIALS, SETTING, METHODS Women aged at least 18 years who lived in Victoria, Australia, and who had been surgically diagnosed with endometriosis were invited to participate in in-depth interviews about their experience of endometriosis. Twenty-six women of diverse backgrounds and experiences of endometriosis were interviewed from January to September 2014. Interviews were transcribed and analysed thematically using a data-driven approach. MAIN RESULTS AND THE ROLE OF CHANCE All women encountered medical professionals who were aware of the association between endometriosis and infertility, and who were proactive in ensuring fertility was addressed within endometriosis care. Women recalled being given varied, often conflicting, information about the consequences for their fertility of an endometriosis diagnosis. While some recounted positive experiences with the way their doctor communicated with them about endometriosis and fertility, all women reported adverse experiences such as receiving insufficient or inappropriate information or having their doctor prioritize their fertility over other aspects of their care, including quality of life and symptom relief, without first consulting them. LIMITATIONS, REASONS FOR CAUTION The perspectives of the women's doctors were not sought. The findings may not translate to settings that differ from a predominantly Anglo-Saxon country with both universal public and private healthcare systems. WIDER IMPLICATIONS OF THE FINDINGS Women's fertility needs and priorities differ for many reasons; there can be no 'one size fits all' approach to care. Women may benefit most from endometriosis care in which they are first asked about their fertility needs and preferences and in which medical uncertainty is acknowledged. STUDY FUNDING/COMPETING INTERESTS K.Y. receives a scholarship from the National Health and Medical Research Council and Australian Rotary Health. J.F. is supported by a Monash Professional Fellowship and the Jean Hailes Professional Fellowship which is funded by Perpetual Trustees Pty Ltd. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- K Young
- The Jean Hailes Research Unit, Monash University, 1st Floor, 549 St Kilda Rd, Melbourne, Victoria 3004, Australia
| | - J Fisher
- The Jean Hailes Research Unit, Monash University, 1st Floor, 549 St Kilda Rd, Melbourne, Victoria 3004, Australia
| | - M Kirkman
- The Jean Hailes Research Unit, Monash University, 1st Floor, 549 St Kilda Rd, Melbourne, Victoria 3004, Australia
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Law M, Mathai A, Veinot P, Webster F, Mylopoulos M. Exploring lesbian, gay, bisexual, and queer (LGBQ) people's experiences with disclosure of sexual identity to primary care physicians: a qualitative study. BMC FAMILY PRACTICE 2015; 16:175. [PMID: 26651342 PMCID: PMC4675062 DOI: 10.1186/s12875-015-0389-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 12/01/2015] [Indexed: 11/10/2022]
Abstract
Background It has been demonstrated that health disparities between lesbian, gay, bisexual and queer (LGBQ) populations and the general population can be improved by disclosure of sexual identity to a health care provider (HCP). However, heteronormative assumptions (that is, assumptions based on a heterosexual identity and experience) may negatively affect communication between patients and HCPs more than has been recognized. The aim of this study was to understand LGBQ patients’ perceptions of their experiences related to disclosure of sexual identity to their primary care provider (PCP). Methods One-on-one semi-structured telephone interviews were conducted, audio-recorded, and transcribed. Participants were self-identified LGBQ adults with experiences of health care by PCPs within the previous five years recruited in Toronto, Canada. A qualitative descriptive analysis was performed using iterative coding and comparing and grouping data into themes. Results Findings revealed that disclosure of sexual identity to PCPs was related to three main themes: 1) disclosure of sexual identity by LGBQ patients to a PCP was seen to be as challenging as coming out to others; 2) a solid therapeutic relationship can mitigate the difficulty in disclosure of sexual identity; and, 3) purposeful recognition by PCPs of their personal heteronormative value system is key to establishing a strong therapeutic relationship. Conclusion Improving physicians’ recognition of their own heteronormative value system and addressing structural heterosexual hegemony will help to make health care settings more inclusive. This will allow LGBQ patients to feel better understood, willing to disclose, subsequently improving their care and health outcomes.
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Affiliation(s)
- Marcus Law
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 3157, Toronto, ON, M5S 1A8, Canada. .,Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | - Anila Mathai
- Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | | | - Fiona Webster
- Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | - Maria Mylopoulos
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 3157, Toronto, ON, M5S 1A8, Canada. .,The Wilson Centre, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada.
