A Quantitative Comparison of the Health-Care Disclosure Experiences of Rural and Nonrural Lesbians

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Concealment of sexual orientation from health-care providers and/or delay of care due to fears of discrimination or maltreatment in the health-care setting can be major risk factors for the health and well-being of lesbians. Given the added vulnerabilities that rural lesbians may face as they interact with the traditional health-care system, the purpose of the current study was to investigate the relation of sexual minority status and rural background to lesbians’ health-care disclosure-related attitudes or beliefs, behaviors, and experiences. A national, diverse sample of 746 lesbians from rural (38.3%) and nonrural (61.7%) backgrounds participated in the current online study. Participants completed a series of demographic questions and the Multidimensional Disclosure to Health Care Providers Scale. A multivariate analysis of covariance was used to investigate rural versus nonrural differences across 5 disclosure indices. Post hoc analyses of covariance were then conducted for each subscale to explore the specific direction of the rural versus nonrural differences. After race or ethnicity and education were controlled for, the results revealed that rural lesbians endorsed fewer attitudes and beliefs that facilitated disclosure to a health-care provider, experienced fewer health-care opportunities in which disclosure could be initiated, reported less communication of their sexual orientation to providers, and reported previously experiencing greater negative reactions to their disclosure by providers when compared to their nonrural counterparts. Rural lesbians appear to face multiple risks related to health-care disclosure. It is important for rural health-care providers to examine their own biases and beliefs and seek out cultural competency training and consultation related to providing affirming care to lesbians in order to facilitate positive disclosure and overall health-care experiences.

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