Romanelli Meghan, Fredriksen-Goldsen Karen, Kim Hyun-Jun
University of Washington, School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, United States.
SSM Health Syst. 2024 Dec;3. doi: 10.1016/j.ssmhs.2024.100011. Epub 2024 May 8.
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) midlife and older adults are a health disparity population whose health and health care needs are distinguished by the intersection of gender, sexuality, and age. Research and measurement considering multidimensional factors influencing health care access among this population, however, remain limited. Theoretically cohesive indicators of health care access were combined to develop a comprehensive and reliable, yet parsimonious scale that assesses the unique health care access needs and experiences of LGBTQ midlife and older adults.
Data from the U.S.-based Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) were used, including 2322 LGBTQ participants from the 2015 wave of data collection. Twenty-four items were initially included in an assessment of scale reliability. The underlying factor structure of health care access was tested. Differences in mean health care access scores were examined across sexual identity, current gender, gender identity, and age cohort.
Nineteen items remained in the final scale (α=0.90). Data supported health care access as multidimensional among NHAS participants. Heterogeneity in health care access scores was identified across participants. Bisexual, straight, and sexually diverse participants, women and gender diverse participants, and transgender participants faced more difficulties accessing care. Participants aged 66-80 and 81+ reported significantly higher health care access scores.
Final indicators represented the complex health care experiences of LGBTQ midlife and older adults. This scale can be utilized in future health equity research. Using NHAS longitudinal data, future research could assess changes in access over the life-course and as a predictor of health outcomes.
女同性恋、男同性恋、双性恋、跨性别者和酷儿（LGBTQ）中年及老年成年人是一个健康差距群体，其健康和医疗保健需求因性别、性取向和年龄的交叉而有所不同。然而，考虑到影响该群体获得医疗保健的多维度因素的研究和测量仍然有限。将理论上具有凝聚力的医疗保健可及性指标结合起来，开发出一个全面、可靠且简洁的量表，以评估LGBTQ中年及老年成年人独特的医疗保健可及性需求和经历。
使用了来自美国的“自豪地变老：全国健康、衰老与性取向/性别研究”（NHAS）的数据，包括2015年数据收集浪潮中的2322名LGBTQ参与者。最初在量表信度评估中纳入了24个项目。对医疗保健可及性的潜在因素结构进行了测试。考察了不同性取向、当前性别、性别认同和年龄组在医疗保健可及性平均得分上的差异。
最终量表保留了19个项目（α=0.90）。数据支持NHAS参与者的医疗保健可及性具有多维度性。在参与者中发现了医疗保健可及性得分的异质性。双性恋、异性恋和性取向多元的参与者、女性和性别多元的参与者以及跨性别参与者在获得医疗保健方面面临更多困难。66 - 80岁和81岁及以上的参与者报告的医疗保健可及性得分显著更高。
最终指标代表了LGBTQ中年及老年成年人复杂的医疗保健经历。该量表可用于未来的健康公平研究。利用NHAS纵向数据，未来的研究可以评估一生中医疗保健可及性的变化以及作为健康结果的预测指标。
