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Lesbian, Gay and Bisexual People and Primary Healthcare Services

Introduction

In an era when homosexuality is a tangible enough concern to merit religious, moral and legal debate (and two journals devoted solely to partnering without the possibility of procreation and natural offspring), Neville and Henrickson (2006) analyze a portion of the 2004 New Zealand Lavender Islands: Portrait of the Whole Family nationwide survey. The study investigated a wide spectrum of “…identity and self-definition, families of origin, relationships and sexuality, families of choice, immigration and internal migration, wellbeing, politics, income and spending, education, careers and leisure, community connections, challenges, and spirituality…” (Henrickson, Neville, Jordan, & Donaghey, 2007, p. 223). The self-evident findings – that the self-selected population “…experience same-sex relationships and identity in significantly different ways” (Ibid.) – gave the researchers an opportunity to explore acceptance barriers in health care.

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Research Purpose and Problem

In essence, the Neville and Henrickson (2006) extract on health care issues investigates the extent to which homosexuals experience inequity and discrimination in primary health care establishments. The researchers argue that patient reticence about disclosing their homosexuality elevates the risk of incomplete histories being taken and that health care personnel will consequently overlook the elevated pathological, epidemiological, substance-abuse, and suicide incidence that characterize homosexuals.

Literature Review

  1. Most of the references are relevant though one concedes that the authors cast a very wide net. This is about the universal right to equality in health care and the put-upon feelings of homosexuals. Hence, the subject is not so much medical ethics as the social and political discourse about homosexual rights. A few references are inconsequential, such as when the research team felt the need to cite the publisher of SPSS software for no better reason than to demonstrate that they had adhered to the professional standard for the social sciences.
  2. and c) Exactly half of the 37 references were published no earlier than 2000. This is the cut-off for being current since the full survey ran in 2004 and the article subject of this critique saw print in 2006. Given the wide-ranging nature of what is essentially a socio-political opinion survey, being very current does not seem especially critical. After all, Neville and Henrickson go all the way back to 1997 for an international agency (WHO) affirming the universal right to health.
  3. Current knowledge about the research problem centers on two phenomena. First, practicing homosexuals confront greater risks for suicide, depression, HIV/AIDS, alcohol and drug abuse. Second, the authors argue, primary health care staff miss opportunities for more effective therapies and compliance by not knowing more about the aforementioned risks or not taking into account their special domestic arrangements.

Framework or Theoretical Perspective

  1. Hence, the authors pull together disparate threads of health care “inequity” that tend to confuse cause and effect. Put simply, health care personnel stand accused of not acknowledging the special needs of homosexuals who are themselves so concerned about being stigmatized by society at large they are loathe to admit their homosexuality.
  2. Evidently, then, the study framework is both ethical and socio-political. The theory that prevails is based on equity: the desire of a marginalized group for acceptance and “equal but special” treatment.
  3. Far from synthesizing relationships among the concepts of interest, the study framework strikes the thoughtful empiricist as a plea for acceptance by heterosexual society at large.
  4. Accordingly, the framework relates to the body of knowledge in nursing primarily to remind health care practitioners that homosexuals confront emotional, health and abuse risks aggravated at diagnosis by their fear of rejection.

Research Objectives, Questions and Hypotheses

Inferring from the published report, the research questions may well have been:

  • RQ1: Is there a measurable incidence of homosexuals convinced that health care personnel unfairly presume the patients they see are usually “normative” heterosexuals?
  • RQ2: Do homosexuals gravitate towards health care personnel who have an accepting attitude about their “sexual identity”?
  • RQ3: Is the attitude of health care personnel about homosexuals perceived to alter the quality of treatment they render?

Study Variables

Given the ideological construct with which the authors approach both the target population and the probable bias of normal, heterosexual health care personnel, the key variables may be classed as follows:

  1. Independent variables: These are i) the prevailing attitude that patients are usually heterosexual (implemented operationally as the item, “In your experience, unless you specifically tell them otherwise, do health professionals presume you are heterosexual?”); ii) the importance of accepting or rejecting attitudes on the part of the medical profession (operationally, “When you chose a primary healthcare provider (like a doctor), how important is that person’s attitude to your sexual identity?”); and, iii) Whether perceived bias or discrimination altered the quality of health care performed (operationally, “Do you believe that in general your healthcare provider’s attitude to your sexual identity influenced the medical treatment you received?”) (all material in quotation marks are from Neville & Henrickson, 2006, p. 410).
  2. The dependent variables (DVs) are: perceptions about the quality of professional service received, and, by implication, how homosexual patients rated their overall health. The latter was defined operationally as, “overall (how would you rate your health?)”. A second DV was the patient’s perception that disclosing his or her homosexuality had adverse effects on quality of care received (operationally, a filter item was asked “If you have seen a healthcare professional in the last 3 years, have you told that person about your sexual identity?” followed by the crucial outcome or DV operationalized as “If yes, how did you feel your healthcare professional responded?” ) (all material in quotation marks are from Neville & Henrickson, 2006, p. 410).
  3. There were no intervention variables that the authors manipulated as such (Burns & Grove, 2005). The closest such factor was the data-collection procedure that included both postal and Internet surveys.

