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Lim G, Waling A, Lyons A, Pepping CA, Brooks A, Bourne A. Trans and Gender-Diverse peoples' experiences of crisis helpline services. Health Soc Care Community 2021; 29:672-684. [PMID: 33704863 DOI: 10.1111/hsc.13333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 10/05/2020] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
Crisis helplines are typically easily accessible and deliver interventions in a timely manner, regardless of geographical location. The efficacy and user experiences of these services are the subject of considerable interest within the field, but the experiences of trans and gender-diverse individuals remain unexplored despite high rates of mental ill health being documented in this population. A total of 134 trans and gender-diverse Australians were surveyed about their experiences of personal crises and of utilising crisis helplines. Within our sample, 84.2% (n = 113) of participants recognised at least one service - however, only 32.8% (n = 44) utilised a service to cope with a personal crisis. Participants cited poor recognition and understanding of the challenges specific to trans and gender-diverse individuals among helpline workers as a primary reason for avoiding these services, and articulated needs which were a poor fit for the one-off intervention model commonly employed by helpline services. In order for helpline services to be viable avenues of support for trans and gender-diverse individuals during a personal crisis, helpline workers must be sufficiently equipped to work with trans and gender-diverse callers and to facilitate their enrolment in 'traditional' mental health services.
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Affiliation(s)
- Gene Lim
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- School of Social Sciences, Monash University, Melbourne, Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | | | - Anna Brooks
- Lifeline Research Foundation, Canberra, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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2
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Solazzo AL, Tabaac AR, Agénor M, Austin SB, Charlton BM. Sexual orientation inequalities during provider-patient interactions in provider encouragement of sexual and reproductive health care. Prev Med 2019; 126:105787. [PMID: 31374238 PMCID: PMC7008518 DOI: 10.1016/j.ypmed.2019.105787] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 11/22/2022]
Abstract
The human papillomavirus (HPV) vaccination, sexually transmitted infection (STI) tests, and Papanicolaou (Pap) testing rates vary by sexual orientation, which may be due in part to healthcare providers (HCP) recommending this care unevenly. Data (N = 17,675) came from the Growing Up Today Study (GUTS) (N = 8039) and Nurses' Health Study 3 (NHS3) (N = 9636). Among participants who met clinical guidelines to receive the care in question, we estimated the probability of an HCP encouraging participants to have the HPV vaccination, STI tests, or Pap test. Regardless of sexual orientation, participants whose HCP knew their sexual orientation were more likely to have been encouraged to get care compared to those whose HCP did not know the participant's sexual orientation. Sexual minority men and women were more likely to be encouraged to obtain HPV vaccination, STI tests, and Pap test than same-gender, completely heterosexuals with no same-sex partners, with some variation by gender and the care in question. Lesbian women were the sole sexual orientation subgroup that was less likely to be encouraged to receive care (HPV vaccination and Pap test) than their same gender, completely heterosexual counterparts with no same-sex partners (odds ratio [95% confidence interval]: 0.90 [0.80-1.00] and 0.94 [0.91-0.98], respectively). The differences across sexual orientation in HCPs' encouragement of care indicate a possible explanation for differences in utilization across sexual orientation. Across the US, HCPs under-encourage HPV vaccination, STI tests, and Pap test for all sexual orientation groups. Lesbian patients appear to be at high risk of under-encouragement for the Pap test.
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Affiliation(s)
- Alexa L Solazzo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States of America; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 333 Longwood Ave, Boston, MA 02115, United States of America.
| | - Ari R Tabaac
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 333 Longwood Ave, Boston, MA 02115, United States of America; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States of America.
| | - Madina Agénor
- Department of Community Health, Tufts University, 574 Boston Ave, Medford, MA 02155, United States of America; Tufts Clinical and Translational Science Institute, Tufts Medical Center, 35 Kneeland St, Boston, MA 02111, United States of America; The Fenway Institute, Fenway Health, Boston, MA, 1340 Boylston St, 02215, United States of America.
