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Defining the Impact of SGM Status Disclosure on Health Outcomes to Ensure Equity: the DISCLOSE study

Lauren Beach, JD, PhD
Vanderbilt University Medical Center
Award Year: 2016

Initial Abstract

Sexual and gender minority (SGM) populations face increased health inequities compared to their non- SGM peers, including less access to health care, higher rates of mental health and substance abuse disorders, and higher rates of HIV and diabetes. Previous studies report non-disclosure of SGM status to medical providers is associated with lower levels of SGM health care utilization, lower adherence to treatment protocols, and worse health outcomes. We designed the Defining the Impact of SGM Status Disclosure on Health Outcomes to Ensure Equity (DISLCOSE) study to examine in a racially, sexually and gender diverse Southeastern United States SGM patient population 1. the determinants of SGM status disclosure to chronic disease medical providers and 2. the impact of SGM status disclosure on HIV and/or diabetes medication adherence, patient-reported outcomes and health outcomes.
In total, the DISCLOSE study will enroll 100 disclosed and 100 non-disclosed SGM and 200 age, gender and race matched non-SGM participants from the HIV and Diabetes clinics of Vanderbilt University Medical Center (200 patients) and Meharry Medical College (200 patients). Of these patients, enrollment projections indicate approximately 77 will be sexual minority lesbian and bisexual women, of whom ~25% will identify as African-American. Potential participants will be screened for study eligibility as they arrive at their appointments. To be eligible, participants must complete SGM identity screening questions, have been in care at the clinic study site for at least 2 years, release their medical records to the study, and provide written informed consent, consistent with Vanderbilt IRB approval. To ensure balanced demographics between SGM and non-SGM patients, an age, race and gender matched non-SGM participant will be enrolled within 7 days of each SGM participate. To facilitate SGM participant enrollment, the DISCLOSE team is partnering with VUMC’s Program for LGBTI Health and the Tennessee HIV/AIDS service organization Nashville CARES to raise awareness of DISCLOSE in local LGBTI communities.
Before their provider visit, consented participants will complete validated survey metrics assessing stigma, medication adherence, demographic information, quality of patient-provider communications, selfefficacy,
depressive symptoms, and social support. After their shared visit, both patients and their providers will be sent a text message survey to assess visit quality and actual/perceived patient satisfaction. Additionally, 50 SGM female participants (25 disclosed and 25 non-disclosed) will be recruited to consent to audio-recording of their provider visit. Roter interaction analysis system (RIAS) coding (10) assessing the patient-centeredness of patient-provider communications will be performed. As sample size allows, stratified analyses will be conducted to identify themes emerging for distinct SGM groups. These methods will allow identification of unique outcomes impacting the health of lesbians and other SGM women. DISCLOSE will be the first study to examine the health impacts of SGM non-disclosure conducted in a clinical research setting utilizing non-selfreported lab values. Overall, results from DISCLOSE will contribute to developing a deeper understanding of why diverse SGM patients may not disclose their SGM identity to providers and the contributions nondisclosure may make to observed health disparities in vulnerable SGM populations.

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