Deciding Who to See: Lesbians Discuss Their Preferences in Health and Mental Health Care Providers

Lesbians' access to high-quality physical and mental health care is hampered by longstanding provider biases (Garnets, Hancock, Cochran, Goodchilds, & Peplau, 1991; Lucas, 1992; Saghir & Robins, 1973; Stevens, 1992; Stevens & Hall, 1988). These negative attitudes on the part of physical and mental health care providers continue to interfere with services provision despite the progress that has been made in increasing lesbian visibility and decreasing overall stigma against lesbians and gay men (Appleby & Anastas, 1998). Like most people, lesbians seek acceptance, respect, and a welcoming attitude in health care providers (Stevens & Hall, 1988). Few researchers have asked lesbians to elaborate on what else they want in a health care provider or on the factors that enter into their decision making when they choose a provider. Most of the information we have documents lesbians' preferences concerning the gender, sexual orientation, or race of their providers. Preferences regarding a clinician s sexual orientation vary. Modrcin and Wyers' (1990) nonprobability study of 128 lesbians and gay men found that only 40 percent of the respondents said they preferred to see someone of their own sexual orientation for counseling. In a national nonprobability survey of 1,925 lesbians, Bradford, Ryan, and Rothblum (1994) found that 66 percent said they wanted to see a lesbian or gay male counselor. Lucas (1992) found that 92 percent of a convenience sample of 178 southwestern lesbians preferred a lesbian health care provider. Preference for a female health care provider is consistently high: 89 percent of lesbian respondents to the Bradford et al. (1994) survey stated a preference for women counselors, as did 68 percent of those in the study by Modrcin and Wyers (1990) and most of the 25 lesbians in the Midwestern snowball sample by Stevens and Hall (1988). Bradford and colleagues found that 73 percent of lesbian respondents had no preference and bisexual women have been grouped together for comparison with heterosexual women in alcohol studies both for practical reasons, such as sample size (Bloomfield, 1993), and theoretical reasons, such as an effort by bisexual women to be included in lesbian communities (Kelly, 1991). First and Second Community Focus Groups. For the middle-class and working-class groups, LHCP members attended a lesbian community function and solicited volunteers to attend one of two already scheduled community focus groups. Volunteers signed up for the group of their choosing and were encouraged to invite other lesbian and bisexual women to accompany them. They were asked for suggestions and contact information for additional women. The focus groups were held in convenient locations, known to community members and accessible by public transportation. Youth Focus Group. For the youths, we asked a local gay and lesbian youth services agency for assistance in identifying potential participants. LHGP members were invited to use a Friday evening drop-in session at the agency to conduct the focus group. Older Women and African American Focus Group. One member of LHCP was also a member of two lesbian organizations: one for older aduts and one for African American lesbian and bisexual women. Because both organizations are relatively small, and the facilitator anticipated limited participation, she invited members of both organizations to attend a single focus group, which was held at the usual meeting place of one of the organizations. Bar Focus Group. A local bar owner, a longtime activist in the lesbian community, offered to conduct outreach. She successfully encouraged a wide range of her patrons, including local athletes, extremely poor women with chronic illnesses, wealthy professionals and executives, students, laborers, and rural, suburban and urban lesbians representing a significant range of experience with physical health, mental health, and alcohol and drug services organizations to attend the focus group, malting it the best attended (15 participants), longest running (two hours), and most widely representative of all the focus groups. …