Health Care Utilization and Care-seeking Behavior Among Vulnerabilized Sexual Minority Women: A Social-ecological Approach.

Sexual minority women (SMW) experience worse health than their heterosexual counterparts but have largely been omitted from health services research. To address this gap, we conducted 25 semi-structured, in-depth interviews with SMW. Transcripts were analyzed using thematic analysis, and findings were organized using a modified socioecological framework. Key themes at each socioecological level include (1) structural: stigma, sociocultural norms, health infrastructure; (2) organizational: stigma, patient-provider relationship, hours and location, linkage to care and co-location of services; (3) interpersonal: stigma and social support; (4) individual: internalized stigma, self-efficacy, socioeconomic status, health literacy, and intersecting identities. Stigma is the central theme affecting vulnerabilized SMW's experiences accessing care. Anti-stigma initiatives and factors that lead to personal resilience and can mitigate care access barriers were identified at each level. Interventions should focus on building inclusive policies/infrastructure and using SMW's unique social networks to empower and improve care access and health outcomes among vulnerabilized SMW.