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Sexual Minority Women and Discriminatory Health Care Experiences: An Intersectional Evaluation Across Race and Ethnicity

Published:December 12, 2022DOI:https://doi.org/10.1016/j.whi.2022.10.007

      Abstract

      Objective

      Health care discrimination contributes to medical mistrust among marginalized communities. Sexual minority women of color (SM-WOC) are marginalized because of the intersection of their sexual orientation, gender, and race/ethnicity and regularly report poor health care experiences at the intersection of these identities. However, research has yet to quantify differences in the prevalence of reported health care discrimination across SM women of various racial/ethnic backgrounds. As such, this study compared the rates of discriminatory treatment during the most recent medical appointment between SM-WOC (Black, Hispanic, Asian American, Native American) and White SM women.

      Methods

      We used nationally representative data from the Association of American Medical Colleges survey of health care services. Data were collected from 2010 to 2019 from N = 1,499 SM women (n = 458 SM-WOC). Binary logistic regressions compared frequencies of reported identity-based discrimination between each minoritized racial/ethnic group to White SM women.

      Results

      Across the sample, 33% of SM-WOC reported discrimination during their last medical appointment compared with 19% of White SM women. Discriminatory treatment was more common among every minoritized racial/ethnic group of SM women compared with White SM women, with variability in frequency of specific forms of identity-based discrimination across minoritized racial/ethnic groups.

      Conclusions

      Although discriminatory treatment during the last medical appointment was common for all SM women, prevalence was higher for SM-WOC compared with White SM women. Findings have important implications for policy and practice to reduce health disparities such as targeted interventions for SM-WOC and provider trainings in cultural humility, implicit bias, and common microaggressions.
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      Biography

      Shelby B. Scott, PhD, is an Assistant Professor of Psychology at the University of Texas at San Antonio and a Licensed Clinical Psychologist. Her research interests include health disparities and intimate relationships among marginalized populations (e.g., LGBTQ, women of color).

      Biography

      Karie Gaska, PhD, MSW, is an Assistant Professor of Behavioral Sciences at Ross University School of Medicine. Her research interests are in health equity, building empathy within medical education, and community-based approaches to mental health and wellbeing.

      Biography

      Kayla C. Knopp, PhD, is a Clinical Research Psychologist at the VA San Diego Health care System. Her specialty is intimate relationships, with a focus on diversity, mental health, and increasing access and efficacy of relationship interventions.

      Biography

      Quyen A. Do, MEd, is a PhD Candidate in Psychology at the University of Texas at San Antonio (UTSA). Her research interests include psychological trauma and interpersonal violence in marginalized communities examined within an intersectionality framework.

      Biography

      Joyce P. Yang, PhD, is an Assistant Professor of Psychology at the University of San Francisco. She uses community-based participatory research methods to examine issues of mental health equity and identity-related oppression such as race-based stress and trauma.