Question

dentify all the barriers contributing to lack of quality health care in this situation. Describe the one you think most contributes to health care disparities among sexual minority groups. Finally, suggest at least four culturally appropriate approaches that might be used to improve his experience in the hospital and explain how each would result in a better quality of care. Reference the readings to prove your points

Answer 1

Despite the paucity of population-based research on the health status and health needs of lesbian, bisexual and transgender (LGBT) individuals, there is evidence of health disparities between sexual minority and heterosexual populations. Although the focus of LGBT health research has been HIV/AIDS and sexually transmitted infection among men who have sex with men, there is some documentation of health disparities among sexual minority women, with sexual minority women reporting poorer mental and physical health, in addition to less access to and less health care utilization. Using the minority stress framework, these disparities may be due in part to individual prejudice, social stigma and discrimination. To ensure equitable health for all, there is urgent need for targeted culturally sensitive health promotion, cultural sensitivity training for healthcare providers and intervention focused research.

In the past decade, there has been significant emphasis on reducing disparities in health, resulting in substantial attention on race/ethnic, socio-economic and gender disparities, but very little on sexual orientation disparities. The lesbian,bisexual and transgender [LGBT] community is becoming more visible in society and there has been substantial progress in the social acknowledgement of the LGBT community. Common terms used in LGBT health are shown in Box 1. A recent report by the United States Center for Health Statistics [NCHS] using 2013 National Health Interview Survey (NHIS) data stated that 1.6% of US adults 18 and older self-identify lesbian and 0.7% self-identify as bisexual.

Example-

Health risk indicators included being overweight (BMI≥25) or obese (BMI>30), current smoking (i.e., smoked at least 100 cigarettes in lifetime and currently smokes some days or every day), smokeless tobacco use (every day/some days versus not at all), binge drinking (>five drinks on one occasion for men and ≥four drinks on one occasion for women), and drinking and driving at least once in the past 30 days.Respondents aged <65 years indicated any one of four behaviors related to HIV risk in the past year (i.e., intravenous drug use, being treated for a sexually transmitted or venereal disease, given or received money or drugs in exchange for sex, or had anal sex without a condom). Respondents answered yes or no to engaging in any of these behaviors without identifying how many or specific behaviors.

Preventive health indicators included seatbelt use exercise in the past 30 days,and a flu shot in the past year. Screening tests included ever having an HIV test (respondents aged <65 years), colorectal cancer screening (respondents aged ≥50 years), ever having a mammogram, clinical breast exam, and Papanicolaou test (all women), and ever having a digital rectal test or a prostate-specific antigen (PSA) test.

Health care utilization indicators included having any form of health care coverage and past 12 months, prevalence of not seeking medical care owing to the cost of care, having a routine physical cheq, and having a dental visit. Medical diagnosis indictors included being told by a health care professional that the respondent had diabetes, asthma, symptoms of CVD (i.e., heart attack, angina/coronary heart disease, or stroke), or prostate cancer.

Physical health indicators-- included self-rated health status (excellent/very good/good versus fair/poor), reporting ≥14 days in the last 30 days in which physical health was not good, limitations of activities due to physical, mental, or emotional problems and whether the respondent had a health problem requiring use of special equipment.

Reducing health disparities and achieving equitable health care remains an important goal for the U.S. healthcare system. Cultural competence is widely seen as a foundational pillar for reducing disparities through culturally sensitive and unbiased quality care. Culturally competent care is defined as care that respects diversity in the patient population and cultural factors that can affect health and health care, such as language, communication styles, beliefs, attitudes, and behaviors.The Office of Minority Health, Department of Health and Human Services, established national standards for culturally and linguistically appropriate services in health and health care (National CLAS Standards) to provide a blueprint to implement such appropriate services to improve health care in the U.S.The standards cover areas such as governance, leadership, workforce communication and language assistance organizational engagement, continuous improvement, and accountability.

A lack of conceptual clarity around cultural competence persists in the field and the research community. There is confusion about what cultural competence means, and different ways in which it is conceptualized and operationalized. This confusion leads to disagreement regarding the topic areas and practices in which a provider should train to attain cultural competence.The populations to which the term cultural competence applies are also ill-defined. Cultural competence is often seen as encompassing only racial and ethnic differences, omitting other marginalized population groups who are ethnically and racially similar to a provider but who are at risk for stigmatization or discrimination, are different in other identities, or have differences in healthcare needs that result in health disparities. This broader concept may be termed diversity competence. In keeping with this broader view and commitment to a comprehensive approach to priority populations, this systematic literature review considers, alongside race and ethnicity, two of these less considered populations: persons with disabilities and persons identifying as lesbian, bisexual, transgender, queer/questioning, and/or intersex (LGBTQI).