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Family Practice Advance Access published online on June 23, 2006
Family Practice, doi:10.1093/fampra/cml030
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© The Author (2006). Published by Oxford University Press. All rights reserved.
Received September 15, 2005
Accepted May 23, 2006

Article

Regular health care use by lesbians: a path analysis of predictive factors

Leah S. Steele 1 *, Jill M. Tinmouth 2, and Annie Lu 3

1 Department of Family and Community Medicine, St Michael's Hospital, University of Toronto and the Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Toronto, Canada
2 Department of Medicine, Sunnybrook College Hospital, Toronto, Canada
3 University of Toronto Medical School, Toronto Canada

* To whom correspondence should be addressed.
Leah S. Steele, E-mail: leah_steele{at}camh.net


  Abstract

Background. Lesbians have more health risks than other women but access preventive medical care less frequently.

Objective. To test the influence of (i) provider inquiry about sexual orientation, (ii) perceived provider gay-positivity and (iii) patient disclosure of sexual orientation on regular health care use in a sample of Canadian lesbians.

Methods. A path analysis using community survey data from 489 lesbian respondents.

Results. 78.5% [95% confidence interval (CI): 74.7-82.0] of women reported regular health service use; 75.8% (95% CI: 72.2-79.8) of women had disclosed their sexual orientation to their provider; and 24.4% (95% CI: 20.6-28.2) of women had been asked about their sexual orientation by their provider. Of those women whose physicians had inquired about their sexual orientation, 100% (95% CI: 97.5-100.0) had disclosed. In the final path analysis, perceived provider gay-positivity and level of patient outness predicted disclosure, which, along with health status predicted regular health care use. All paths were significant at P < 0.05.

Conclusions. Provider-related factors including perceived gay-positivity and inquiry about sexual orientation are strongly associated with disclosure of sexual orientation. Disclosure is associated with regular health care use. Minor changes to practice could improve access to health services for lesbians.

Keywords: Disclosure; health services accessibility; homosexuality; physician-patient relations; primary health care.
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