scholarly journals The role of country-level structural stigma on sexual orientation disclosure and discrimination in health care settings among lesbian, gay, and bisexuals across Europe

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
R Bränström ◽  
J E Pachankis
Keyword(s):  
Health Care ◽  
Sexual Orientation ◽  
Health Care Providers ◽  
Sexual Minority ◽  
Sexual Minorities ◽  
Care Providers ◽  
Health Care Settings ◽  
Country Level ◽  
Disclosure Of Sexual Orientation ◽  
Sexual Orientation Disclosure

Abstract Background The national climate surrounding sexual minorities (i.e., those self-identifying as lesbian, gay, or bisexual [LGB]) varies greatly worldwide. Recent Cross-European studies have shown that country-level structural stigma is a strong determinant of sexual minority individuals health risk behaviors and mental health. The consequences of the significant country-level variation in structural stigma on sexual minorities’ experiences of health care discrimination and disclosure of sexual orientation to health care providers have not been previously investigated. Methods In 2012, 86 000 sexual minority individuals (aged 18 years and older) from all 28 European Union countries responded to questions concerning discrimination in health care settings and sexual orientation disclosure to health care providers (EU LGBT survey). Structural stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of sexual minority acceptance among citizens of each country. Results Disclosure of sexual orientation to health care providers were much more common in low stigma coutries (e.g., the Netherlands, Sweden, UK) compared to high stigma coutries (e.g., Lithuania, Latvia, Slovakia). Experiences of discrimination in health care settings were more common among LGB indiviudals who were open about their sexual orientaiton and increased by degree of country-level structural stigma. Conclusions Disclosure of sexual orientation and experiences of discrimination in health care settings varies greatly among LGB individuals in Europe largely due to structural stigma surrounding sexual minorities. Main messages These findings highlight the importance of eliminating legislation, policies, and national attitudes that promote the unequal treatment of sexual minorities in currently unsupportive European countries.

scholarly journals An Integrative Theoretical Framework for HPV Vaccine Promotion Among Male Sexual Minorities

2016 ◽  
Vol 12 (5) ◽  
pp. 1409-1420 ◽  
Author(s):  
Christopher W. Wheldon ◽  
Ellen M. Daley ◽  
Eric R. Walsh-Buhi ◽  
Julie A. Baldwin ◽  
Alan G. Nyitray ◽  
...  
Keyword(s):  
Health Care ◽  
Sexual Orientation ◽  
Health Care Providers ◽  
Hpv Vaccine ◽  
Sexual Minorities ◽  
Behavioral Control ◽  
Hpv Vaccination ◽  
Perceived Threat ◽  
Perceived Behavioral Control ◽  
Care Providers

The objective of the current study was to quantify the behavioral intentions of young adult male sexual minorities (MSM) to initiate human papillomavirus (HPV) vaccination and test an integrative model of HPV vaccine decision making. Participants were 575 MSM who were residing in the United States and were between ages 18 and 26 years. Standard direct and indirect measures of attitudes, perceived norms, and perceived behavioral control were employed to explain variation in behavioral intention. Additional background factors—such as concealment of one’s sexual identity, suspicion of health care provider competence in LGBT health issues, perceived threat, and information orientation—were also included in the model. The final model fit the data well and identified a set of salient attitudinal and control beliefs as the strongest determinants of intention ( R2 = .38). Perceived threat and information orientation were positively correlated with HPV-related beliefs. Perceived threat was higher among men infected with HIV and lower among men in monogamous relationships. Self-efficacy, as an indirect measure of perceived behavioral control, was inversely related to the general tendency to conceal aspects of one’s sexual orientation and a suspicion of health care providers. Bisexual identified men were more likely to conceal their sexual orientation and be more suspicious of health care providers. In this study, a number of modifiable determinants of HPV vaccine intentions—both psychosocial and environmental—were identified and have implications for targeted and tailored behavioral interventions to promote HPV vaccination among MSM.

Characterizing Sexual Orientation Disclosure to Health Care Providers: Lesbian, Gay, and Bisexual Perspectives

2016 ◽  
Vol 32 (5) ◽  
pp. 578-586 ◽  
Author(s):  
Maria K. Venetis ◽  
Beth E. Meyerson ◽  
L. Brooke Friley ◽  
Anthony Gillespie ◽  
Anita Ohmit ◽  
...  
Keyword(s):  
Health Care ◽  
Sexual Orientation ◽  
Health Care Providers ◽  
Care Providers ◽  
And Bisexual ◽  
Sexual Orientation Disclosure

scholarly journals Defining and Achieving Health Equity in Genomic Medicine

2019 ◽  
Vol 29 (Suppl 1) ◽  
pp. 173-178 ◽  
Author(s):  
Sonya Jooma ◽  
Michael J. Hahn ◽  
Lucia A. Hindorff ◽  
Vence L. Bonham
Keyword(s):  
Health Care ◽  
Health Equity ◽  
Health Care Providers ◽  
Genomic Medicine ◽  
Genomic Research ◽  
Infrastructure Development ◽  
Care Providers ◽  
Health Care Settings ◽  
Traditional Research ◽  
Improve Health

