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Ertl MM, Maroney MR, Becker A, Paschen-Wolff MM, Blankenau A, Hoffman S, Tross S. Sexual and Reproductive Justice and Health Equity for LGBTQ+ Women. JOURNAL OF LESBIAN STUDIES 2024:1-29. [PMID: 38946155 DOI: 10.1080/10894160.2024.2369434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
LGBTQ+ women have long been overlooked in sexual and reproductive health research. However, recent research has established that LGBTQ+ women have unique and specific needs that need to be addressed in order to improve effectiveness of sexual health education and practice with this historically and presently underserved population. Informed by a reproductive justice framework coupled with liberation psychology theory, this review discusses the current state of sexual and reproductive health and technologies among LGBTQ+ women. In particular, we focus on a range of HIV prevention and reproductive technologies and their use and promotion, including the internal condom, abortion, oral contraceptives, dapivirine ring, HIV pre-exposure prophylaxis, intrauterine device, and other less studied options, such as the contraceptive sponge. Grounded in an intersectional framing, this review acknowledges the intersecting systems of oppression that affect multiply marginalized women inequitably and disproportionately. A sociohistorical, critical lens is applied to acknowledge the well-documented racist origins of reproductive health technologies and ongoing coercive practices that have led to medical mistrust among marginalized and stigmatized communities, particularly racialized LGBTQ+ women, women with disabilities, and women who are poor or incarcerated. Moreover, we discuss the urgent need to center LGBTQ+ women in research and clinical care, community-engaged health promotion efforts, affirming non-heteronormative sexual health education, and health policies that prioritize autonomy and dismantle structural barriers for this population. We conclude with recommendations and future directions in this area to remedy entrenched disparities in health.
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Affiliation(s)
- Melissa M Ertl
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Meredith R Maroney
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Andréa Becker
- Department of Sociology, Hunter College, New York, NY, USA
| | - Margaret M Paschen-Wolff
- Department of Psychiatry, Division on Substance Use Disorders, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Amelia Blankenau
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Susie Hoffman
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Susan Tross
- Department of Psychiatry, Division on Substance Use Disorders, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, USA
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
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2
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Tzur-Peled S, Kushnir T, Sarid O. Nurses' Perceptions of the Quality of Perinatal Care Provided to Lesbian Women. Front Psychol 2022; 13:742487. [PMID: 35273537 PMCID: PMC8902149 DOI: 10.3389/fpsyg.2022.742487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Aim Based on the Theory of Reasoned Action (TRA), we examined whether attitudes of nurses from different ethnic groups, subjective norms, behavioral intentions, assessments of relationships and communication were associated with their perceptions of the quality of perinatal care provided to lesbian women. Background Nurses administer healthcare, provide pertinent information and consultation to lesbians from pregnancy planning through birth. Introduction During the past few decades, worldwide, there has been a rise in lesbian-parenting. Despite the changes in Israeli society's public and legal reality, intolerance and discrimination to the homosexual population is still prevalent in Israel's healthcare system. Methods A cross-sectional study conducted between 12/2015-4/2016. Of the 270 nurses approached, 184 completed a self-report anonymous questionnaire (a response rate of 74%). Findings This is an important and timely study reflecting nurses' perceptions of the quality of perinatal care provided to lesbians. The study findings reflect that attitudes, subjective norms, behavioral intentions, assessments of relationships and communication of nurses from different ethnic groups are associated with their perceptions of the quality of perinatal care provided to the lesbians. The hierarchical regression analysis demonstrated that attitudes, subjective norms, behavioral intentions, assessments of relationships and communication of nurses contributed 56% to the variance of nurses' perception of their own quality of perinatal care. Discussion TRA conceptualization predicted the quality of care of nurses from different ethnic groups treating lesbians in a perinatal setting. Conclusion TRA provides a useful framework for understanding and predicting the motivational effect of health care personnel with the lesbian population, being at risk for stigmatization and receiving less quality perinatal care. Implications for nursing and heath policy Our findings revealed the importance of formulating a recognized policy in the field of LGBT medicine at the national level. Further training of nurses as to the lesbians' unique health needs, might improve the nurses' relationships and communication as well as the quality of perinatal nursing care.
