April 7-9, 2022 • Hyatt Regency • Lexington, KY
Communication Strategies to Promote Comprehensive Well-being
Communication Strategies to Promote Comprehensive Well-being
Abstract: LGBT Medical Mistrust and Perceptions of Patient-Provider Communication in the Southern United States
Significance: Lesbian, gay, bisexual, and transgender (LGBT+) populations have higher health risks and poorer outcomes compared with their sexual majority counterparts, including higher illicit drug and alcohol use, higher rates of cardiovascular stress, higher body mass indexes (Whitehead, Shaver, & Stephenson, 2016), and increased potential exposure to HIV/AIDS and other sexually transmitted infections (Whitehead, Shaver, & Stephenson, 2016). Sexual minorities are less likely to attend routine and preventative cancer screenings (Bristow et al., 2018), and have higher cancer prevalence rates (Valanis et al., 2000). In addition to significant institutional and policy challenges, such as lack of health coverage by insurance and lack of access to appropriate medical care, health disparities in this population stem from stigma and discrimination from health care providers; practitioners are reported to often be uncomfortable communicating with sexual minorities, and insensitivity to identity-specific needs (Institute of Medicine, 2011). Inadequate access to inclusive healthcare facilities in Southern states is particularly concerning (Ruben et al., 2017). Research on verbal and nonverbal messaging by healthcare providers that would encourage LGBT patients’ disclosure is imperative, but there is a dearth in theoretically-driven communication scholarship addressing these challenges. This study aimed to understand the extent to which LGBT participants perceive healthcare providers’ behaviors as accommodative and nonaccommodative, and how this dynamic impacts LGBT patients’ self-disclosure in healthcare settings. Method: We used a Qualtrics survey distributed to LGBT adults throughout the Southern United States (N=274; mean age=32.58; SD=10.98), including items on LGBT self-disclosure to healthcare providers (Watson & Gallois, 1998) and perceived accommodative and non accommodative behaviors of healthcare providers (Communication Accomodation Theory; Colaner et al., 2014; Makoul et al., 2007; Soliz & Harwood, 2003), and perceived discrimination and mistrust (Thomspon et al., 2004; Peek et al., 2011). To examine these relationships, ANOVA, regression and mediation analyses using SPSS Process (Hayes, 2017) model 4 were conducted, with sexual identity entered as a covariate. Results: The direct relationship between provider accommodation and patient self-disclosure was positive and significant, confirming the predictions of H1 (p < 0.05). Mistrust did not mediate the relationship between provider accommodation and patient self-disclosure, failing to confirm H2, (b = -0.074, 95% CI [-0.0059, 0.0732], t = -1.504, p>.05). However, H3 was statistically significant, such that patient mistrust mediated the relationship between provider nonaccommodative behaviors and patient self-disclosure (b = -0.212, 95% CI [-.202, -.005], t = -3.63, p<.05). Post hoc tests found significant differences in mistrust by gender (p=<.01) and sexual (p=.05) idenities. Conclusion: Our findings provide some evidence that provider accommodation both directly and indirectly impacts self-disclosure of LGBT patients; decreased self-disclosure may lead to patients' health concerns not being properly addressed. Additionally, variations in experiences of mistrust suggest the need for further research on the efficacy of tailored messages and communication interventions within LGBT+ communities. Overall, the current study demonstrates the practical and theoretical potential of improving healthcare provider accommodative behaviors with LGBT patients to decrease patient mistrust and minimize health disparities in the US South.