理解污名化和医疗不信任对与女性发生性关系的黑人女性参与常规医疗保健的影响。
Understanding the Influence of Stigma and Medical Mistrust on Engagement in Routine Healthcare Among Black Women Who Have Sex with Women.
机构信息
1 Department of Human Development and Family Studies and the Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut , Storrs, Connecticut.
2 Mental Health Counseling, Florida State University , Tallahassee, Florida.
出版信息
LGBT Health. 2017 Feb;4(1):4-10. doi: 10.1089/lgbt.2016.0083.
PURPOSE
For Black women who have sex with women (BWSW), obtaining routine healthcare can be obstructed by a number of psychosocial barriers, including experiences of stigma, related to both sexual orientation and race, and medical mistrust, both race-based and global. Previous research demonstrates that sexual orientation and race-based stigma, as well as global and race-based medical mistrust, each have a negative impact on health outcomes and engagement in care (EIC) independently. This study addresses gaps in the literature by examining the impact of these psychosocial barriers and their interactions among BWSW, an understudied population.
METHODS
Participants (256 BWSW) were surveyed at a Black Gay Pride festival. Separate generalized linear models assessed the independent and multiplicative effects of participants' self-reported sexual orientation stigma, race-based stigma, race-based medical mistrust, and global medical mistrust related to their engagement in routine physical exams and blood pressure screenings.
RESULTS
Prevalence rates of both stigma measures were low, but prevalence rates of global and race-based medical mistrust were high. The results show that experiencing sexual orientation stigma or having race-based medical mistrust predicts significantly lower EIC. Furthermore, the frequencies of obtaining recent physical examinations and blood pressure screenings were significantly related to three- and two-way interactions between stigma and medical mistrust, respectively.
CONCLUSION
There is an urgent need to address the intersectionality of these psychosocial barriers in an effort to increase BWSW's EIC.
目的
对于与女性发生性关系的黑人女性（BWSW），由于多种社会心理障碍，包括与性取向和种族相关的污名化经历以及基于种族和全球性的医疗不信任感，获得常规医疗保健可能会受到阻碍。先前的研究表明，性取向和种族相关的污名化以及基于种族和全球性的医疗不信任感，都会对健康结果和参与护理（EIC）产生负面影响，而这两者都是独立的。本研究通过研究这些社会心理障碍及其在 BWSW 中的相互作用，解决了文献中的空白，BWSW 是一个研究不足的群体。
方法
在黑人骄傲节上对参与者（256 名 BWSW）进行了调查。单独的广义线性模型评估了参与者报告的性取向污名、基于种族的污名、基于种族的医疗不信任感以及与常规体检和血压筛查参与相关的全球性医疗不信任感对他们的独立和乘法影响。
结果
尽管两个污名化指标的流行率都较低，但全球性和基于种族的医疗不信任感的流行率却很高。结果表明，经历性取向污名或存在基于种族的医疗不信任感会显著降低 EIC。此外，最近进行体检和血压筛查的频率与污名和医疗不信任感之间的三向和双向交互作用分别显著相关。
结论
迫切需要解决这些社会心理障碍的交叉问题，以提高 BWSW 的 EIC。
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