Modeling lesbian, gay, and bisexual patient disclosures : an exploration of the role of memorable messages, past experiences, perceived visibility, screening behaviors, and efficacy

Lesbian, gay, and bisexual (LGB) people in the United States face unique challenges such as the denial of civil and human rights, discrimination, and societal stigma (HealthyPeople.gov). These challenges facilitate additive minority stress, as evidenced by significantly poorer physical and mental health outcomes for LGBs as compared to heterosexuals. One root of these health disparities is a disclosure-based dilemma in the patient-provider context. Summarized, this dilemma is: "Should I reveal my sexual orientation to my doctor and risk discrimination or stigmatization, or should I conceal my sexual orientation and risk not receiving quality medical care that is tailored to my needs as a patient?" This study investigated competing, predictive models, all of which are grounded in existing research regarding interpersonal health communication and LGB health. The models hypothesized that the following variables predict likelihood of disclosure of sexual orientation: Memorable messages about sexual orientation and receiving care, past disclosure experiences in the patient-provider context, self-perceived visibility of sexual orientation, and patients' pre-screening behaviors of providers. Disclosure efficacy and target efficacy were predicted to mediate these relationships. LGB individuals (N = 209) completed an online questionnaire about receiving health care. Results revealed that disclosure efficacy mediated the predictive relationship between positivity of a past disclosure experience and likelihood of future disclosure. Significance of a past disclosure experience directly, negatively predicted likelihood of future disclosure. Some evidence indicated that self-perceived visibility of sexual minority status positively predicted likelihood of future disclosure. Results failed to support the predictive power of memorable messages and patients' pre-screening behaviors of providers. Theoretical contributions to interpersonal communication models of disclosure are offered, as are practical contributions meant to address patient-provider interactions and, more broadly, the reduction of health disparities for LGB individuals.