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Affiliation(s)
- Sharona Tzur-Peled
- Dina Academic School of Nursing, Rabin Medical Center, Petah Tikva, Israel
| | - Talma Kushnir
- Adelson School of Medicine, Department of Behavioral Sciences, Ariel University, Ariel, Israel.,Department of Public Health, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Orly Sarid
- The Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beersheba, Israel
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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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4
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Akré ERL, Boekeloo BO, Dyer T, Fenelon AT, Franzini L, Sehgal NJ, Roby DH. Disparities in Health Care Access and Utilization at the Intersections of Urbanicity and Sexual Identity in California. LGBT Health 2021; 8:231-239. [PMID: 33600724 DOI: 10.1089/lgbt.2020.0259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim was to examine differences in health care access at the intersections of urbanicity and sexual identity in California. Methods: We used the 2014-2017 Adult California Health Interview Survey paired with the sexual orientation special use research file to create dummy groups representing each dimension of urbanicity and sexual identity to compare access to health care outcomes. We calculated unadjusted proportions and estimated adjusted odds ratios of each dimension relative to urban heterosexual people using logistic regressions. Results: Relative to urban heterosexual people, urban gay/lesbian people had 1.651 odds of using the emergency room (ER). Urban bisexual people had 1.429 odds of being uninsured, 1.575 odds of delaying prescriptions, and 1.907 odds of using the ER. Rural bisexual people experienced similar access barriers having 1.904 odds of uninsurance and 2.571 odds of using the ER. Conclusions: Our study findings demonstrated disparate access to health care across sexual orientation and rurality. The findings are consistent with literature that suggests urban and rural sexual minority people experience health care differently and demonstrate that bisexual people experience health care differently than gay/lesbian people. These findings warrant further study to examine how social identities, such as race/ethnicity, interact with sexual orientation to determine health care access. Furthermore, these findings demonstrate the need to emphasize the health care access needs of sexual minority people in both rural and urban areas to eliminate health care access disparities.
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Affiliation(s)
- Ellesse-Roselee L Akré
- Department of Health Policy and Management, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Bradley O Boekeloo
- University of Maryland Prevention Research Center, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Typhanye Dyer
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Andrew T Fenelon
- Department of Sociology and Criminology, College of the Liberal Arts, Penn State University, University Park, Pennsylvania, USA
| | - Luisa Franzini
- Department of Health Policy and Management, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Neil J Sehgal
- Department of Health Policy and Management, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Dylan H Roby
- Department of Health Policy and Management, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
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Sommarö S, Andersson A, Skagerström J. A deviation too many? Healthcare professionals' knowledge and attitudes concerning patients with intellectual disability disrupting norms regarding sexual orientation and/or gender identity. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1199-1209. [PMID: 32281226 DOI: 10.1111/jar.12739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND People with intellectual disability (ID) have few role models for sexual expression and behaviour, and those who identify as LGBTQ experience dual marginalization. The aim of this study is to explore knowledge and attitudes concerning patients with both ID and norm-breaking sexuality and/or gender identity among healthcare professionals in habilitation centres. METHOD Data were collected from four focus group interviews that included 19 healthcare professionals from child and adult teams at two Swedish habilitation centres. Data were analysed using thematic analysis. RESULTS Three themes were identified as follows: heteronormative treatment in health care, barriers for inclusion and possibilities for inclusion. CONCLUSIONS Norm-breaking sexuality and gender identity are still relatively invisible in habilitation centres. People with ID are still predominately desexualized and perceptions regarding their sexuality are lagging behind the rest of society. Conditions that allow for more LGBTQ-affirmative practice were described by the teams that have undergone LGBTQ training.