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 333 Longwood Ave, Boston, MA 02115, United States of America; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States of America; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States of America; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA 02115, United States of America.
| | - Brittany M Charlton
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States of America; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 333 Longwood Ave, Boston, MA 02115, United States of America; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States of America; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA 02115, United States of America.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Yıldız E. Suicide in sexual minority populations: A systematic review of evidence-based studies. Arch Psychiatr Nurs 2018; 32:650-659. [PMID: 30029759 DOI: 10.1016/j.apnu.2018.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/13/2017] [Accepted: 03/06/2018] [Indexed: 02/05/2023]
Abstract
Sexual minority populations are exposed to more forms of distress than heterosexual individuals, thereby increasing the risk of suicidal behavior. It therefore seems surprising that suicidal behavior in sexual minorities is not sufficiently addressed in the nursing literature.The aim of this review was to integrate evidence-based knowledge and experiences related to suicide in sexual minorities into the nursing literature. This study has been conducted according to PRISMA guidelines, which contains a basic systematic screening process. Fourteen articles met the research criteria. The evaluation encompassed 4 themes: 1) Suicide attempts; 2) Thoughts of suicide; 3) Suicide attempts and completed suicide; 4) Suicidal thoughts and suicide attempts. Most studies focused on the dimensions of attempted suicide. The key finding was that young people in sexual minority groups exhibit more suicidal ideation, more suicide attempts and are more at risk of completed suicide than heterosexual individuals. Family-centered care for young people can therefore be one of the basic principles of nursing practice. Nurses can routinely ask adolescents about their sexual orientation and identity to provide appropriate assessment and care. Additionally, nurses can use educational, counseling, case manager and therapist roles to avoid negative experiences such as homophobia, stigmatization and the discrimination of sexual minorities.
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Affiliation(s)
- Erman Yıldız
- Department of Psychiatric Nursing, Faculty of Health Sciences, Inonu University, Malatya 44280, Turkey.
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Rufino AC, Madeiro A, Trinidad AS, Rodrigues dos Santos R, Freitas I. Disclosure of Sexual Orientation Among Women Who Have Sex With Women During Gynecological Care: A Qualitative Study In Brazil. J Sex Med 2018; 15:966-73. [DOI: 10.1016/j.jsxm.2018.04.648] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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6
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Hudak NC, Carmack HJ. Waiting for the doctor to ask: influencers of lesbian, gay, and bisexual identity disclosure to healthcare providers. Qual Res Med Healthc 2018. [DOI: 10.4081/qrmh.2018.7157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Lesbian, gay, and bisexual (LGB) individuals encounter multiple barriers in healthcare, resulting in problematic care. Many LGB patients wrestle with whether to disclose their sexuality to healthcare providers. This article explored what influences LGB patients’ decision to disclose their sexuality to healthcare providers. Guided by Communication Privacy Management theory, the authors conducted in-depth interviews with 20 LGB patients. LGB patients heavily relied on boundary management when negotiating the disclosure of their sexuality. The findings suggest several factors influence LGB patients’ disclosure of sexuality: i) experience with family; ii) fear of gossip and connections; iii) concern for provider care refusal; iv) religion; v) age; and vi) level of trust with providers. Boundary turbulence can be created between patient and provider when there is uncertainty about if and when sexuality is considered private information. Additionally, a site of tension for LGB patients was their concern about providers sharing private information outside the clinic setting.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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Youatt EJ, Harris LH, Harper GW, Janz NK, Bauermeister JA. Sexual Health Care Services among Young Adult Sexual Minority Women. Sex Res Social Policy 2017; 14:345-357. [PMID: 28989554 PMCID: PMC5626006 DOI: 10.1007/s13178-017-0277-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Young adult sexual minority women (YSMW) are at elevated risk for negative reproductive health outcomes, yet are less likely than heterosexual peers to utilize preventive health care. Medical and public health policy organizations advocate sexual orientation disclosure ("coming out") to health care providers as a strategy for increasing service utilization among YSMW. Limited research explores relationships between disclosure and receipt of sexual health services. YSMW (N=285) ages 21-24 participated in an online survey assessing their health behaviors and care utilization. We employed multivariable logistic regression models to examine the association between receipt of sexual health services and sexual orientation disclosure to provider, after adjusting for sociodemographic covariates. Thirty-five percent of YSMW were out to their provider. Less than half the sample had received Pap screening or STI testing in the previous year; approximately 15% had received at least one dose of the HPV vaccination. Disclosure was associated with increased likelihood of Pap screening (OR=2.66, p<.001) and HPV vaccination (OR=4.30, p<.001), but was not significantly associated with STI testing. Promoting coming out to providers may be a promising approach to increase sexual health care use among YSMW. Future research should explore causal relationships between these factors.
