title: Quantitative and mixed analyses to identify factors that affect cervical cancer screening uptake among lesbian and bisexual women and transgender men.
abstract: OBJECTIVE
  The purposes of this study were to measure the prevalence of, and identify factors associated with, cervical cancer screening among a sample of lesbian, bisexual and queer women, and transgender men.
  
  
  BACKGROUND
  Past research has found that lesbian, bisexual and queer women underuse cervical screening service. Because deficient screening remains the most significant risk factor for cervical cancer, it is essential to understand the differences between routine and nonroutine screeners.
  
  
  METHODS
  A convergent-parallel mixed methods design.
  
  
  METHODS
  A convenience sample of 21- to 65-year-old lesbian and bisexual women and transgender men were recruited in the USA from August-December 2014. Quantitative data were collected via a 48-item Internet questionnaire (N = 226), and qualitative data were collected through in-depth telephone interviews (N = 20) and open-ended questions on the Internet questionnaire.
  
  
  RESULTS
  Seventy-three per cent of the sample was routine cervical screeners. The results showed that a constellation of factors influence the use of cervical cancer screening among lesbian, bisexual and queer women. Some of those factors overlap with the general female population, whereas others are specific to the lesbian, bisexual or queer identity. Routine screeners reported feeling more welcome in the health care setting, while nonroutine screeners reported more discrimination related to their sexual orientation and gender expression. Routine screeners were also more likely to 'out' to their provider. The quantitative and qualitative factors were also compared and contrasted.
  
  
  CONCLUSIONS
  Many of the factors identified in this study to influence cervical cancer screening relate to the health care environment and to interactions between the patient and provider.
  
  
  CONCLUSIONS
  Nurses should be involved with creating welcoming environments for lesbian, bisexual and queer women and their partners. Moreover, nurses play a large role in patient education and should promote self-care behaviours among lesbian women and transgender men.
authors.affiliation: School of Nursing, University of Nevada Las Vegas, Las Vegas, NV, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Johnson
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Martina
authors.initials: M
authors.lastname: Mueller
authors.affiliation: Department of Health Education, San Francisco State University, San Francisco, CA, USA.
authors.forename: Michele J
authors.initials: MJ
authors.lastname: Eliason
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Stuart
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Lynne S
authors.initials: LS
authors.lastname: Nemeth
mesh_terms: D000328:Adult; D000368:Aged; D001727:Bisexuality / Q000523:psychology*; D055088:Early Detection of Cancer; D005260:Female; D018452:Homosexuality, Female / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012648:Self Care; D000072339:Sexual and Gender Minorities / Q000523:psychology*; D011795:Surveys and Questionnaires; D014189:Transsexualism / Q000523:psychology*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology; D055815:Young Adult
keywords: Papanicolaou test; cancer screening; cervical smears; cervix neoplasms; early detection of cancer; homosexuality; lesbian, gay, bisexual and transgender persons; nursing