The potential of genomics to improve health comes with the peril that the benefits will not be equitably available to all populations. Existing health disparities can be exacer­bated if the implementation of genomic medicine does not intentionally focus on health equity. Defining what health equity means in the context of genomics and outlining how it can be achieved is impor­tant for the future of the field. Strategies to improve health equity include addressing underrepresentation of diverse popula­tions in genomic research, investigating how genomic services can be deployed in diverse health care settings and underserved communities, increasing workforce diversity, supporting infrastructure development out­side traditional research centers, and engag­ing communities and health care providers. By employing these strategies, the genomic research community can advance health equity in genomic medicine. Ethn Dis. 2019;29(Suppl 1):173-178; doi:10.18865/ed.29.S1.173.

scholarly journals Sexual Minority Women’s Sexual and Reproductive Health Literacy: A Qualitative Descriptive Study

2020 ◽  
Vol 47 (5) ◽  
pp. 728-739
Author(s):  
Margaret M. Paschen-Wolff ◽  
Madelyne Z. Greene ◽  
Tonda L. Hughes
Keyword(s):  
Health Care ◽  
Health Literacy ◽  
Reproductive Health ◽  
Health Care Providers ◽  
Sexual Minority ◽  
Sexual And Reproductive Health ◽  
Descriptive Study ◽  
Access To Information ◽  
Care Providers ◽  
Qualitative Descriptive

Although sexual minority women (SMW) are at risk for cervical cancer and sexually transmitted infections (STIs), they may not seek preventative sexual and reproductive health care at the same rates as their heterosexual peers. We conducted a qualitative descriptive study of 22 adult SMW, a subsample of participants enrolled in the Chicago Health and Life Experiences of Women study. The aim was to describe the sexual and reproductive health literacy of this community sample based on qualitative themes, using an integrated model of health literacy. This model considers not only access to information but also understanding, appraisal, and application of information. We found that family of origin, health care providers, and school-based sexual education were the most important sources of sexual and reproductive health information. Participants described their understanding, appraisal, and application of sexual and reproductive health information as interdependent concepts. Pap test literacy and decision making were strongly independent, with SMW seeking various sources of information, or were driven by health care providers, with SMW following instructions and trusting provider advice. STI-related literacy hinged on whether the participant perceived SMW as at risk for STIs. Our findings reinforce that simply having access to information is insufficient to enact health behaviors that reflect full literacy. Findings have implications for health care providers, who should provide evidence-based recommendations for their SMW clients, and for public health practitioners and educators, who could make sexual health education more inclusive of and specific to the needs of SMW.

scholarly journals Improving Care for Elders Who Prefer Informal Spaces to Age-Separated Institutions and Health Care Settings

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Stacy Torres ◽  
Xuemei Cao
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Providers ◽  
Public Transportation ◽  
Urban Areas ◽  
Health Care Services ◽  
Well Being ◽  
Care Providers ◽  
Third Places ◽  
Health Care Settings

Abstract Background and Objectives Despite advantages of urban areas (such as walkability, public transportation, nearby shopping, and health care services), challenges remain for elders aging in place to access care. The changing demographics of older adults, with higher rates of divorce, singlehood, and childlessness, often living alone and far from family, necessitate new strategies to support health and well-being. Research Design and Methods Drawing on 5 years of ethnographic fieldwork and 25 interviews with elders in New York City, this study presents empirical insights into older adults’ use of “third places” close to home, in conjunction with more formal settings. Results This article identifies external and internalized ageism and complicated age-based identity as important reasons why older adults preferred “third places” to age-separated spaces such as senior centers and formal settings such as health care settings. We find that neighborhood “third places” offer important physical venues for older adults to process negative or hurried interactions in other formal and age-separated places. Discussion and Implications This article makes policy suggestions for increasing access and usage of essential services, including developing attractive and appealing intergenerational spaces in which older community members can obtain services and dispatching caseworkers to public spaces where elders congregate. Furthermore, this article recommends improving exchanges between health care providers and older adults so that they feel recognized, respected, and cared for, which can improve health care outcomes.

