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Disparities in Experience with Culturally Competent Care and Satisfaction with Care by Sexual Orientation.

ABSTRACT: Purpose: Prior studies have identified health care providers' lack of cultural competency as a major barrier to care among sexual minority individuals. However, little is known about disparities in experience with culturally competent care by sexual orientation at the population level. This study assessed experiences with culturally competent care and satisfaction with care across sexual orientation groups in the United States. Methods: We analyzed nationally representative data from the 2017 National Health Interview Survey (n = 21,620) with ordinal logit regression models and compared six aspects of health care experiences across sexual orientation groups. These were: preferences for and frequencies of seeing health care providers who understand or share their culture; perceived experiences of being treated with respect by providers and providers asking about their beliefs and opinions; access to easily understood health information from providers; and satisfaction with received care. Results: Relative to heterosexual men, gay men were more likely to consider it important for providers to understand or share their culture (odds ratio [OR] = 1.4, p < 0.05) and to have providers who ask for their opinions or beliefs about care (OR = 1.5, p < 0.01). Relative to heterosexual women, bisexual- and something else-identified women were less likely to report being treated with respect (ORs = 0.4-0.6, p's < 0.01) and satisfaction with care (ORs = 0.5-0.6, p's < 0.05). No statistical differences in health care experiences were found between other sexual minority groups and their heterosexual counterparts. Conclusions: Access to culturally competent care and satisfaction with care varied by sexual orientation and gender. Clinical practices should address the unique health care barriers faced by bisexual- and something else-identified women.

SUBMITTER: Hsieh N

PROVIDER: S-EPMC8060893 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundOutdated gender, sex, and sexual orientation (GSSO) information practices in health care contribute to health inequities for sexual and gender minorities (SGMs). Governments, statistics agencies, and health care organizations are developing and implementing modernized practices that support health equity for SGMs. Extending our work, we conducted a rapid review of grey literature to explore information practices that support quality health care for SGMs.ObjectiveThe aim of this rapid review of grey literature was to elucidate modern GSSO information practices from leading agencies for adaptation, adoption, and application by health care providers and organizations seeking to modernize outdated GSSO information practices that contribute to health inequities among SGMs.MethodsWe searched MEDLINE and Google from 2015 to 2020 with terms related to gender, sex, sexual orientation, and electronic health/medical records for English-language grey literature resources including government and nongovernment organization publications, whitepapers, data standards, toolkits, health care organization and health quality practice and policy guides, conference proceedings, unpublished academic work, and statistical papers. Peer-reviewed journal articles were excluded, as were resources irrelevant to information practices. We also screened the reference sections of included articles for additional resources, and canvassed a working group of international topic experts for additional relevant resources. Duplicates were eliminated. ATLAS.ti was used to support analysis. Themes and codes were developed through an iterative process of writing and discussion with the research team.ResultsTwenty-six grey literature resources met the inclusion criteria. The overarching themes that emerged from the literature were the interrelated behaviors, attitudes, and policies that constitute SGM cultural competence as follows: shared language with unambiguous definitions of GSSO concepts; welcoming and inclusive care environments and affirming practices to reduce barriers to access; health care policy that supports competent health care; and adoption of modernized GSSO information practices and electronic health record design requirements that address invisibility in health data.ConclusionsHealth equity for SGMs requires systemic change. Binary representation of sex and gender in electronic health records (EHRs) obfuscates natural and cultural diversity and, in the context of health care, places SGM patients at risk of clinical harm because it leads to clinical assumptions. Agencies and agents in health care need to be equipped with the knowledge and tools needed to cultivate modern attitudes, policies, and practices that enable health equity for SGMs. Adopting small but important changes in the language and terminology used in technical and social health care systems is essential for institutionalizing SGM competency. Modern GSSO information practices depend on and reinforce SGM competency in health care.

Project description:BackgroundDespite available evidence-based interventions that decrease health disparities, these interventions are often not implemented. Northwestern Medicine's® Hispanic Kidney Transplant Program (HKTP) is a culturally and linguistically competent intervention designed to reduce disparities in living donor kidney transplantation (LDKT) among Hispanics/Latinos. The HKTP was introduced in two transplant programs in 2016 to evaluate its effectiveness.ObjectiveThis study assessed barriers and facilitators to HKTP implementation preparation.MethodsInterviews and group discussions were conducted with transplant stakeholders (ie administrators, nurses, physicians) during implementation preparation. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis.ResultsForty-four stakeholders participated in 24 interviews and/or 27 group discussions. New factors, not found in previous implementation preparation research in health-care settings, emerged as facilitators and barriers to the implementation of culturally competent care. Implementation facilitators included: stakeholders' focus on a moral imperative to implement the HKTP, personal motivations related to their Hispanic heritage, and perceptions of Hispanic patients' transplant education needs. Implementation barriers included: stakeholders' perceptions that Hispanics' health insurance payer mix would negatively impact revenue, a lack of knowledge about LDKT disparities and patient data disaggregated by ethnicity/race, and a perception that the family discussion component was immoral because of the possibility of coercion.Discussion and conclusionsOur study identified novel barriers and facilitators to the implementation preparation of a culturally competent care intervention. Healthcare administrators can facilitate organizations' implementation of culturally competent care interventions by understanding factors challenging care delivery processes and raising clinical team awareness of disparities in LDKT.

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Disparities in Experience with Culturally Competent Care and Satisfaction with Care by Sexual Orientation.

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