Coming Out in Primary Healthcare: An Empirical Investigation of a Model of Predictors and Health Outcomes of Lesbian Disclosure

Researchers and health practitioners have emphasized the importance of disclosure of sexual orientation by lesbians to their healthcare providers (HCPs). Commonly known as `coming out\u27, during interactions with HCPs this behaviour has been linked to the receipt of appropriate and tailored care by lesbians, an increase in regular preventative healthcare seeking, and a more authentic relationship between patients and their physicians. The current study employed a mixed-methods design to provide a comprehensive understanding of what facilitates disclosure, and subsequently, what happens once lesbians come out to their HCPs. Of particular interest were patient (e.g., outness and other minority stressors such as internalized homophobia), HCP (e.g., LGBT-friendly), healthcare environment (e.g., a safe waiting room), and patient-provider relationship (e.g., women\u27s comfort with their HCPs) facilitators. Preventative health behaviours (e.g., cervical screening) were the outcomes examined. Over 400 lesbian women from across Canada and the USA contributed to the analyses, and allowed for the consideration of cross-cultural similarities and differences. Path analyses were conducted to test models of disclosure and healthcare seeking separately for each sample. Additionally, women\u27s narrative responses to the open-ended questions included as part of the study (i.e., their descriptions of what would influence their willingness to disclose to their HCPs and for those who had disclosed, their HCPs\u27 reactions to this information) supplemented the quantitative data by providing a closer look at context. For example, the contexts of when coming out is perceived by lesbian patients as relevant, and the contexts of unsafe and safe care environments. The current study\u27s findings suggested that a variety of factors influenced disclosure. Having an LGBT-friendly provider played a significant role in both countries\u27 models and had a stronger influence on disclosure than did patient characteristics. Though most processes in the models were similar for the Canadian and American samples, some unique pathways were also present and are explained in terms of differences in socio-political climate. Implications from this study are clear: HCPs who are LGBT-friendly have the potential to reduce the impact of minority stressors, encourage disclosure, and support an overall positive care experience for their lesbian patients