Rural-urban comparison of disclosure experiences with providers for sexual minorities

Concealment of one's sexual orientation to health care providers and/or delay of care due to fears of discrimination and rejection in the health care setting can be a major risk factor for the health and wellbeing of sexual minorities. There are currently no quantitative studies examining the disclosure experiences and practices of rural sexual minorities who are not only more likely to experience unique health risks but also have a tendency to be less comfortable disclosing their sexual identity to others due to the conservative climate of the majority of rural areas. Rural and urban sexual minority participants are currently being recruited (current N= 1,043) using an online survey and snowball sampling methods. Participants complete a series of demographic and health-related questions and the Multidimensional Disclosure to Health Care Providers Scale (MD-HCPS). At interim analysis, of those participants that have a primary care provider (91.9%), 32.7% of the current sample had not disclosed their sexual orientation to them and 26.9% reported that they did not feel comfortable discussing their sexual orientation to their PCP. Sample responses on the MD-HCPS include: 50.3% of the sample indicated that disclosing their sexual orientation to their health care provider is a risky thing to do, 86.9% reported feeling that there are parts of the country where it is never safe to disclose one's sexual orientation to healthcare providers, and 26.8% have avoided answering certain questions to keep from disclosing their sexual orientation. In terms of actual disclosure experiences, 28.8% reported that a healthcare provider has become nervous after they disclosed, 24% reported their provider responding with a “certain look on their face”, and 16.7% indicated that their provider became more rigid and steely. Furthermore, 15.1% reported feeling rejected by a healthcare provider after disclosing, 19.7% report losing confidence in their provider because of how they reacted, 17.1% have become angry over how a provider reacted their disclosure, and 8.7% have felt “traumatized” because of how a disclosure interaction went. Final analysis will include rural-urban comparisons and from preliminary findings it is expected that rural participants will report less frequent disclosures and more negative experiences. Implications for rural patients and providers will be discussed.