title: Addressing health disparities of lesbian and bisexual women: a grounded theory study.
abstract: BACKGROUND
  Lesbian and bisexual (LB) women encounter numerous barriers to equitable health care services, such as lack of quality care and discriminatory health care settings. These barriers affect the well-being of LB women, presumably leading to disparities in health and health care. Despite these disparities, few published research studies explore health services of LB women. This qualitative, grounded theory study addressed that gap.
  
  
  METHODS
  Purposive sampling was used to recruit 18- to 24-year-old women who identified as LB and who reported using health services as an adult. Participants (n = 9) were recruited from lesbian, gay, bisexual, and transgender student groups at universities in the Southwestern United States, and in-depth audio recorded interviews were performed. The nine participants represent 29 unique health care experiences. The transcriptions were uploaded into NVivo, and the constant comparison method was used to analyze the data.
  
  
  RESULTS
  Six themes were identified, including seeking health care, expectations, disclosure of sexual orientation, moment of truth (provider attributes), proximal outcomes, and health outcomes. These themes were sorted into an explanatory conceptual framework that represents three distinct phases of the health care experience: Pre-interaction, health care interaction, and outcomes.
  
  
  CONCLUSIONS
  The women in this study identified disclosure of sexual orientation and provider attributes as major points in the health care experience. Creating health care environments that facilitate disclosure of sexual orientation and educating providers about LB-appropriate care are strategies that may impact health and health care disparities of LB women.
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, South Carolina; School of Nursing, University of Nevada Las Vegas, Las Vegas, Nevada. Electronic address: michael.johnson@unlv.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Johnson
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Lynne S
authors.initials: LS
authors.lastname: Nemeth
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D001727:Bisexuality / Q000523:psychology*; D030881:Disclosure; D005260:Female; D066296:Grounded Theory; D054624:Health Status Disparities; D054625:Healthcare Disparities; D018452:Homosexuality, Female / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D036301:Qualitative Research; D055815:Young Adult