Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations.
Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations.
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DOI：
10.1371/journal.pone.0146139
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Stephenson R
中科院分区：
文献类型：
--
作者：
Whitehead J;Shaver J;Stephenson R
先前的研究已经注意到美国LGBT（女同性恋，男同性恋，双性恋和变性人）人群所经历的重大健康劣势。虽然有几项研究已经确定，对污名化的恐惧或经历以及向卫生保健提供者披露性取向和/或性别认同是LGBT人群利用卫生保健的重大障碍，但这些研究几乎完全集中在城市样本上。对于农村LGBT人群的污名化影响知之甚少，他们可能比城市中心的LGBT人群更难获得高质量的LGBT敏感护理。居住在美国农村地区的LBGT个人被招募参加一项调查，研究耻辱，披露和“outness”之间的关系，并利用初级保健服务。收集并分析了有关LGBT个人的人口统计数据，医疗保健服务，健康风险因素，健康状况，社会接触和初级保健提供者的外向度，以及预期，内化和制定的污名。污名量表得分较高与跨性别和非二元组的医疗服务利用率较低相关，而性取向披露水平较高与顺性别男性的医疗服务利用率较高相关。研究结果表明，污名化在影响农村男女同性恋、双性恋和变性者获得初级卫生保健方面的作用，并指出需要采取干预措施，重点是减少卫生保健环境中的污名化，或增加患者向提供者披露取向或性别认同。这些干预措施有可能增加农村地区男女同性恋、双性恋和变性者对初级和预防性保健服务的利用。
Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.