title: Understanding the Influence of Stigma and Medical Mistrust on Engagement in Routine Healthcare Among Black Women Who Have Sex with Women.
abstract: For Black women who have sex with women (BWSW), obtaining routine healthcare can be obstructed by a number of psychosocial barriers, including experiences of stigma, related to both sexual orientation and race, and medical mistrust, both race-based and global. Previous research demonstrates that sexual orientation and race-based stigma, as well as global and race-based medical mistrust, each have a negative impact on health outcomes and engagement in care (EIC) independently. This study addresses gaps in the literature by examining the impact of these psychosocial barriers and their interactions among BWSW, an understudied population.
  
  
  
  Participants (256 BWSW) were surveyed at a Black Gay Pride festival. Separate generalized linear models assessed the independent and multiplicative effects of participants' self-reported sexual orientation stigma, race-based stigma, race-based medical mistrust, and global medical mistrust related to their engagement in routine physical exams and blood pressure screenings.
  
  
  
  Prevalence rates of both stigma measures were low, but prevalence rates of global and race-based medical mistrust were high. The results show that experiencing sexual orientation stigma or having race-based medical mistrust predicts significantly lower EIC. Furthermore, the frequencies of obtaining recent physical examinations and blood pressure screenings were significantly related to three- and two-way interactions between stigma and medical mistrust, respectively.
  
  
  
  There is an urgent need to address the intersectionality of these psychosocial barriers in an effort to increase BWSW's EIC.
authors.affiliation: 1 Department of Human Development and Family Studies and the Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut , Storrs, Connecticut.
authors.forename: Alaina
authors.initials: A
authors.lastname: Brenick
authors.affiliation: 2 Mental Health Counseling, Florida State University , Tallahassee, Florida.
authors.forename: Kelly
authors.initials: K
authors.lastname: Romano
authors.affiliation: 3 Independent Scholar , New York, New York.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kegler
authors.affiliation: 1 Department of Human Development and Family Studies and the Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut , Storrs, Connecticut.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Eaton
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D018452:Homosexuality, Female / Q000208:ethnology* / Q000523:psychology*; D006801:Humans; D016014:Linear Models; D010808:Physical Examination / Q000523:psychology; D057566:Self Report; D000072339:Sexual and Gender Minorities / Q000523:psychology*; D057545:Social Stigma; D035502:Trust / Q000523:psychology*
keywords: barriers to care; lesbian; race/ethnicity/culture; women who have sex with women (WSW)