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Jalali S, Sauer LM. Improving Care for Lesbian, Gay, Bisexual, and Transgender Patients in the Emergency Department. Ann Emerg Med 2015; 66:417-23. [DOI: 10.1016/j.annemergmed.2015.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Indexed: 11/29/2022]
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Cele NH, Sibiya MN, Sokhela DG. Experiences of homosexual patients' access to primary health care services in Umlazi, KwaZulu-Natal. Curationis 2015; 38:1522. [PMID: 26842074 PMCID: PMC6092696 DOI: 10.4102/curationis.v38i2.1522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/29/2015] [Accepted: 08/18/2015] [Indexed: 12/03/2022] Open
Abstract
Background Homosexual patients are affected by social factors in their environment, and as a result may not have easy access to existing health care services. Prejudice against homosexuality and homosexual patients remains a barrier to them seeking appropriate health care. The concern is that lesbians and gays might delay or avoid seeking health care when they need it because of past discrimination or perceived homophobia within the health care thereby putting their health at risk. Aim of the study The aim of the study was to explore and describe the experiences of homosexual patients utilising primary health care (PHC) services in Umlazi in the province of KwaZulu-Natal (KZN). Method A qualitative, exploratory, descriptive study was conducted which was contextual in nature. Semi-structured interviews were conducted with 12 participants. The findings of this study were analysed using content analysis. Results Two major themes emerged from the data analysis, namely, prejudice against homosexual patients by health care providers and other patients at the primary health care facilities, and, homophobic behaviour from primary health care personnel. Conclusion Participants experienced prejudice and homophobic behaviour in the course of utilising PHC clinics in Umlazi, which created a barrier to their utilisation of health services located there. Nursing education institutions, in collaboration with the National Department of Health, should introduce homosexuality and anti-homophobia education programmes during the pre-service and in-service education period. Such programmes will help to familiarise health care providers with the health care needs of homosexual patients and may decrease homophobic attitudes.
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41
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Curmi C, Peters K, Salamonson Y. Barriers to cervical cancer screening experienced by lesbian women: a qualitative study. J Clin Nurs 2015; 25:3643-3651. [DOI: 10.1111/jocn.12947] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Claire Curmi
- School of Nursing & Midwifery; University of Western Sydney; Penrith NSW Australia
| | - Kath Peters
- School of Nursing & Midwifery; University of Western Sydney; Penrith NSW Australia
| | - Yenna Salamonson
- School of Nursing & Midwifery; University of Western Sydney; Penrith NSW Australia
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Quinn GP, Sutton SK, Winfield B, Breen S, Canales J, Shetty G, Sehovic I, Green BL, Schabath MB. Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ) Perceptions and Health Care Experiences. JOURNAL OF GAY & LESBIAN SOCIAL SERVICES 2015; 27:246-261. [PMID: 30996583 PMCID: PMC6464116 DOI: 10.1080/10538720.2015.1022273] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The goal study of this was to explore attitudes, health knowledge, and experiences with healthcare setting and providers among gay, lesbian, bisexual, transgender, queer/questioning (GLBTQ) individuals and to identify areas for improvement. METHODS Members of Equality Florida™ residing in the five counties of the Tampa Bay region were recruited through email invitation to complete a 60-item questionnaire assessing demographics, attitudes, and experiences with healthcare providers (HCPs). Additional open-ended questions focused on experiences with HCPs and suggestions for ways to improve HCPs' cultural competency. RESULTS 632 respondents completed the survey of which 41% were gay men and 29% were lesbian. The majority of participants was White, non-Hispanic (93%), married/partnered (78%), and had health insurance (88%). The majority (67%) reported they always or often disclosed their sexual orientation/identity to an HCP and few had negative reactions in the healthcare setting (<10%). Healthcare settings with equality signs and gender-neutral language were perceived as safer. Participants' responses suggested need for policy changes and improved cultural competence among HCPs. CONCLUSION Results show high rates of sexual orientation disclosure, greater acceptance from providers of GLBTQ status, and the need for examination of hospital policies and improved cultural competency.
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Affiliation(s)
- Gwendolyn P. Quinn
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- University of South Florida, Tampa, Florida
| | - Steven K. Sutton
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- University of South Florida, Tampa, Florida
| | | | - Shannon Breen
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Jorge Canales
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | - Ivana Sehovic
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - B. Lee Green
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- University of South Florida, Tampa, Florida
| | - Matthew B. Schabath
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- University of South Florida, Tampa, Florida
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Heyes CJ, Thachuk A. Queering know-how: clinical skill acquisition as ethical practice. JOURNAL OF BIOETHICAL INQUIRY 2015; 12:331-41. [PMID: 25037245 DOI: 10.1007/s11673-014-9566-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/28/2014] [Indexed: 05/13/2023]
Abstract
Our study of queer women patients and their primary health care providers (HCPs) in Halifax, Nova Scotia, reveals a gap between providers' theoretical knowledge of "cultural competency" and patients' experience. Drawing on Patricia Benner's Dreyfusian model of skill acquisition in nursing, we suggest that the dissonance between the anti-heteronormative principles expressed in interviews and the relative absence of skilled anti-heteronormative clinical practice can be understood as a failure to grasp the field of practice as a whole. Moving from "knowing-that" to "knowing-how" in terms of anti-heteronormative clinical skills is not only a desirable epistemological trajectory, we argue, but also a way of understanding better and worse ethical practice.