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Affiliation(s)
- Emily J. Youatt
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Lisa H. Harris
- Department of Obstetrics and Gynecology, School of Medicine, University of Michigan, Ann Arbor, MI
| | - Gary W. Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Nancy K. Janz
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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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. J Homosex 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] [What about the content of this article? (0)] [Affiliation(s)] [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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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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12
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De Oliveira JM, Almeida MJ, Nogueira C. Exploring Medical Personnel’s Discourses on the Sexual Health of Lesbian and Bisexual Women in Greater Lisbon, Portugal. Rev colomb psicol 2015. [DOI: 10.15446/rcp.v23n2.38657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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13
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Flemmer N, Dekker L, Doutrich D. Empathetic Partnership: An Interdisciplinary Framework for Primary Care Practice. J Nurse Pract 2014; 10:545-551. [DOI: 10.1016/j.nurpra.2014.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
The experiences of lesbian women in medical encounters prove particularly relevant for understanding their difficulties in their relationship with professionals and health services. We carried out semistructured interviews with 30 women aged 21 to 63 years, who define themselves as lesbian. The analysis highlights the difficulties experienced in disclosure of sexuality in medical encounters, the tendency for doctors to come across as heteronormative, and also medical practices experienced as appropriate by interviewees. Analysis of participant experiences demonstrates the need for reflection and decision making to promote the recognition of the sexual citizenship of lesbian women and their empowerment.
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Affiliation(s)
- António Manuel Marques
- a Departamento de Ciências Sociais e Humanas, Escola Superior de Saúde do Instituto Politécnico de Setúbal , Setúbal , Portugal
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15
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Haugstvedt Å, Moi H. Å. Haugstvedt & H. Moi svarer:. Tidsskriftet 2014; 134:498. [DOI: 10.4045/tidsskr.14.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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16
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Abstract
To promote psychological health among lesbian, gay, and bisexual (LGB) individuals, more comprehensive research on resilience factors in LGB individuals is needed. This article presents a theoretical framework based on the existing literature, with an eye toward guiding future research in this area. Social support clearly serves as a resilience factor for LGB individuals, in part through its ability to lower reactivity to prejudice. Social support is particularly effective when it specifically supports people’s sexual orientation and is congruent with individuals’ developmental needs. The ability to accept emotions and to process them in an insightful manner also buffers the negative impact of prejudice. In addition, hope and optimism allow LGB individuals to maintain psychological health when faced with prejudice.
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Affiliation(s)
- Paul Kwon
- Washington State University, Pullman, USA
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18
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McNair RP, Hegarty K, Taft A. From silence to sensitivity: A new Identity Disclosure model to facilitate disclosure for same-sex attracted women in general practice consultations. Soc Sci Med 2012; 75:208-16. [DOI: 10.1016/j.socscimed.2012.02.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 02/12/2012] [Accepted: 02/13/2012] [Indexed: 11/25/2022]
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Abstract
Aims: Even though homosexuality is apparently widely accepted, minority stress prevails. Successful coping may reduce the negative impact of minority stress on health. We wanted to explore lesbian women’s positive coping experiences related to sexual minority stress. Methods: A convenience sample of self-defined lesbian women living in Norway was recruited mainly via internet. Qualitative data about coping strategies were obtained as written answers to a web-based, open-ended questionnaire. Data were analysed with systematic text condensation supported by theories of stress and coping, and salutogenesis. Results: Openness about the lesbian orientation, and how disclosure was carried out, were means to counter anticipated prejudice. Maintaining dignity when prejudice appeared could be accomplished by actions to demand one’s rights or claim respect, or by unexpressed thoughts boosting self-respect when unable to talk back. Prejudice within family relations lead to compromises to enable contact, but never compromising self-respect. Underlying successful coping strategies we identified a personal conviction that being lesbian is respectable and worthy – lesbian confidence. Conclusions: Promoting lesbian confidence, a healthcare provider can contribute to psychological wellbeing and enhance health among lesbian women. Open lesbian women in the community, who are responded to in a positive or every-day-like manner, may nurture lesbian confidence and contribute to coping and health.
