{"id":8392,"date":"2016-07-19T19:06:32","date_gmt":"2016-07-20T00:06:32","guid":{"rendered":"https:\/\/thesocietypages.org\/girlwpen\/?p=8392"},"modified":"2016-07-19T19:06:32","modified_gmt":"2016-07-20T00:06:32","slug":"less-stigma-better-patient-care-for-lesbian-and-bisexual-women","status":"publish","type":"post","link":"https:\/\/thesocietypages.org\/girlwpen\/2016\/07\/19\/less-stigma-better-patient-care-for-lesbian-and-bisexual-women\/","title":{"rendered":"Less Stigma, Better Patient Care for Lesbian and Bisexual Women"},"content":{"rendered":"

This month\u2019s column features our first guest-post from Liz Borkowski, MPH<\/a>. Liz is the managing editor of Women\u2019s Health Issues<\/em> and a researcher at the George Washington University Milken Institute School of Public Health. She focuses on reproductive health, paid leave, and US health policy, and is a regular contributor to the public health blog The Pump Handle<\/em><\/a>.<\/p>\n

__________<\/p>\n

What\u2019s the best way to help lesbian and bisexual (LB) women lose weight, when their communities may question the very goal of weight loss<\/a>? That\u2019s a question behind the \u201cHealthy Weight in Lesbian and Bisexual Women: Striving for a Healthy Community\u201d (HWLB) initiative. The answer they came up with was to focus the program on physical activity and nutrition, rather than numbers on a scale. Their findings<\/a> suggest that this can be an effective approach for helping lesbian and bisexual women adopt healthier habits. Nearly all (95%) of participants achieved one or more of the health objectives<\/a>, which included nutrition and physical activity goals as well as weight reduction. That included 57% of participants increasing their weekly physical activity minutes by 20% \u2013 habits that, if sustained, could contribute to years of improved health.<\/p>\n

\"041\/365<\/a><\/p>\n

The Women\u2019s Health Issues supplement<\/a><\/em> about the study contains lessons for healthcare providers who serve lesbian and bisexual women. As Natalie Ingraham and her colleagues explain in an article about provider interventions<\/a>, lesbian and bisexual women may not disclose their sexuality to providers who seem to presume heterosexuality; lack of disclosure can lead to inadequate care. Weight bias can also be common among healthcare providers:<\/p>\n

\u201c…stigma and discrimination related to sexual orientation and gender identity may be compounded by stigma related to weight and body size.\u201d<\/p><\/blockquote>\n

To address this, the researchers developed and evaluated two curricula for providers to enhance their ability to provide high-quality care to LB \u201cwomen of size\u201d (overweight or obese). Focus group participants explained that they wanted providers\u2019 help in overcoming barriers to healthy habits, not providers making them feel shamed or blamed for their weight. Based on this feedback and prior studies, the team developed two curricula that involved cultural competency training and motivational interviewing (MI) techniques:<\/p>\n

\u201cRather than trying to convince clients to change, providers trained in MI elicit arguments for change from the clients themselves\u2026These techniques help clients to explore and resolve ambivalence, develop self-efficacy, and set personal goals.\u201d<\/p><\/blockquote>\n

The team pilot tested the \u201cacademic format\u201d training with physicians, residents, and medical students at universities in Washington, DC and Nashville, Tennessee. They pilot tested the \u201cclinic format\u201d training with staff and providers at Lyon-Martin Health Services, a Program of HealthRight360, which provides care to LGBT clients in the San Francisco Bay Area. Ninety-six participants completed tests before and after the trainings; results showed the most change on questions about patient-provider interactions and LB women\u2019s avoidance of care.<\/p>\n

Specifically, after the trainings, more participants (correctly) agreed with the statements \u201cLesbians and bisexual women may avoid health care because they don\u2019t trust the practitioner to be culturally competent\u201d and \u201cOverweight and obese women often delay or avoid health care if they feel their health care provider holds a bias against women who are large.\u201d More participants also (correctly) disagreed with the statement \u201cPhysicians\/nurses should always instruct their overweight\/obese patients to lose weight.\u201d There was also more (correct) agreement with this statement, which encapsulates what providers can do to help overweight clients:<\/p>\n

\u201cPatients who are advised by their physician how to modify their behavior to lose weight are more likely to lose weight than those who do not get this advice.\u201d<\/p><\/blockquote>\n

While the authors of this article note the need for additional research on these curricula \u2013 including studies to see whether they improve clinical practice \u2013 their findings, combined with the findings of the overall HWLB study, have some clear implications. Instead of instructing all overweight or obese lesbian and bisexual patients to lose weight, providers should offer advice on adopting healthier behaviors. It is key that this advice be presented in ways that don\u2019t contribute to stigma on the basis of larger size or sexual orientation. \u00a0To better serve lesbian and bisexual patients, health care providers should familiarize themselves with cultural norms and problematic stigmas that LB women may face. Then, during patient interactions they should make sure to sensitively include \u201copen and positive acknowledgement of sexual orientation.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

This month\u2019s column features our first guest-post from Liz Borkowski, MPH. Liz is the managing editor of Women\u2019s Health Issues and a researcher at the George Washington University Milken Institute School of Public Health. She focuses on reproductive health, paid leave, and US health policy, and is a regular contributor to the public health blog […]<\/p>\n","protected":false},"author":1918,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[21094],"tags":[9981,988,2998,1434,3182,21925],"class_list":["post-8392","post","type-post","status-publish","format-standard","hentry","category-bedside-manners","tag-bisexual","tag-health-care","tag-lesbian","tag-lgbt","tag-obesity","tag-womens-health"],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/posts\/8392","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/users\/1918"}],"replies":[{"embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/comments?post=8392"}],"version-history":[{"count":3,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/posts\/8392\/revisions"}],"predecessor-version":[{"id":8395,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/posts\/8392\/revisions\/8395"}],"wp:attachment":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/media?parent=8392"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/categories?post=8392"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/tags?post=8392"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}