Health Care Utilization in a Sample of Canadian Lesbian Women: Predictors of Risk and Resilience

Abstract

This study was designed to test an exploratory path model predicting health care utilization by lesbian women. Using structural equation modeling we examined the joint influence of internalized homophobia, feminism, comfort with health care providers (HCPs), education, and disclosure of sexual identity both in one's life and to one's HCP on health care utilization. Surveys were completed by 254 Canadian lesbian women (54% participation rate) recruited through snowball sampling and specialized media. The majority (95%) of women were White, 3% (n = 7) were women of colour, and the remaining six women did not indicate ethnicity. Participants ranged in age from 18 to 67 with a mean age of 38.85 years (SD = 9.12). In the final path model, higher education predicted greater feminism, more disclosure to HCPs, and better utilization of health services. Feminism predicted both decreased levels of internalized homophobia and increased disclosure across relationships. Being more open about one's sexual identity was related to increased disclosure to HCPs, which in turn, led to better health care utilization. Finally, the more comfortable women were with their HCP the more likely they were to seek preventive care. All paths were significant at p < .01. The path model offers insight into potential target areas for intervention with the goal of improving health care utilization in lesbian women.

Pap smear rates among Australian community-attached lesbian and bisexual women: some good news but disparities persist

“…On the other hand, some women may be avoiding Pap smears because they are worried about disclosing their sexuality and risking a negative reaction from a clinician; there is some support for this in the literature. (8) We know that disclosure is positively associated with better health care utilisation, (26) and preventative care (26) including Pap smear testing. (8,27) Disclosure is strongly associated with higher levels of satisfaction with health care, (8,28) and with higher levels of comfort discussing sexual health with a health care practitioner.…”

Building a Foundation to Reduce Health Inequities: Routine Collection of Sociodemographic Data in Primary Care

“…15,16 Questions about immigration status can be a source of fear for those residing in Canada without legal status. 17 The question was phrased purposefully to not require disclosure of immigration status.…”

“…15,16 Transgender patients report high rates of discrimination when seeking health care. 17 New immigrants to Canada access fewer primary care services than their Canadian-born counterparts.…”

“…LGB Canadians consistently report more negative experiences within the health system. 59,60 When encounters are not overtly discriminatory, LGB patients are treated "just like everybody else," with inattention to the unique health needs of this population. 61,62 Many LGB persons do not divulge sexual orientation for fear of provider bias, 63 and experiences of stigma leads to future avoidance or delay of care seeking.…”

“…61,62 Many LGB persons do not divulge sexual orientation for fear of provider bias, 63 and experiences of stigma leads to future avoidance or delay of care seeking. 59,64 Lesbians are less likely to see a family physician for a Pap test than heterosexual women. 64 Canadian LGB youth are at higher risk of suffering from mental illness (including suicidal ideation, suicide attempts, and depression), physical and sexual abuse, homelessness, and exposure to human immunodeficiency virus.…”