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Affiliation(s)
- Mari Bjorkman
- Research Unit for General Practice, Uni Health/Uni Research Bergen, Bergen, Norway
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Kirsti Malterud
- Research Unit for General Practice, Uni Health/Uni Research Bergen, Bergen, Norway
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
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20
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Chapman R, Wardrop J, Zappia T, Watkins R, Shields L. The experiences of Australian lesbian couples becoming parents: deciding, searching and birthing. J Clin Nurs 2012; 21:1878-85. [DOI: 10.1111/j.1365-2702.2011.04007.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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St Pierre M. Under what conditions do lesbians disclose their sexual orientation to primary healthcare providers? A review of the literature. J Lesbian Stud 2012; 16:199-219. [PMID: 22455342 DOI: 10.1080/10894160.2011.604837] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Under what conditions do lesbians disclose their sexual orientation to primary healthcare providers? A review of the literature was undertaken to answer this question and to provide insight into the ways healthcare professionals can play an active role assisting their lesbian patients in "coming out." Thirty empirical studies met the inclusion criteria and were reviewed. Collectively, these separate studies have found that a myriad of internal (patient attributes) and external (healthcare context, patient-provider relationship) factors influence disclosure. The discussion highlights the critical role of healthcare professionals in supporting disclosure.
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Affiliation(s)
- Melissa St Pierre
- Department of Psychology, University of Windsor, Chrysler Hall South, Room 173, 401 Sunset Avenue, Windsor, Ontario, Canada, N9B 3P4.
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Frederiksen HB, Kragstrup J, Dehlholm-Lambertsen B. Attachment in the doctor-patient relationship in general practice: a qualitative study. Scand J Prim Health Care 2010; 28:185-90. [PMID: 20642396 PMCID: PMC3442335 DOI: 10.3109/02813432.2010.505447] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 06/29/2010] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To explore why interpersonal continuity with a regular doctor is valuable to patients. DESIGN, SETTING, AND SUBJECTS A qualitative study based on 22 interviews with patients, 12 who saw their regular general practitioner (GP) and 10 who saw an unfamiliar GP. The patients were selected after an observed consultation and sampled purposively according to reason for encounter, age, and sex. The research question was answered by means of psychological theory. RESULTS A need for attachment was a central issue for the understanding of the value of interpersonal continuity for patients. The patients explained that they preferred to create a personal relationship with their GP and the majority expressed a degree of vulnerability in the doctor-patient relationship. The more sick or worried they were the more vulnerable and the more in need of a regular GP. Furthermore, patients stated that it was difficult for them to change GP even if they had a poor relationship. CONCLUSION Attachment theory may provide an explanation for patients' need to see a regular GP. The vulnerability of being a patient creates a need for attachment to a caregiver. This need is fundamental and is activated in adults when they are sick or scared.
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Affiliation(s)
- Heidi Bøgelund Frederiksen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Abstract
BACKGROUND For lesbian women, we know more about causes of health problems than health-promoting factors. The aim of this study was to explore what lesbian women have perceived as health-promoting experiences. MATERIAL AND METHODS Focus group study with two group interviews (with nine lesbian women aged 40-55 years). Participants were required to be "out of the closet" regarding sexual orientation and to feel comfortable with their lives as lesbians. The interviews were audiotaped, transcribed, and analyzed with systematic text condensation supported by a salutogenic frame of reference. RESULTS The women told about how a perception of being different could translate into opportunities and a positive strength. A good "coming-out process" could lead to companionship and strategies for coping with challenges. Furthermore, feelings of exemption from expectations of a narrow gender role had a positive impact on identity and sexuality. Finally, the liberating consequences of being able to organize personal relationships and family according to own priorities opened up new possibilities, especially regarding choosing to have children or not. INTERPRETATION Health promoting strategies and initiatives must be grounded in what individuals consider to be important in their own lives. Knowledge about lesbians' health-promoting experiences may contribute to a positive focus on coping with minority stress and challenge an established understanding of pathology in a marginalized group.
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Affiliation(s)
- Mona Flatval
- Seksjon for helsefag, Universitetet i Oslo, Gydas vei 8, 0363 Oslo, Norway.
