Lesbian and bisexual women are less likely to obtain routine care and are more likely to be overweight or obese (Blosnich et al., 2014; McElroy et al., 2016). Lack of insurance or lack of knowledge about cervical cancer risk may contribute to the fact that only 74.6% of lesbian women obtain cervical screening compared to 83.3% of heterosexual and 77.9% of bisexual women (White et al., 2017). As a group, lesbian and bisexual women have breast cancer risks from a higher BMI, higher frequency of nulliparity, socioeconomic disparity, delay in care,
and potential lack of provider relationship, which should spur a conversation about screening mammogram before age 50 (Boehmer, 2018). Although research and public advocacy groups cluster LGBTQ patients into categories, variances exist among each group, as do potential ethnic and familial risk factors. These factors compound the serious nature of LGBTQ health risks.
CHANGING MINDSETS
Healthcare providers must be caring and open in a non-biased way to provide an equal level of care for all patients. Sensing negativity may cause patients to withhold important information about sexual identity or avoid returning for follow-up care. It is important that personal belief systems are mutually exclusive of the healthcare relationships with all patients, including LGBTQ patients, to avoid influencing the interaction and quality of the healthcare provided. Healthcare professionals traditionally receive minimal education about the LGBTQ population’s needs. The National LGBTQQIA+ Health Education Center (2016) has published resources and maintains a website with webinars and learning modules. Knowledge of basic terms and definitions will assist in establishing a mutual understanding and increasing communication with LGBTQ people (Berkeley University of
California, n.d.; New Jersey Institute of Technology, n.d.; University of California Davis, n.d.). Healthcare Professional Consideration: Healthcare professionals should ensure that they keep up to date with the concerns and needs of the LGBTQ population through continuing education opportunities. Continuing education with a focus on human sexuality, sexual minorities, and specific aspects of LGBTQ healthcare can increase knowledge and provider/staff comfort, as well as decrease bias. In addition to self-education and national guidelines, healthcare providers and their patients benefit from identifying specialty providers familiar with LGBTQ concerns and risks and knowledge of local LGBTQ-friendly resources. Displaying sensitivity to the healthcare needs of all patients is an important step in decreasing healthcare disparity in the United States.
HEALTHCARE PREFERENCES
Martos and colleagues (2018) examined qualitative data from Lifestyle Interviews of LGB persons in three age cohorts from the Generations Study, looking for influences on healthcare preferences in the population. Findings centered around themes of stigma, expertise, identity, service type, and access. Stigma was the factor that most influenced participants’ preferences and communication with providers. Martos and colleagues (2018) defined stigma as “real or perceived negative social attitudes directed toward participants about one or more of their identities” (p. 6). Findings showed that stigma influenced participants’ communication with their providers and varied from concern over one’s own comfort to comfort of both provider Cultural differences Cultural competence in healthcare is the ability to provide care to people from diverse backgrounds and adapting or designing that care to meet their social, cultural, and linguistic needs (Health Research and Educational Trust, 2013). To achieve cultural competence in healthcare systems, there must be policies in place along with training and education to change behaviors at the systems and personal levels. For systems, there may be the provision of language assistance or a cultural specialist that is part of the care team and interacts in the community. Benefits to these changes are social, such as promoting inclusion, increasing community participation in their health, and increased trust. Health benefits include improved preventive care, fewer missed appointments, and reduced disparity. The resulting benefits then lead to business benefits such as more efficient care, closer to meeting guideline recommendations, and increased market share (Health Research & Educational Trust, 2013). There are several stages in cultural competency: blindness (ignorance), awareness (you know you do not know), knowledge (you see differences and accept the person and their beliefs), Treatment recommendations McNair and Hegarty (2010) conducted a systematic review on primary care guidelines, available in several countries including the US, for LGB people, to determine if they met the Appraisal of Guidelines Research & Evaluation Instrument (AGREE) criteria for quality. The AGREE instrument is a framework for assessing the quality of development for clinical practice guidelines for
and participant. Although avoiding stigma was a high priority, there were many different ideas on how to achieve this in the healthcare experience. They included a desire for an LGB- provider/venue, or a provider of a particular gender, to no concern at all as long as the provider was comfortable with the patient’s sexuality. Expertise was also a priority and providers were frequently selected based on their specific skills. Barriers in access to healthcare were varied by age groups and insurance coverage. A frustration for many was the additional cost for utilization of a provider outside the network or the compromise between preferences such as skill set or “queer friendly” (Martos et al., 2018, p. 10). and skills (gain ability to interact with different cultures; Martin & Vaughn, 2021). Cultural competence develops in stages with individuals moving through stages at various rates with the assistance of education, training, commitment, and practice (Martin & Vaughn, 2021). While cultural competency training can be beneficial, there is a concern of forming assumptions and stereotypes (Sprik & Gentile, 2020) and no one person manifests all expectations of their culture. Cultural humility involves a personal commitment to self- evaluation and critique to focus on improving relationships (Sprik & Gentile, 2020). The benefit to cultural humility is a focus on individuals, getting to know a person’s health goals, fears, and expectations, allowing for person-centered care. Cultural humility also calls for self-reflection of one’s thoughts and biases, allowing for an equal provider-patient relationship and not requiring specific courses. Regardless of the method, identification of one’s feeling as they encounter someone with a different lifestyle or experiences is important in both cultural competence and humility. potential bias, validity, and feasibility for practice. AGREE does not assess a guideline’s impact on patient outcomes, but looks at “the methods of development, the content used to develop and the content of final recommendations” (AGREE Consortium, 2013). McNair and Hegarty (2010) found that, although the available guidelines are consistent philosophically and practically,
Page 115
Book Code: SWTX1524
EliteLearning.com/Social-Work
Powered by FlippingBook