Saturday, January 23, 2016

Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations

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.

Reporting of Health Care Access and Utilization of an online sample of rural LGBT people.
Cisgender Women (n = 368)Cisgender Men (n = 477)Transgender & Non-binary Persons (n = 169)All (n = 1014)P5
Health Insurance
305 (83%)393 (82%)137 (81%)835 (82%)0.845
Single PCP Location1
312 (85%)396 (83%)138 (82%)846 (83%)0.628
Single PCP2
283 (77%)349 (73%)116 (69%)748 (74%)0.119
Routine Check-up3
302 (82%)360 (75%)125 (74%)787 (78%)0.034
Travel time >1hr to main provider4
20 (5%)25 (5%)24 (14%)69 (7%)0.000
Average “outness” to personal contacts5
Mean +/- StdDev5.12 +/- 1.485.10 +/- 1.374.28 +/- 1.344.97 +/- 1.440.000
Average “outness” to main provider5
Mean +/- StdDev4.47 +/- 2.274.52 +/- 2.334.88 +/- 2.514.56 +/- 2.340.1062
Ranked “Provider sees other LGBT patients” in top 3 reasons for choosing provider
29 (8%)30 (6%)46 (27%)105 (10%)N/A
Importance of provider having LGBT-specific knowledge & support Scale of 1 (not important) to 5 (very important)
Mean +/- StdDev3.90 +/- 1.154.11 +/- 1.064.57 +/- 0.814.11 +/- 1.080.000
Primary Care Provider Visits6
073 (20%)142 (30%)36 (21%)251 (25%)0.005
1–2136 (37%)174 (36%)64 (38%)374 (37%)
3+158 (43%)157 (33%)67 (40%)382 (38%)
One or more visits to an LGBT-specific clinic6
7 (2%)18 (4%)19 (11%)44 (4%)0.000
1Has one office location where primary care services are obtained.
2Has one single provider that they consider to be their primary care provider (PCP).
3Has had a routine check-up/physical exam within the last 2 years.
4For most, their main provider is their PCP, but for those without a PCP, it indicates the provider they visited most often within the last year.
5The chi-squared test or the Kruskal-Wallis test was used to determine significant differences between each of the 3 gender categories.
6Self-reported visits in the last 12 months.

Full article at:

  • 1Department of Pediatrics, School of Medicine, Northwestern University, Chicago, IL, United States of America.
  • 2Department of Health and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, United States of America. 

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