Research Article
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Published Online: 3 April 2023

Sexual Minority Women, Health Care Discrimination, and Poor Health Outcomes: A Mediation Model Through Delayed Care

Publication: LGBT Health
Volume 10, Issue Number 3

Abstract

Purpose: Sexual minority (SM) women are a heterogeneous group who commonly report negative health care experiences at the intersection of their diverse sexual orientations and racial/ethnic identities. However, scarce research has evaluated how negative health care experiences may affect health outcomes among this population. Informed by the Health Equity Promotion Model for SM health, this study evaluated mediation models in which delayed care mediated the association between provider discrimination and poor health outcomes in SM women. Sexual orientation (plurisexual or monosexual) and race/ethnicity (women of color or White) were evaluated as moderators of the direct and indirect pathways.
Methods: The sample included SM women (N = 1530) from the nationally representative Association of American Medical Colleges biannual Consumer Survey of Healthcare Access (2010–2020). Mediation models were conducted with lavaan structural equation modeling software.
Results: Reported discrimination from a health care provider was associated with higher physical and emotional impairment, and these associations were partially mediated through delayed care. Sexual orientation and race/ethnicity also moderated several indirect and direct pathways.
Conclusion: Results provide evidence of delayed care as a possible mediation pathway between provider discrimination and worse health in SM women and that the strength of these associations may vary by sexual orientation and race/ethnicity. Results indicate a need for policy change and clinical trainings to reduce the harm of provider discrimination on SM women.

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This material is based upon data provided by the AAMC. The views expressed herein are those of the authors and do not necessarily reflect the position or policy of the AAMC.

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Information & Authors

Information

Published In

cover image LGBT Health
LGBT Health
Volume 10Issue Number 3April 2023
Pages: 202 - 210
PubMed: 36521166

History

Published online: 3 April 2023
Published in print: April 2023
Published ahead of print: 15 December 2022

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Authors

Affiliations

Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA.
Kayla Knopp
Advanced Fellowship for Women's Health, VA San Diego Healthcare System, San Diego, California, USA.
Joyce P. Yang
Department of Psychology, University of San Francisco, San Francisco, California, USA.
Quyen A. Do
Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA.
Department of Clinical Foundations, Ross University School of Medicine, St. Michael, Barbados.

Notes

Address correspondence to: Shelby B. Scott, PhD, Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA [email protected]

Authors' Contributions

All authors made substantial contributions to this scholarly output. Specifically, S.B.S. led the conceptualization, methodological design, writing of the original draft, and reviewing and editing subsequent drafts of the article. K.K. contributed to formal data analysis, developing methodological models, and the visualization of the models and figures. Q.A.D. was responsible for reviewing and editing the original draft and contributed to data curation. J.P.Y. contributed to interpretation of results and reviewing and editing of the article. K.A.G. provided critical review of the original draft and contributed to editing of the article. S.B.S., J.P.Y., and K.A.G. contributed the data access award providing acquisition to data for this article. All authors approved the final article before submission and agreed to be accountable for all aspects of the work in ensuring that the accuracy or integrity of any part of the work is appropriately investigated and resolved.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

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