When Rural Isolation Means More than Geography: Rural-Urban Differences in Inclusive Practices for LGBT Patients

People who identify along the LGBT spectrum experience health inequalities in the United States.  Often, in documents like Healthy People 2020, LGBT status is understood to be correlated with certain exposures or behaviors that account for differences in health outcomes.  However, LGBT group membership could also affect healthcare access, in ways that mediate disparate health outcomes.  According to a recent survey with thousands of LGBT respondents, most sexual minorities and gender-nonconforming individuals report community fear or dislike of LGBT persons to be a barrier to care (Lambda Legal, 2010).  Conservative community values, limited alternatives for providers, and dual roles with providers in rural social networks might reasonably exacerbate these challenges in rural communities.  When these barriers have been studied, the central focus has been discrimination and visitation policies at hospitals.  However, if the rural LGBT community is to achieve healthy equity, inclusive practice at primary care providers (PCPs) will be important.

In this study, researchers conducted interviews with rural and urban PCPs, as well as collected qualitative data from each clinic’s registration forms, patient educational materials, patient rights policies, and employment nondiscrimination policies. Building from decades of stigma and stereotype research which indicates that pervasive stigma inhibits equitable opportunity even without explicit endorsements, these results suggest meaningful differences in inclusive practices that conceivably harm access to care and health outcomes for LGBT patients in rural areas.

Lambda Legal.  (2010).  When Health Care Isn’t Caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV. Available at: http://www.lambdalegal.org/ publications/when-health-care-isnt-caring