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

• Published in: PloS one 2016-01, Vol.11 (1), p.e0146139
• Main Authors: Whitehead, J, Shaver, John, Stephenson, Rob
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adolescent; Adult; Aged; Alcohol; Analysis; Baby boomers; Behavior; Bisexual; Bisexuality; Cancer vaccines; Data processing; Demographics; Demography; Female; Gays & lesbians; Gender aspects; Gender identity; Health care; Health care industry; Health risks; Health Services Accessibility; Health services utilization; Homosexuality; Humans; Immunization; Immunotherapy; Male; Medical care; Medical screening; Mens health; Mental health; Middle Aged; Nursing schools; Older people; Population studies; Populations; Preventive medicine; Primary Health Care; Risk analysis; Risk factors; Rural areas; Rural Population; Rural populations; Sexual behavior; Sexual orientation; Social Stigma; Stigma; Stress; Transgender Persons; Urban areas; Urban environments; Utilization; Vaccines; Womens health; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0146139

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.