Waiting for the doctor to ask: influencers of lesbian, gay, and bisexual identity disclosure to healthcare providers

Nicole C. Hudak; Heather J. Carmack

doi:10.4081/qrmh.2018.7157

Authors

Nicole C. Hudak
nh017915@ohio.edu
School of Communication Studies, Ohio University, Athens, OH, United States.
Heather J. Carmack Department of Communication Studies, University of Alabama, Tuscaloosa, AL, United States.

Lesbian, gay, and bisexual (LGB) individuals encounter multiple barriers in healthcare, resulting in problematic care. Many LGB patients wrestle with whether to disclose their sexuality to healthcare providers. This article explored what influences LGB patients’ decision to disclose their sexuality to healthcare providers. Guided by Communication Privacy Management theory, the authors conducted in-depth interviews with 20 LGB patients. LGB patients heavily relied on boundary management when negotiating the disclosure of their sexuality. The findings suggest several factors influence LGB patients’ disclosure of sexuality: i) experience with family; ii) fear of gossip and connections; iii) concern for provider care refusal; iv) religion; v) age; and vi) level of trust with providers. Boundary turbulence can be created between patient and provider when there is uncertainty about if and when sexuality is considered private information. Additionally, a site of tension for LGB patients was their concern about providers sharing private information outside the clinic setting.

Healthy People 2020. Lesbian, gay, bisexual and transgender health [Internet]. United States Department of Health and Human Services. Washington, DC: USDHHS; 2013 [cited 2015 May 1]. Available from: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25

Mimiaga MJ, Goldhammer H, Belanoff C, et al. Men who have sex with men: perceptions about sexual risk, HIV and sexually transmitted disease testing, and provider communication. Sex Transm Dis 2007;34:113–119. DOI: https://doi.org/10.1097/01.olq.0000225327.13214.bf

Kuyper L, Vanwesenbeek I. Examining sexual health differences between lesbian, gay, bisexual, and heterosexual adults: the role of sociodemographics, sexual behavior characteristics, and minority stress. J Sex Res 2011;48:263–274. DOI: https://doi.org/10.1080/00224491003654473

McNair R. Outing lesbian health in medical education. Women Health 2003;4:89-103. DOI: https://doi.org/10.1300/J013v37n04_07

Hudak N. “Do you have to ask me one more time?”: communicating heterosexism in healthcare. Competitive paper presented at the NCA, Philadelphia, PA.

Goins ES, Pye D. Check the box that best describes you: reflexivity managing theory and praxis in LGBTQ health communication research. Health Commun 2012;28;397-407. DOI: https://doi.org/10.1080/10410236.2012.690505

Hudak N, Bates BR. In pursuit of “queer-friendly” healthcare: an interview study of how queer individuals select care providers. Health Commun 2018;1-7. DOI: https://doi.org/10.1080/10410236.2018.1437525

Utamsingh PD, Smart Richman L, Martin JL, et al. Heteronormativity and practitioner-patient interaction. Health Commun 2016;31:566-574. DOI: https://doi.org/10.1080/10410236.2014.979975

Venetis, MK, Meyerson, BE, Friley, BL, et al. Characterizing sexual orientation disclosure to heatlh care providers: lesbian, gay, and bisexual perspectives. Health Commun 2017;32;578-586. DOI: https://doi.org/10.1080/10410236.2016.1144147

Greene K, Magsamen-Conrad K, Venetis MK, et al. Assessing health diagnosis disclosure decisions in relationships: testing the disclosure decision-making model. Health Commun 2012;27:356–368. DOI: https://doi.org/10.1080/10410236.2011.586988

Neville Miller A, Rubin DL. Factors leading to self-disclosure of a positive HIV diagnosis in Nairobi, Kenya. Qual Health Res 2007;17:586-598. DOI: https://doi.org/10.1177/1049732307301498

Smith RA, Hernandez R, Catona D. Investigating initial disclosures and reactions to unexpected, positive HPV diagnosis. West J Commun 2014;78:426–440. DOI: https://doi.org/10.1080/10570314.2013.786120