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Affiliation(s)
- Susanna Sommarö
- Department of Habilitation, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Agneta Andersson
- Research and Development Unit, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Janna Skagerström
- Research and Development Unit, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Soinio JII, Paavilainen E, Kylmä JPO. Lesbian and bisexual women’s experiences of health care: “Do not say, ‘husband’, say, ‘spouse’”. J Clin Nurs 2019; 29:94-106. [DOI: 10.1111/jocn.15062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Eija Paavilainen
- Faculty of Social Sciences Nursing Science Tampere University Tampere Finland
- South Ostrobothnia Hospital District Seinäjoki Finland
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7
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Zeeman L, Sherriff N, Browne K, McGlynn N, Mirandola M, Gios L, Davis R, Sanchez-Lambert J, Aujean S, Pinto N, Farinella F, Donisi V, Niedźwiedzka-Stadnik M, Rosińska M, Pierson A, Amaddeo F. A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities. Eur J Public Health 2019; 29:974-980. [PMID: 30380045 PMCID: PMC6761838 DOI: 10.1093/eurpub/cky226] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience significant health inequalities. Located within a European Commission funded pilot project, this paper presents a review of the health inequalities faced by LGBTI people and the barriers health professionals encounter when providing care. METHODS A narrative synthesis of 57 papers including systematic reviews, narrative reviews, meta-analyses and primary research. Literature was searched in Cochrane, Campbell Collaboration, Web of Science, CINAHL, PsychINFO and Medline. The review was undertaken to promote understanding of the causes and range of inequalities, as well as how to reduce inequalities. RESULTS LGBTI people are more likely to experience health inequalities due to heteronormativity or heterosexism, minority stress, experiences of victimization and discrimination, compounded by stigma. Inequalities pertaining to LGBTI health(care) vary depending on gender, age, income and disability as well as between LGBTI groupings. Gaps in the literature remain around how these factors intersect to influence health, with further large-scale research needed particularly regarding trans and intersex people. CONCLUSION Health inequalities can be addressed via changes in policy, research and in practice through health services that accommodate the needs of LGBTI people. With improved training to address gaps in their knowledge of LGBTI health and healthcare, health professionals should work in collaboration with LGBTI people to address a range of barriers that prevent access to care. Through structural change combined with increased knowledge and understanding, services can potentially become more inclusive and equally accessible to all.
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Affiliation(s)
- Laetitia Zeeman
- School of Health Sciences, University of Brighton, Brighton, UK
- Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Nigel Sherriff
- School of Health Sciences, University of Brighton, Brighton, UK
- Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Kath Browne
- Department of Geography, Maynooth University, Maynooth, Ireland
| | - Nick McGlynn
- Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
- School of Environment and Technology, University of Brighton, Brighton, UK
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- CReMPE—Regional Coordination Centre for European Project Management, Veneto Region—Department of Health, The Verona University Hospital, Verona, Italy
| | - Lorenzo Gios
- CReMPE—Regional Coordination Centre for European Project Management, Veneto Region—Department of Health, The Verona University Hospital, Verona, Italy
| | - Ruth Davis
- CReMPE—Regional Coordination Centre for European Project Management, Veneto Region—Department of Health, The Verona University Hospital, Verona, Italy
| | | | | | | | - Francesco Farinella
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Valeria Donisi
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | | | - Magdalena Rosińska
- Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
| | | | - Francesco Amaddeo
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
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8
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Fish J, Williamson I, Brown J. Disclosure in lesbian, gay and bisexual cancer care: towards a salutogenic healthcare environment. BMC Cancer 2019; 19:678. [PMID: 31291940 PMCID: PMC6617610 DOI: 10.1186/s12885-019-5895-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 06/30/2019] [Indexed: 11/15/2022] Open
Abstract
Background The literature on sexual orientation disclosure is arguably one of the most developed in the field of lesbian, gay and bisexual (LGB) people in healthcare in English speaking countries however, relatively little research has been conducted into disclosure in cancer care. Studies have been mainly undertaken in primary care where distinct circumstances pertain and where the benefits of disclosure include obtaining appropriate health information, treatment advice and avoiding misdiagnosis. Methods We conducted an in-depth qualitative study primarily recruiting patients through oncology care in hospital settings and through LGB community cancer support groups. Data were gathered through semi-structured interviews with 30 LGB patients with different cancer types. Results Data were analysed using thematic analysis and interpreted and interrogated through salutogenesis theory which offers a useful lens through which to consider the health promoting effects of sexual orientation disclosure in cancer care. We present three themes as part of the analysis: Authenticity as a driver for disclosure in cancer care, Partners as a (potential) salutogenic resource and Creating safe, healing environments conducive to disclosure. The findings are reported and discussed in relation to three inter-related concepts from current salutogenesis theorising including a sense of coherence, generalised resistance resources and healing environments which can facilitate sexual orientation disclosure. Conclusion Our findings enable a more nuanced approach to understanding disclosure in this context. This study contributes to the literature through its articulation of the salutogenic potential of disclosure (if responded to appropriately) for LGB patients as individuals, in relationship to their partners or carers and the role of creating a visible healing-oriented optimal environment to promote quality of life and recovery. Electronic supplementary material The online version of this article (10.1186/s12885-019-5895-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julie Fish
- Centre for LGBTQ Research, De Montfort University, The Gateway, Leicester, LE1 9BH, UK.
