Journal of Obstetric, Gynecologic & Neonatal Nursing
PRINCIPLES & PRACTICEMultisystem Factors Contributing to Disparities in Preventive Health Care Among Lesbian Women
Section snippets
Multisystem ecologic model of health disparities
Individuals do not exist in isolation; they live within an ecology of nested systems and engage in constant and reciprocal interaction with multiple systems such as families, schools, and communities (Bronfenbrenner, 1989). When the ecologic view is applied to health behavior and health disparities, it becomes clear that there are multiple systems and multiple system levels that influence individuals’ health behaviors, their ability to access care, and the likelihood of selected health outcomes
Individual risk for sexually transmitted infections
Women who self‐identify as lesbians describe themselves as having a same‐sex sexual orientation. However, sexual orientation is not synonymous with, nor should it be confused with, sexual behavior. As has been extensively discussed in the literature, sexual orientation and sexual behaviors can be quite discordant (Diamant et al., 1999, Marrazzo, 2004, Marrazzo and Stine, 2004). More than 80% of lesbians report a history of intercourse with a male partner at some time in their lives (Marrazzo et
Provider factors that contribute to health disparities among lesbians
In addition to client factors and individual behaviors and practices, there are a number of factors at the provider and health care system levels that create barriers for lesbian women accessing preventive care. Too often, providers assume that clients are heterosexual, unless they explicitly state otherwise (Robertson, 1992). Standards of care, teaching materials, and language used in practice settings are often based on assumptions of heterosexuality. Stevens (1995) asserts that this
Health care system factors
In addition to individual‐ and provider‐level factors, there are a myriad of health care system level factors that have an impact on clients, providers, and the interactions between the two to create barriers to effective care and contribute to disparities in health outcomes among lesbian women. Stevens (1995) identified the heterosexist structuring of health care delivery as a major barrier to lesbians’ health care knowledge and a direct influence of whether lesbians sought out preventive
Conclusions and implications for practice
Experience with, access to, and interactions with HCP differ considerably between heterosexual and lesbian women and contribute to discrepancies in health care utilization between the two populations. Lesbian women, as compared to their heterosexual counterparts, more often underutilize preventive health measures, perceive difficulty in obtaining needed case, and when a health issue arises, may delay seeking treatment or seek care only after the persistence of severe symptoms (Koh, 2000, White
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