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University of Windsor Scholarship at UWindsor Electronic Theses and Dissertations Theses, Dissertations, and Major Papers 2013 Coming Out in Primary Healthcare: An Empirical Investigation of a Model of Predictors and Health Outcomes of Lesbian Disclosure Melissa St. Pierre University of Windsor Follow this and additional works at: https://scholar.uwindsor.ca/etd Recommended Citation St. Pierre, Melissa, "Coming Out in Primary Healthcare: An Empirical Investigation of a Model of Predictors and Health Outcomes of Lesbian Disclosure" (2013). Electronic Theses and Dissertations. 4880. https://scholar.uwindsor.ca/etd/4880 This online database contains the full-text of PhD dissertations and Masters’ theses of University of Windsor students from 1954 forward. These documents are made available for personal study and research purposes only, in accordance with the Canadian Copyright Act and the Creative Commons license—CC BY-NC-ND (Attribution, Non-Commercial, No Derivative Works). Under this license, works must always be attributed to the copyright holder (original author), cannot be used for any commercial purposes, and may not be altered. Any other use would require the permission of the copyright holder. Students may inquire about withdrawing their dissertation and/or thesis from this database. For additional inquiries, please contact the repository administrator via email ([email protected]) or by telephone at 519-253-3000ext. 3208. Coming Out in Primary Healthcare: An Empirical Investigation of a Model of Predictors and Health Outcomes of Lesbian Disclosure by Melissa St. Pierre A Dissertation Submitted to the Faculty of Graduate Studies through the Department of Psychology in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy at the University of Windsor Windsor, Ontario, Canada © 2013 Melissa St. Pierre Library and Archives Bibliothèque et Canada Archives Canada Published Heritage Direction du Branch Patrimoine de l'édition 395 Wellington Street 395, rue Wellington Ottawa ON K1A 0N4 Ottawa ON K1A 0N4 Canada Canada Your file Votre référence ISBN: 978-0-494-98367-6 Our file Notre référence ISBN: 978-0-494-98367-6 NOTICE: AVIS: The author has granted a non- L'auteur a accordé une licence non exclusive exclusive license allowing Library and permettant à la Bibliothèque et Archives Archives Canada to reproduce, Canada de reproduire, publier, archiver, publish, archive, preserve, conserve, sauvegarder, conserver, transmettre au public communicate to the public by par télécommunication ou par l'Internet, prêter, telecommunication or on the Internet, distribuer et vendre des thèses partout dans le loan, distrbute and sell theses monde, à des fins commerciales ou autres, sur worldwide, for commercial or non- support microforme, papier, électronique et/ou commercial purposes, in microform, autres formats. paper, electronic and/or any other formats. The author retains copyright L'auteur conserve la propriété du droit d'auteur ownership and moral rights in this et des droits moraux qui protege cette thèse. Ni thesis. Neither the thesis nor la thèse ni des extraits substantiels de celle-ci substantial extracts from it may be ne doivent être imprimés ou autrement printed or otherwise reproduced reproduits sans son autorisation. without the author's permission. In compliance with the Canadian Conformément à la loi canadienne sur la Privacy Act some supporting forms protection de la vie privée, quelques may have been removed from this formulaires secondaires ont été enlevés de thesis. cette thèse. While these forms may be included Bien que ces formulaires aient inclus dans in the document page count, their la pagination, il n'y aura aucun contenu removal does not represent any loss manquant. of content from the thesis. Coming Out in Primary Healthcare: An Empirical Investigation of a Model of Predictors and Health Outcomes of Lesbian Disclosure by Melissa St. Pierre APPROVED BY: C. M. Mathieson, External Examiner University of British Columbia C. Yanchula Schulich School of Medicine & Dentistry S. Bergeron Department of Psychology R. Menna Department of Psychology C. Y. Senn, Advisor Department of Psychology 29 April 2013 AUTHOR’S DECLARATION OF ORIGINALITY I hereby certify that I am the sole author of this thesis and that no part of this thesis has been published or submitted for publication. I certify that, to the best of my knowledge, my thesis does not infringe upon anyone’s copyright nor violate any proprietary rights and that any ideas, techniques, quotations, or any other material from the work of other