Legal and Ethical Imperatives for Using Certified Sign Language Interpreters in Health Care Settings: How to “Do No Harm” When “It’s (All) Greek” (Sign Language) to You

2016 ◽  
Vol 17 (3) ◽  
pp. 114-128 ◽  
Author(s):  
Angela M. Nonaka
Keyword(s):  
Health Care ◽  
Sign Language ◽  
Health Care Providers ◽  
Limited English Proficiency ◽  
Ethical Issues ◽  
The United States ◽  
Care Providers ◽  
Sign Language Interpreters ◽  
Health Care Settings ◽  
Sign Language Interpreting

Communication obstacles in health care settings adversely impact patient–practitioner interactions by impeding service efficiency, reducing mutual trust and satisfaction, or even endangering health outcomes. When interlocutors are separated by language, interpreters are required. The efficacy of interpreting, however, is constrained not just by interpreters’ competence but also by health care providers’ facility working with interpreters. Deaf individuals whose preferred form of communication is a signed language often encounter communicative barriers in health care settings. In those environments, signing Deaf people are entitled to equal communicative access via sign language interpreting services according to the Americans with Disabilities Act and Executive Order 13166, the Limited English Proficiency Initiative. Yet, litigation in states across the United States suggests that individual and institutional providers remain uncertain about their legal obligations to provide equal communicative access. This article discusses the legal and ethical imperatives for using professionally certified (vs. ad hoc) sign language interpreters in health care settings. First outlining the legal terrain governing provision of sign language interpreting services, the article then describes different types of “sign language” (e.g., American Sign Language vs. manually coded English) and different forms of “sign language interpreting” (e.g., interpretation vs. transliteration vs. translation; simultaneous vs. consecutive interpreting; individual vs. team interpreting). This is followed by reviews of the formal credentialing process and of specialized forms of sign language interpreting—that is, certified deaf interpreting, trilingual interpreting, and court interpreting. After discussing practical steps for contracting professional sign language interpreters and addressing ethical issues of confidentiality, this article concludes by offering suggestions for working more effectively with Deaf clients via professional sign language interpreters.

scholarly journals Between Private and Public: AIDS, Health Care Capitalism, and the Politics of Respectability in 1980s America

2018 ◽  
Vol 54 (1) ◽  
pp. 159-183
Author(s):  
JONATHAN BELL
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Reagan Administration ◽  
Access To Health Care ◽  
Sexual Minorities ◽  
Opportunistic Infections ◽  
Task Force ◽  
Care Providers ◽  
Health Crisis ◽  
Aids Crisis

The AIDS crisis in the US in the 1980s radically transformed the relationship between sexual minorities and capitalism. Opportunistic infections given free rein in human bodies by HIV rendered employees visible to employers and to health care providers as an economic risk, and set the stage for battles between health capitalists, politicians, and AIDS activists over access to health care. Health capitalism in 1980s America was both an arena of integration of queer Americans into mainstream society and also a political cul-de-sac, blunting the radical possibilities of sexual politics that were alive in the years before the AIDS crisis. In this article I focus on activist groups, primarily ACT UP, Gay Men's Health Crisis, National Gay Rights Advocates, and National Gay and Lesbian Task Force, and the liberal politicians who led legislative battles at federal and state level to force the health care system to respond to AIDS. In shifting our gaze from the Reagan administration and the religious right as the primary foils to AIDS activism, we can gain new insights into the direction of liberal politics in an era of supposed conservative ascendancy. An understanding of how AIDS activists and their allies negotiated questions of health access suggests that health care activism was in part a marker of class privilege, as gay activists and liberal Democrats openly embraced a medical model for sexual minorities that lifted them above the stigma of a public welfare system and integrated them further into heteronormative capitalism.

Incident Reporting by Health-Care Workers in Noninstitutional Care Settings

2016 ◽  
Vol 18 (4) ◽  
pp. 445-456 ◽  
Author(s):  
Colleen L. Campbell
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Workers ◽  
Public Affairs ◽  
Incident Reporting ◽  
Care Providers ◽  
Comprehensive Review ◽  
Health Care Settings ◽  
Patient Violence ◽  
Care Workers

Patient-perpetrated violence and aggression toward health-care workers, specifically in noninstitutional health-care settings, cause concerns for both health-care providers and the clients whom they serve. Consequentially, this presents a public affairs problem for the entire health-care system, which the current research has failed to adequately address. While the literature overwhelmingly supports the assertion that accurate incident reporting is critical to fully understanding patient violence and aggression toward health-care providers, there is limited research examining provider decision making related to reporting incidents of patient violence and aggression targeted toward the provider. There is an even greater paucity of research specifically examining this issue in noninstitutional health-care settings. It is therefore the objective of this review to examine this phenomenon across disciplines and service settings in order to offer a comprehensive review of incident reporting and to examine rationales for providers reporting or failing to report instances of patient violence and aggression toward health-care providers.

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