Broekema K, Weber KM. Disclosures of cystic fibrosis-related information to romantic partners. Qual Health Res 2017;27:1575-1585. DOI: https://doi.org/10.1177/1049732317697675

Qiao S, Li X, Staunton B. Practice and perception of parental HIV disclosure to children in Beijing, China. Qual Health Res 2014;24:1276-1286. DOI: https://doi.org/10.1177/1049732314544967

Carmack HJ. “What happens on the van, stays on the van”: the (re)structuring of privacy and disclosure scripts on an Appalachian mobile health clinic. Qual Health Res 2010;20:1393-1405. DOI: https://doi.org/10.1177/1049732310372618

Petronio S. Boundaries of privacy: dialectics of disclosure. Albany, NY: State University of New York Press; 2002.

Bjorkman M, Malterud K. Being lesbian – does the doctor need to know?: a qualitative study about the significance of disclosure in general practice. Scand J Prim Health Care 2007;25:58–62. DOI: https://doi.org/10.1080/02813430601086178

Austin EL. Sexual orientation disclosure to health care providers among urban and non-urban southern lesbians. Women Health 2013;53:41–55. DOI: https://doi.org/10.1080/03630242.2012.743497

Kitts RL. Barriers to optimal care between physicians and lesbian, gay, bisexual, transgender, and questioning adolescent patients. J Homosex 2010:57:730–747. DOI: https://doi.org/10.1080/00918369.2010.485872

Labig CE, Peterson TO. Sexual minorities and selection of a primary care physician in a Midwestern U.S. city. J Homosex 2006;51:1–5.

Fish J. Heterosexism in health and social care. New York, NY: Palgrave Macmillan; 2006. DOI: https://doi.org/10.1057/9780230800731

Mayer KH, Bradford JB, Stall R, et al. Sexual and gender minority health: what we know and what needs to be done. Am J Public Health 2008;98:989–995. DOI: https://doi.org/10.2105/AJPH.2007.127811

Petronio S, Sargent J. Disclosure predicaments arising during the course of patient care: nurses’ privacy management. Health Commun 2011;26:255–266. DOI: https://doi.org/10.1080/10410236.2010.549812

Parkhill AL, Mathews JL, Fearing S, Gainsburg J. A transgender health care panel discussion in a required diversity course. Am J Pharm Educ 2014;78:1–7. DOI: https://doi.org/10.5688/ajpe78481

Lindlof TR, Taylor BC. Qualitative communication research methods. 3rd ed. Thousand Oaks, CA: Sage Publications; 2011.

Keyton J. Communication research: asking questions, finding answers. 2nd ed. New York, NY: McGraw-Hill; 2006.

Johnson JM. In-depth interviewing. In: Gubrium JF, Holstein JA, editors. Handbook of interview research: context and method. Thousand Oaks, CA: Sage; 2002. p. 103-119.

Creswell JW. Research designs: qualitative, quantitative, and mixed methods approaches. 4th ed. Thousand Oaks, CA: Sage Publications; 2014.

Tracy SJ. Qualitative quality: eight “big-tent” criteria for excellent qualitative research. Qual Inq 2010;16:837-851. Retrieved from http://qix.sagepub.com/ DOI: https://doi.org/10.1177/1077800410383121

Owen WF. Interpretive themes in relational communication. Q J Speech 1984;70:274–287. DOI: https://doi.org/10.1080/00335638409383697

Sankar P, Mora S, Merz JF, Jones NL. Patient perspectives of medical confidentiality: a review of literature. J Gen Intern Med 2003;18:659-669. DOI: https://doi.org/10.1046/j.1525-1497.2003.20823.x

Hudak, Nicole C., and Heather J. Carmack. 2018. “Waiting for the Doctor to Ask: Influencers of Lesbian, Gay, and Bisexual Identity Disclosure to Healthcare Providers”. Qualitative Research in Medicine and Healthcare 2 (1). https://doi.org/10.4081/qrmh.2018.7157.