| | - Iain Williamson
- Division of Psychology, De Montfort University, Leicester, LE1 9BH, UK
| | - Jayne Brown
- Leicester Academy for the Study of Ageing (LASA) The Leicester School of Nursing and Midwifery, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
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9
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Sherriff N, Zeeman L, McGlynn N, Pinto N, Hugendubel K, Mirandola M, Gios L, Davis R, Donisi V, Farinella F, Amaddeo F, Costongs C, Browne K. Co-producing knowledge of lesbian, gay, bisexual, trans and intersex (LGBTI) health-care inequalities via rapid reviews of grey literature in 27 EU Member States. Health Expect 2019; 22:688-700. [PMID: 31228361 PMCID: PMC6737757 DOI: 10.1111/hex.12934] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/13/2019] [Accepted: 05/24/2019] [Indexed: 11/28/2022] Open
Abstract
Background The health inequalities experienced by lesbian, gay, bisexual, trans and intersex (LGBTI) people are well documented with several reviews of global research summarizing key inequalities. These reviews also show how the health‐care needs of LGBTI people are often poorly understood whilst suggesting that targeted initiatives to reduce inequalities should involve LGBTI people. Objectives To determine what is known about the health‐care inequalities faced by LGBTI people? What are the barriers faced by LGBTI people whilst accessing health care, and health professionals when providing care? What examples of promising practice exist? Design Rapid reviews of grey literature were co‐produced with LGBTI people in 27 countries followed by a thematic analysis and synthesis across all data sets. The review included grey literature from each country that might not otherwise be accessible due to language barriers. Main results Rapid reviews showed that LGBTI people faced various inequalities and barriers whilst accessing health care. Where heterosexuality, binary gender and assumed male/female sex characteristics were upheld as the norm, and where LGBTI people differed from these norms, discrimination could result. In consultations where LGBTI people feared discrimination and did not disclose their LGBTI status, health professionals lacked the information required for appropriate assessments. Conclusion With greater understanding of sexual orientation (LGB people), gender identity (trans people) and sex characteristics (intersex people), combined with access to contemporary knowledge and training, health professionals can work in collaboration with researchers, policymakers and LGBTI people to develop systems that are better attuned to the needs of all service users.
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Affiliation(s)
- Nigel Sherriff
- School of Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Laetitia Zeeman
- School of Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Nick McGlynn
- Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK.,School of Environment and Technology, University of Brighton, Brighton, UK
| | | | | | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy
| | - Lorenzo Gios
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy
| | - Ruth Davis
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Valeria Donisi
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Francesco Farinella
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Francesco Amaddeo
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | | | - Kath Browne
- Department of Geography, Maynooth University, Maynooth, Ireland
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11
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Liu PL, Yeo TED. Breast health, risk factors, and cancer screening among lesbian, bisexual, and queer/questioning women in China. Health Care Women Int 2019; 42:947-961. [PMID: 30730783 DOI: 10.1080/07399332.2019.1571062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this study, we examine the health disparities of sexual minority women by surveying 310 lesbian, bisexual, and queer/questioning women (LBQW) in China about their breast health and cancer screening practices. We found that Chinese LBQW, particularly those identified with a masculine gender role and practice chest binding, are vulnerable to breast cancer given their high rates of behavioral risk factors (e.g., cigarette smoking) and symptoms (e.g., breast lumps) but low rates of self and clinical breast examinations. Salient barrier (stigma) and facilitators (social support availability, self-efficacy, and breast cancer information exposure) of breast cancer screening were also identified.
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Affiliation(s)
- Piper Liping Liu
- School of Communication, Hong Kong Baptist University, Hong Kong
| | - Tien Ee Dominic Yeo
- Department of Communication Studies, Hong Kong Baptist University, Hong Kong
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12
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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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13
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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: 121] [Impact Index Per Article: 20.2] [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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14
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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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15
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Wells MB, Lang SN. Supporting same-sex mothers in the Nordic child health field: a systematic literature review and meta-synthesis of the most gender equal countries. J Clin Nurs 2016; 25:3469-3483. [DOI: 10.1111/jocn.13340] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Michael B Wells
- Child and Adolescent Public Health Epidemiology Group; Department of Public Health Sciences; Karolinska Institutet; Stockholm Sweden
- Centre for Health Equity Studies (CHESS); Stockholm University/Karolinska Institute; Stockholm Sweden
| | - Sarah N Lang
- Department of Human Sciences; The Ohio State University; Columbus OH USA
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16
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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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17
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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. REVISTA COLOMBIANA DE PSICOLOGÍA 2015. [DOI: 10.15446/rcp.v23n2.38657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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