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25
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Abstract
Aims: A broad range of socio-cultural issues have been recognized as determinants for health and disease. A notion of gender neutrality is still alive in the medical culture, suggesting that gender issues are not relevant within this field. Methods: We have explored the claim that doctors encounter their patients as human beings, not as men or women, and discuss causes and consequences of such a claim. Results: Empirical evidence does not support such a claim — gender seems to have a strong impact on medical knowledge and practice. The concept andronormativity signifies a state of affairs where male values are regarded as normal to the extent that female values disappear or need to be blatantly highlighted in order to be recognized. We have applied this frame of reference to understand how the idea of gender neutrality has been established in medicine. The average medical practitioner, teacher, or researcher is a man. We suggest that notions of normality subtly construct gender in medicine in ways where men become normal, while women become deviant. Finally, we discuss strengths and pitfalls of three different strategies which have been used by gender researchers in health to challenge andronormativity: demonstrating gender differences, revealing the consequences of gendered power inequalities, and deconstructing the meaning of gender. Conclusions: We conclude that gender still matters in medicine.
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Affiliation(s)
- Bibi Hølge-Hazelton
- University of Aarhus, Department of Pedagogy, Copenhagen, Denmark, The Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark,
| | - Kirsti Malterud
- The Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark, Research Unit for General Practice, Unifob Health, Bergen, Norway
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Abstract
BACKGROUND Although the social situation for gay, lesbian, and bisexual people has improved over the last decades, lesbian women still face unique challenges when seeking healthcare services. OBJECTIVES To explore lesbian women's healthcare experiences specifically related to sexual orientation to achieve knowledge which can contribute to increased quality of healthcare for lesbian women. METHODS Qualitative study based on written stories, with recruitment, information, and data sampling over the internet. Data consisted of 128 anonymously written answers to a web-based, open-ended questionnaire from a convenience sample of self-identified lesbian women. Data were analysed with systematic text condensation. Interpretation of findings was supported by theories of heteronormativity. Main outcome measures. Patients' histories of experiences where a lesbian orientation was significant, when seeing a doctor or another healthcare professional. RESULTS Analysis presented three different aspects of healthcare professionals' abilities, regarded as essential by our lesbian participants. First, the perspective of awareness was addressed--is the healthcare professional able to think of and facilitate the disclosure of a lesbian orientation? Second, histories pointed to the attitudes towards homosexuality--does the healthcare professional acknowledge and respect the lesbian orientation? Third, the impact of specific and adequate medical knowledge was emphasized--does the healthcare professional know enough about the specific health concerns of lesbian women? CONCLUSION To obtain quality care for lesbian women, the healthcare professional needs a persistent awareness that not all patients are heterosexual, an open attitude towards a lesbian orientation, and specific knowledge of lesbian health issues. The dimensions of awareness, attitude, and knowledge are interconnected, and a positive direction on all three dimensions appears to be a necessary prerequisite.
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Affiliation(s)
- Mari Bjorkman
- Research Unit for General Practice, Unifob Health Bergen
- Department of Public Health and Primary Health Care, University of Bergen, Norway
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Malterud K, Bjorkman M, Flatval M, Ohnstad A, Thesen J, Rortveit G. Epidemiological research on marginalized groups implies major validity challenges; lesbian health as an example. J Clin Epidemiol 2009; 62:703-10. [PMID: 19070465 DOI: 10.1016/j.jclinepi.2008.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 07/02/2008] [Accepted: 07/29/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Several studies have suggested an increased risk of health problems among lesbian women. Evidence-based practice calls for knowledge about risks and prevalences of diseases deserving special awareness. However, research on marginalized groups raises ethical challenges from normative assumptions underlying analysis, because models are drawn from the cultural context where marginalization itself is created and recreated. Several methodological problems consequently appear. STUDY DESIGN AND SETTING In this article, we aim to explicate some challenges related to validity in epidemiological research on minority groups where members can conceal their identity -- lesbian health being our case. Our approach is a case study drawing on analytic induction. RESULTS We demonstrate challenges related to conceptual indistinctness, internal and external validity, confounders, cultural context, type II error, and the issue of small population subgroups. As women with a lesbian orientation constitute a relatively small fraction of the population, modest measurement problems can lead to serious errors in inference about health in "lesbians." CONCLUSION Generalization of the findings about health to "all lesbians," and comparison between "all lesbians" and "women in general," should be undertaken with great caution. Similar awareness should be exercised in studies on any minority group where members can conceal their identity.
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