Many lesbian, gay, bisexual, and transgender (LGBT) individuals report experiencing discrimination in their health care that leads to avoidance of regular appointments with providers. Lack of regular primary care can delay diagnoses of preventable conditions and increase patient risks for chronic disease complications. A systematic review of the literature was conducted to understand LGBT cultural competencies for nursing and other health care providers. The Cochrane Handbook for Systematic Reviews and Melnyk's levels of evidence framed this systematic literature review. Articles for inclusion were limited to those published in English between 2008 and 2018. Keywords used in the literature search included LGBT health disparity, LGBT cultural competency orientation, and nursing LGBT education. The search yielded 70 article results, which were further reduced to 12 articles by critically analyzing the applicability of the literature to the practice-related questions and removing duplicate articles. Five articles met the criteria for Levels III-IV (case-control or cohort), 6 met the criteria for Level II (randomized control trials), and 1 was Level 1 (systematic review). The analysis of evidence demonstrated the importance of providing education to nurses and other health care providers regarding LGBT cultural competency. Recommendations are offered for best practice strategies regarding the inclusion of LGBT cultural competencies in nursing orientation modules. Application of the findings may lead to positive social change if knowledgeable health care providers engage the LGBT population in primary care leading to improved health care outcomes.

The documented experiences and perceptions of lesbian, gay, bisexual, and transgender (LGBT) patients receiving hospice or palliative care gives merit to the need for the implementation of LGBT affirming environments in hospice care settings. The guidelines for creating these affirming environments are described in this paper. Applying the Donabedian (1988) model of structure, process, and outcome this thesis project analyzes identified interventions relevant to the implementation of LGBT affirming environments in hospice care settings. Utilizing a formal PICO questioning method, a search strategy was devised and studies were identified based on established criteria. The results suggest that there is a paucity of data in relation to the implementation of LGBT affirming environments in hospice care settings. In an effort to assist in identifying existing interventions that have not been studied this project also includes a recommended survey tool to measure the active efforts of hospice organizations to implement LGBT affirming environments.

This Master's Thesis reports on the experiences of Type 2 Diabetes of Lesbian, Queer, and Women-Loving Women. The thesis examines the impact of sexual orientation on experiences with diabetes, and how this chronic disease affects the way a woman views herself, her health, and her body image. Each participant presented her narrative and world views in regards to her diabetes health care and management, stress and trauma, and management of relationships. Through narrative analysis, I have revealed differing mechanisms of coping and explanatory models; the many women of this study selectively chose to be more open about her sexual orientation than her diabetes status.

Sexual minority women (SMW) demonstrate lower rates of cervical cancer screening than heterosexual women. This is concerning as lesbian and bisexual women tend to engage in higher rates of substance-related cancer risk behaviors, unprotected sex, and tend to have higher body mass indices, all of which are risk factors for cancer development. Another major risk factor, screening avoidance, places SMW at increased risk for the development of high grade cervical lesions in the absence of early detection practices, which is likely to impact overall cervical cancer morbidity in this population. The aim of the present study was to utilize the Health Equity Promotion Model in order to investigate the interplay of medical heterosexism, social and community, behavioral, biological, and social identity/position factors on cervical cancer screening rates in a sample of SMW from a large metro area in the southeastern United States. 145 women who identify as sexual minorities were recruited from local LGBT-friendly venues, events, community organizations, email LISTSERVs, and related social media accounts and were asked to complete a fifteen-minute survey. A series of bivariate correlation, t-test, and multivariate regression analyses were run. Findings from mediation analyses demonstrated that health communication factors mediated the relationship between perceived medical heterosexism and cervical cancer screening outcomes. Further, after accounting for demographic factors, greater provider communication quality, provider trust, eHealth literacy, and ever having an HIV test significantly and differentially predicted cervical cancer screening outcomes in the multivariate models (ps < .05). Findings suggest that health communication factors play an important role in facilitating cervical cancer screenings for SMW, and provider training interventions and policy that focus on reducing medical heterosexism may aid in improving patient-provider relationships in this population.

Submitted by Micheli Abreu (mabreu@fiocruz.br) on 2015-11-10T13:17:37Z No. of bitstreams: 1 Arnaldo_Laurentino_EPSJV_Mestrado_2015.pdf: 1467023 bytes, checksum: 41ed36509d7c92a68ff913265accd69e (MD5) / Approved for entry into archive by Mario Mesquita (mbarroso@fiocruz.br) on 2015-11-11T15:37:11Z (GMT) No. of bitstreams: 1 Arnaldo_Laurentino_EPSJV_Mestrado_2015.pdf: 1467023 bytes, checksum: 41ed36509d7c92a68ff913265accd69e (MD5) / Approved for entry into archive by Mario Mesquita (mbarroso@fiocruz.br) on 2015-11-11T17:46:44Z (GMT) No. of bitstreams: 1 Arnaldo_Laurentino_EPSJV_Mestrado_2015.pdf: 1467023 bytes, checksum: 41ed36509d7c92a68ff913265accd69e (MD5) / Made available in DSpace on 2015-11-11T17:46:44Z (GMT). No. of bitstreams: 1 Arnaldo_Laurentino_EPSJV_Mestrado_2015.pdf: 1467023 bytes, checksum: 41ed36509d7c92a68ff913265accd69e (MD5) Previous issue date: 2015 / Fundação Oswaldo Cruz. Escola Politécnica de Saúde Joaquim Venâncio. Programa de Pós-Graduação em Educação Profissional em Saúde. / A comunidade de Lésbicas, Gays, Bissexuais, Travestis e Transexuais veio vivenciando a escassez de ações específicas, o descaso e o fortalecimento de preconceitos na área da saúde. No âmbito das ciências sociais, a política social é entendida como modalidade de política pública, importante e necessária para o desenvolvimento de todos. Neste contexto, há a necessidade de se ampliar o debate sobre a cidadania LGBT, compreendendo a demanda da comunidade como uma necessidade e luta pelo reconhecimento. Através de revisão bibliográfica, análise de documentos oficiais, e entrevistas com servidores públicos federais diretamente envolvidos com a implementação da Política Nacional de Saúde Integral LGBT, analisou-se o processo de como esta política se relaciona com a camada populacional LGBT, que esteve ao longo das últimas décadas relegada às políticas parciais de combate ao HIV e a disseminação da Aids. A Política Nacional de Saúde Integral LGBT reconhece os efeitos perversos da discriminação e da exclusão, e devolve aos LGBT o reconhecimento de sua cidadania. A criação, e posterior implementação, desta política decorre de um processo de amadurecimento e conquista de espaços, que é cotidiano. / The Lesbian, Gay, Bisexual, Travesty and Transgender community has been experiencing a scarcity of specific actions, and also the negligence and strengthening of prejudices in the health area. In the scope of social sciences, the social policy is understood as a modality of public policy, which is important and necessary to the development of all. In this context, there is the necessity of amplifying the debate about LGBT citizenship, realizing the community demand as a need and struggle for recognition. Through a literature review, analysis of official documents and interviews with federal civil servants directly involved with the implementation of the National Integral LGBT Health Policy, it was analyzed the process of how this policy is related to the LGBT population layer, which has been over the last decades relegated to the partial anti-HIV policies and the fight against the dissemination of AIDS. The National Integral LGBT Health Policy recognizes the perverse effects of discrimination and exclusion, and gives back to the LGBT community the acknowledgment of their citizenship. The creation, and posterior implementation, of this policy derive of a process of ripening and conquest of space, that is everyday.