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Affiliation(s)
- Cressida J Heyes
- Departments of Political Science and Philosophy, University of Alberta, HM Tory Building 11-27, Edmonton, Alberta, Canada, T6G 2H4,
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McCauley HL, Silverman JG, Decker MR, Agénor M, Borrero S, Tancredi DJ, Zelazny S, Miller E. Sexual and Reproductive Health Indicators and Intimate Partner Violence Victimization Among Female Family Planning Clinic Patients Who Have Sex with Women and Men. J Womens Health (Larchmt) 2015; 24:621-8. [PMID: 25961855 DOI: 10.1089/jwh.2014.5032] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sexual minority women are more likely than heterosexual women to have ever experienced intimate partner violence (IPV). Although IPV is associated with sexual risk and poor reproductive health outcomes among US women overall, little is known about whether IPV is related to sexual and reproductive health indicators among sexual minority women in particular. METHODS Baseline data from a prospective intervention trial were collected from women ages 16-29 years at 24 family planning clinics in western PA (n=3,455). Multivariable logistic regression for clustered survey data was used to compare women who have sex with men only (WSM) and women who have sex with women and men (WSWM) on (1) IPV prevalence and (2) sexual and reproductive health behaviors, outcomes, and services use, controlling for IPV. Finally, we tested the interaction of sexual minority status and IPV. RESULTS WSWM were significantly more likely than WSM to report a lifetime history of IPV (adjusted odds ratio (AOR): 3.00; 95% confidence interval (CI): 2.30, 3.09). Controlling for IPV, WSWM reported higher levels of sexual risk behaviors (e.g., unprotected vaginal and anal sex), male-perpetrated reproductive coercion, unwanted pregnancy, and sexually transmitted infection (STI) and pregnancy testing but less contraceptive care seeking. The association between IPV and lifetime STI diagnosis was greater among WSWM than among WSM. CONCLUSIONS IPV was pervasive and associated with sexual risk and reproductive health indicators among WSWM in this clinic-based setting. Healthcare providers' sexual risk assessment and provision of sexual and reproductive health services should be informed by an understanding of women's sexual histories, including sex of sexual partners and IPV history, in order to help ensure that all women receive the clinical care they need.
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Affiliation(s)
- Heather L McCauley
- 1 Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC , Pittsburgh, Pennsylvania
| | - Jay G Silverman
- 2 Division of Global Public Health, University of California San Diego School of Medicine , La Jolla, California
| | - Michele R Decker
- 3 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Madina Agénor
- 4 Department of Social and Behavioral Sciences, Harvard School of Public Health , Boston, Massachusetts.,5 Center for Community-Based Research, Dana-Farber Cancer Institute , Boston, Massachusetts
| | - Sonya Borrero
- 6 Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.,7 VA Center for Health Equity Research and Promotion , Pittsburgh, Pennsylvania
| | - Daniel J Tancredi
- 8 Department of Pediatrics, University of California Davis School of Medicine , Sacramento, California
| | - Sarah Zelazny
- 1 Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC , Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- 1 Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC , Pittsburgh, Pennsylvania
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Mor Z, Eick U, Wagner Kolasko G, Zviely-Efrat I, Makadon H, Davidovitch N. Health Status, Behavior, and Care of Lesbian and Bisexual Women in Israel. J Sex Med 2015; 12:1249-56. [DOI: 10.1111/jsm.12850] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Grigorovich A. The meaning of quality of care in home care settings: older lesbian and bisexual women's perspectives. Scand J Caring Sci 2015; 30:108-16. [PMID: 25919504 DOI: 10.1111/scs.12228] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/20/2015] [Indexed: 11/29/2022]
Abstract
Research suggests that the experience of being a lesbian or bisexual woman influences women's interactions with health care providers, and their perception of the quality of care. Limited research to date, however, has examined how ageing and sexuality mediates women's experiences of quality, when accessing health care in the community. To fill a gap in the literature, this study investigated older lesbian and bisexual women's perspectives on the meaning of quality of care in the context of receiving home care services. This was a qualitative single case study. Sixteen participants, aged 55-72 from Ontario, Canada, participated in semi-structured interviews between 2011 and 2012. The interviews were recorded and transcribed. The interview data were analysed using iterative thematic analysis and guided by a feminist ethic of care perspective. Participants described quality of care in ways that were in line with a feminist ethic of care; that is, they wanted care providers to be responsive and attentive to their needs, to involve them in the caring process and to demonstrate respect and caring. Participants also indicated that providers' comfort with, and knowledge of, sexual diversity was important for enabling quality of care. These findings deepen our understanding of how to support quality of care for this population through changes to provider education and training, and health policy.
