Lesbian disclosure to health care providers and delay of care

M. van Dam, A. Koh, S. Dibble

Purpose/Objective: 1) To identify if lesbians delay seeking health care because of sexual identity issues. 2) To examine the frequency of sexual identity disclosure for both lesbians and heterosexual women to health care provider (HCP). 3) To identify the methods used by HCPs, lesbians, and heterosexual women to disclose sexual identity. 4) To identify lesbians' perceptions of how disclosure of sexual identity could be made easier for them. Design: Descriptive study with convenience sample. Data gathered by survey. Setting: Thirty-three health care offices or clinics across the United States. Sample: The typical participant (n = 1161) was 40.14 years old (SD = 11.32, range = 15-92). Of this sample, 45.1% (n = 524) identified as lesbian and 54.9% (n = 637) identified as heterosexual. Most identified as white (83.6%) and educated, with variability in income levels. Measurement: Written survey was designed by expert clinicians and refined after two pilot studies. Results: Seventeen percent of HCPs inquired about client's sexual identity verbally; only 43% of HCPs (inclusive of this 17%) inquired about sexual identity in writing or in some other way. Lesbians reported that HCPs were less likely to know their sexual identity than heterosexual women. Lesbians were more likely to voluntarily report their sexual identity to HCPs than heterosexual women. Lesbians reported that ease of disclosure could be assisted by asking verbally, asking in writing, and by "improvement of HCP attitude." Lesbians reported more delays in seeking health care because of sexuality issues, specifically, fear of discrimination against them because of their sexual identity compared to heterosexual women. Lesbians were more likely to conceal their lesbian identity from HCPs when they were less disclosed to family, co-workers, and friends. Conclusion: Most HCPs did not assess for sexual identity, even though related issues are important to discuss with clients. HCPs can ease disclosure by asking about sexual identity and by awareness of their expression of attitudes toward lesbianism. Delay of care related to discrimination can be considered a social risk factor for lesbian health and well-being.