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      Exploring Health Care Access Among Lesbian, Gay, Bisexual, and Transgender Populations in Orange County, California : A Pilot Cross-sectional Study

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          Abstract

          There are approximately 90 000 lesbian, gay, bisexual, and transgender (LGBT) individuals in Orange County, California. LGBT individuals have significant health disparities, particularly if they are from racial or ethnic minority groups and/or have a disability. There are structural and access barriers in the health care system that increase these health disparities. These individuals experience discriminatory situations when accessing health care and mental health services, which may affect their health-seeking behaviors. The purpose of this pilot quantitative cross-sectional study was to gather information about the current health care experiences and needs of this LGBT population including priority health issues, physical and mental health care utilization, and perceived adequacy of LGBT-friendly physical and mental health care providers. These findings will inform organizational strategies for nursing administrators and other health care leaders when tailoring, planning, and redesigning structures that meaningfully address the service needs of this at-risk group. Seventy-five participants were recruited from 2 organizations serving the LGBT community to complete an online survey. Findings include trouble finding an LGBT competent provider, delays or being unable to access care, and worried about losing insurance. Most participants needed to visit multiple different locations to receive care and preferred a 1-stop shop.

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          Sexual orientation disclosure in health care: a systematic review

          Hannah Brooks, Carrie D Llewellyn, Tom Nadarzynski … (2018)
          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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            Individual and systemic barriers to health care: Perspectives of lesbian, gay, bisexual, and transgender adults.

            Kimberly D. Hudson (2017)
            Access to effective services is imperative to address the many health and mental health disparities that lesbian, gay, bisexual, and transgender (LGBT) people face. This population, however, remains underserved and often ill-served in health care environments. Furthermore, interactions between system- and individual-level dimensions of access create barriers to service engagement. Within much of the extant literature surrounding health care barriers among LGBT people, the rich narratives and varied experiences of LGBT community members from diverse backgrounds have often been excluded. The current interview-based study was conducted with a sample of 40 self-identified LGBT adults living in New York City. Participants were recruited through flyers distributed to LGBT-specific social and health service organizations. Twenty-nine participants who discussed health care access as a major health concern were included in the current study. Framework analysis revealed barriers stemming from characteristics of services and providers (system-level) and characteristics of care-seekers (individual-level) as major health concerns. The root causes of system-level barriers were all attributed to social-structural factors that worked to exclude and erase LGBT people from the institutions that shape the health and mental health systems. Individual-level barriers were attributed to both individual and social-structural factors, such as health literacy and stigma. Participants linked access barriers to forgone care and to other health and mental health concerns within their communities. We argue that addressing barriers at the individual and sociostructural levels will better serve LGBT communities. (PsycINFO Database Record
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              A Qualitative Study Examining Young Adults' Experiences of Disclosure and Non-Disclosure of LGBTQ Identity to Healthcare Providers.

              Kinton Rossman, Paul Salamanca, Kathryn R Macapagal (2017)
              Shifting cultural attitudes and legislation have increased focus on the healthcare needs of lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients. However, patient non-disclosure of LGBTQ identity creates a barrier to accessing care. This qualitative study examined a diverse sample of LGBTQ young adults and their experiences of disclosure and non-disclosure to medical providers. Participants (n = 206, age range 18-27) completed questionnaires assessing healthcare access and use as part of a larger study. Participants' responses to open-ended items asking about experiences of LGBTQ identity disclosure to medical providers and reasons for non-disclosure were analyzed thematically. Results revealed intra- and interpersonal factors related to patient disclosure and nondisclosure of LGBTQ identity. Reasons for participant non-disclosure included providers not asking about identity, internalized stigma, and belief that health and LGBTQ identity are not related. When participants did disclose, they experienced reactions ranging from discrimination and disbelief to affirmation and respect. Findings confirm and extend previous research on young adults' identity disclosure and provide avenues for health professionals' continuing education when working with LGBTQ patients.
              Article 0 comments Cited 45 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Austin Nation: (View ORCID Profile)
                Jonathan Pelayo: (View ORCID Profile)
                J. Carlo Hojilla: (View ORCID Profile)
                Phyllis Raynor: (View ORCID Profile)
                Journal
                Title: Nursing Administration Quarterly
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 0363-9568
                Publication date Created: 2024
                Publication date (Print): January 2024
                Publication date (Electronic): December 01 2023
                Volume: 48
                Issue: 1
                Pages: 11-20
                Article
                DOI: 10.1097/NAQ.0000000000000616
                SO-VID: 391fc7cb-de2c-40a5-8ad7-634f5744b547
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