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Affiliation(s)
- Alisa Grigorovich
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
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47
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Mattocks KM, Sullivan JC, Bertrand C, Kinney RL, Sherman MD, Gustason C. Perceived Stigma, Discrimination, and Disclosure of Sexual Orientation Among a Sample of Lesbian Veterans Receiving Care in the Department of Veterans Affairs. LGBT Health 2015; 2:147-53. [PMID: 26790121 DOI: 10.1089/lgbt.2014.0131] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Many lesbian women experience stigma and discrimination from their healthcare providers as a result of their sexual orientation. Additionally, others avoid disclosure of their sexual orientation to their providers for fear of mistreatment. With the increasing number of lesbian, gay, bisexual, and transgender (LGBT) veterans seeking care from the Veterans Health Administration (VHA), it is important to understand lesbian veterans' experiences with stigma, discrimination, and disclosure of sexual orientation. This article examines lesbian veterans' experiences with perceived stigma and discrimination in VHA healthcare, their perspectives on disclosure of sexual orientation to VHA providers, and their recommendations for improvements in VHA healthcare to create a welcoming environment for lesbian veterans. METHODS This is a mixed methods study of twenty lesbian veterans at four VHA facilities. The women veterans participated in a one-hour interview and then completed an anonymous survey. RESULTS Ten percent of lesbian veterans had experienced mistreatment from VHA staff or providers, but nearly 50% feared that their Veterans Affairs (VA) providers would mistreat them if they knew about their sexual orientation. A majority of lesbian veterans (70%) believed that VHA providers should never ask about sexual orientation or should only ask if the veteran wanted to discuss it. A majority (80%) believed the VHA had taken steps to create a welcoming environment for LBGT veterans. CONCLUSION Though many lesbian veterans have fears of stigma and discrimination in the context of VHA care, few have experienced this. Most lesbian veterans believed the VHA was trying to create a welcoming environment for its LGBT veterans. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.
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Affiliation(s)
- Kristin M Mattocks
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
- 2 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts
| | - J Cherry Sullivan
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Christina Bertrand
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Rebecca L Kinney
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Michelle D Sherman
- 3 Department of Psychology, University of Minnesota , St. Paul, Minnesota
| | - Carolyn Gustason
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
- 4 Department of Nursing, University of Massachusetts , Amherst, Massachusetts
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von Doussa H, Power J, McNair R, Brown R, Schofield M, Perlesz A, Pitts M, Bickerdike A. Building healthcare workers' confidence to work with same-sex parented families. Health Promot Int 2015; 31:459-69. [PMID: 25736035 DOI: 10.1093/heapro/dav010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article reports on a qualitative study of barriers and access to healthcare for same-sex attracted parents and their children. Focus groups were held with same-sex attracted parents to explore their experiences with healthcare providers and identify barriers and facilitators to access. Parents reported experiencing uncomfortable or anxiety-provoking encounters with healthcare workers who struggled to adopt inclusive or appropriate language to engage their family. Parents valued healthcare workers who were able to be open and honest and comfortably ask questions about their relationships and family. A separate set of focus groups were held with mainstream healthcare workers to identity their experiences and concerns about delivering equitable and quality care for same-sex parented families. Healthcare workers reported lacking confidence to actively engage with same-sex attracted parents and their children. This lack of confidence related to workers' unfamiliarity with same-sex parents, or lesbian, gay and bisexual culture, and limited opportunities to gain information or training in this area. Workers were seeking training and resources that offered information about appropriate language and terminology as well as concrete strategies for engaging with same-sex parented families. For instance, workers suggested they would find it useful to have a set of 'door opening' questions they could utilize to ask clients about their sexuality, relationship status or family make-up. This article outlines a set of guidelines for healthcare providers for working with same-sex parented families which was a key outcome of this study.
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Affiliation(s)
- Henry von Doussa
- The Bouverie Centre, La Trobe University, Melbourne, VIC, Australia
| | - Jennifer Power
- The Bouverie Centre, La Trobe University, Melbourne, VIC, Australia
| | - Ruth McNair
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia
| | - Margot Schofield
- Counselling and Psychological Health, School of Public Health and Human Biosciences, La Trobe University, Melbourne, VIC, Australia
| | - Amaryll Perlesz
- The Bouverie Centre, La Trobe University, Melbourne, VIC, Australia
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Alang SM, Fomotar M. Postpartum Depression in an Online Community of Lesbian Mothers: Implications for Clinical Practice. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2015. [DOI: 10.1080/19359705.2014.910853] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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