Aleshire Mollie E, Ashford Kristin, Fallin-Bennett Amanda, Hatcher Jennifer
University of Kentucky College of Nursing, Lexington, KY, USA.
Health Promot Pract. 2019 Mar;20(2):173-187. doi: 10.1177/1524839918778835. Epub 2018 Jun 27.
The purpose of this article is to review the current literature describing primary care providers' (PCPs) attitudes related to lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people. LGBTQ individuals experience significant health disparities, and these inequities may be better understood via an ecological systems framework. PCPs' actual or perceived discriminatory attitudes can lead to suboptimal treatment or health outcomes for LGBTQ people. A review of the literature from 2005 through January 2017 was completed using the Cumulative Index for Nursing and Allied Health Literature and PubMed (Medline) databases. The purpose, sample, measure(s), design, findings, strengths, and weaknesses of each study were examined; and findings were synthesized, summarized, and critically appraised. Eight articles were eligible for review. There was significant heterogeneity in the studies' purposes, research questions, LGBTQ population(s) of focus, and findings. Many PCPs' attitudes toward LGBTQ people were positive, but a minority of each studies' participants had negative attitudes toward LGBTQ people. Stigma and health care barriers negatively affect LGBTQ health. Interventions must address LGBTQ health disparities at the individual, mesosytem, exosystem, and macrosystem levels. Research, education, and practice strategies all must be integrated across socioecological levels as components of a population-based approach to eliminate health disparities for LGBTQ persons.
本文旨在综述当前描述初级保健提供者（PCP）对女同性恋、男同性恋、双性恋、跨性别者和酷儿/疑问者（LGBTQ）态度的文献。LGBTQ个体面临显著的健康差距，通过生态系统框架或许能更好地理解这些不平等现象。PCP实际的或被认为的歧视性态度可能导致LGBTQ人群的治疗效果欠佳或健康状况不佳。利用护理及联合健康文献累积索引数据库和PubMed（医学索引数据库）完成了对2005年至2017年1月期间文献的综述。对每项研究的目的、样本、测量方法、设计、结果、优点和缺点进行了审查；并对结果进行了综合、总结和批判性评估。有八篇文章符合综述要求。这些研究在目的、研究问题、所关注的LGBTQ人群以及结果方面存在显著异质性。许多PCP对LGBTQ人群的态度是积极的，但每项研究中的少数参与者对LGBTQ人群持消极态度。耻辱感和医疗保健障碍对LGBTQ健康产生负面影响。干预措施必须在个体、中观系统、外部系统和宏观系统层面解决LGBTQ健康差距问题。研究、教育和实践策略都必须作为基于人群的方法的组成部分，在社会生态层面进行整合，以消除LGBTQ人群的健康差距。