Attributes of Concern and Demographic Variables

The profiling or socio-demographic variables were: self-claimed gender, education, reported annual income, domestic or family arrangements, and whether the homosexual couple lived together at all.

Research Design

  1. This is an opinion poll, promoted via both mainstream and specialist media (those catering to homosexuals), and permitting responses by regular mail or email.
  2. Being a straightforward opinion poll, there was no treatment or intervention variable in the research design.
  3. Subjects were self-selected as to participation, gender and homosexual status.
  4. The authors report no pilot study, presumably because they were confident in the straightforward wording of the survey items.

Sample and Setting

  1. Since survey participation was entirely voluntary and in response to advertising in mass media, no inclusion or exclusion criteria were employed.
  2. The method used to obtain the sample was solicitation in mass-media and lesbian, gay or bisexual (LGB) media. Being effectively the same as a convenience or “viral” sample, reliability in point of giving every member of the universe (in this case, all New Zealand LGB’s) a chance to be chosen is not as optimal as pure-random or stratified sampling (Babbie, 2009; Burns & Grove, 2005).
  3. Total voluntary returns came to 2,216 Internet and postal responses. Given the data-collection mechanics employed, researchers dispense with power analysis and cannot account for refusal rates (Brown, 2005).
  4. By channel, the responses arrived preponderantly via the survey Web site (84%). The gender ratio was somewhat skewed in favor of men (54.5%), followed by women (45.2%) and a tiny minority of those who had undergone a sex-change operation (0.2%). More of the self-admitted homosexuals had had the benefit of undergraduate education or a college degree (51%) than was the norm for the New Zealand population (15%). Average annual incomes were therefore higher (modal income range NZ$ 50,001-70,000) than for the average New Zealand male ($30,001–$40,000) or female ($10,001–$15,000). This may suggest that those with better education and incomes are both more confident about their homosexuality and more conscious about discrimination and harassment. More often than not (45%), survey respondents lived with their homosexual partner while close to one-fourth seemed to be married, succored children and likely had an extramarital affair with their homosexual partner.
  5. Sample mortality and attrition do not count in an Internet or postal survey.
  6. The authors claim approval by the Massey University human (research) ethics committee. Consent is assumed from the fact of voluntary participation.

Measurement and Study Instruments

  1. and b) Neville and Hendrickson formulated the subset of questions defined previously (in section VI, “Study Variables” above). It was a self-administered set of Likert-interval and simple ordinal scales, supported by categorical items for the socio-demographic items.
  2. The authors claim to have consulted LGB’s on item formulation, presumably so as to ensure neutrality, objectivity and sensitivity to target participant feelings.
  3. It appears the researchers relied on no prior literature. There is also no mention of a pilot study or post-fieldwork tests of internal consistency.
  4. No report. The team may have been confident of their own sound judgment.

Data Collection Procedures

  1. There was no intervention protocol since this was a straightforward opinion survey.
  2. Since sampling was purposive, the authors relied on advertising and publicity to drive interested homosexuals to the online survey Web site. Referrals from social and community agencies aiding homosexuals also proved productive.

Statistical Analyses

  1. Data analyses relied chiefly on rudimentary ANOVA and chi-square tests.
  2. α < 0.05.
Purpose of Analysis Statistical Procedure Statistic Result Probability (p)
Difference between males and females on importance of primary health care provider attitude about (their) sexual identity Chi-square χ 5.41 vs. 5.12 p <.001
Difference between younger and older homosexuals on importance of primary health care provider attitude about (their) sexual identity Chi-square χ 5.46 vs. 5.07 p <.001
Difference by gender on whether health care provider “always” or “usually” presumed them to be heterosexual t-test t Not given Not given

References

Babbie, E. R. (2009). The practice of social research. South Melbourne, VIC: Dale Cengage Learning.

Brown, A. (2005). Proceedings of the 4th European Conference on Research Methods: In Business and Management Studies. Kidmore End, UK: Academic Conferences Limited.

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Burns, N. & Grove, S. K. (2005). The practice of nursing research: Conduct, critique, and utilization (5th ed.). Philadelphia, PA: Elsevier.

Henrickson, M., Neville, S., Jordan, C. & Donaghey, S. (2007). Lavender islands: The New Zealand study. J Homosex., 53 (4) 223-48.

Neville, S. & Henrickson, M. (2006). Perceptions of lesbian, gay and bisexual people of primary healthcare services. Journal of Advanced Nursing, 55 (4) 407–415.

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