people included in my thesis, published or otherwise, are fully acknowledged in accordance with the standard referencing practices. Furthermore, to the extent that I have included copyrighted material that surpasses the bounds of fair dealing within the meaning of the Canada Copyright Act, I certify that I have obtained a written permission from the copyright owner(s) to include such material(s) in my thesis and have included copies of such copyright clearances to my appendix. I declare that this is a true copy of my thesis, including any final revisions, as approved by my thesis committee and the Graduate Studies office, and that this thesis has not been submitted for a higher degree to any other University or Institution. iii ABSTRACT Researchers and health practitioners have emphasized the importance of disclosure of sexual orientation by lesbians to their healthcare providers (HCPs). Commonly known as ‘coming out’, during interactions with HCPs this behaviour has been linked to the receipt of appropriate and tailored care by lesbians, an increase in regular preventative healthcare seeking, and a more authentic relationship between patients and their physicians. The current study employed a mixed-methods design to provide a comprehensive understanding of what facilitates disclosure, and subsequently, what happens once lesbians come out to their HCPs. Of particular interest were patient (e.g., outness and other minority stressors such as internalized homophobia), HCP (e.g., LGBT-friendly), healthcare environment (e.g., a safe waiting room), and patient-provider relationship (e.g., women’s comfort with their HCPs) facilitators. Preventative health behaviours (e.g., cervical screening) were the outcomes examined. Over 400 lesbian women from across Canada and the USA contributed to the analyses, and allowed for the consideration of cross-cultural similarities and differences. Path analyses were conducted to test models of disclosure and healthcare seeking separately for each sample. Additionally, women’s narrative responses to the open-ended questions included as part of the study (i.e., their descriptions of what would influence their willingness to disclose to their HCPs and for those who had disclosed, their HCPs’ reactions to this information) supplemented the quantitative data by providing a closer look at context. For example, the contexts of when coming out is perceived by lesbian patients as relevant, and the contexts of unsafe and safe care environments. The current study’s findings suggested that a variety of factors influenced disclosure. Having an LGBT-friendly provider played a significant role in both countries’ models and had a stronger influence on disclosure than did patient characteristics. Though most processes in the models were similar for the Canadian and American samples, some unique pathways were also present and are explained in terms of differences in socio-political climate. Implications from this study are clear: HCPs who are LGBT- friendly have the potential to reduce the impact of minority stressors, encourage disclosure, and support an overall positive care experience for their lesbian patients. iv ACKNOWLEDGMENTS If I can think of one word that truly captures my experiences of successfully moving through undergraduate and graduate school, it would be supported. From my first encounters with research through my honours thesis, I was able to pursue work that was meaningful to me through my access to the most amazing mentors. Thank you, Drs. Carmen Poulin and Lynne Gouliquer, for supporting my early development as a young scholar, feminist, and lesbian. Thank you to Dr. Sandi Byers, who convinced me that it would be in my best interest to pursue graduate studies at a different university – that I had taken and learned what I could from my mentors at UNB and that it was time to expand my experiences and perspectives. Thank you also to you, Sandi, and Dr. Ann Cameron for taking a chance on what was a very junior scholar to manage your important work on dating violence in NB schools. The experiences I gained early as your Research Coordinator prepared me well for the journey I was about to embark at the University of Windsor. I could not have navigated 6.5 years of life events, politics, courses, research, and training without the support of my advisor, Dr. Charlene Senn. I feel incredible privilege when I tell people that I worked under your supervision, Charlene, for both my MA and my PhD. You have taught me and continue to teach me so much about discipline, commitment, passion, taking a stand, and praxis. Thank you, Charlene – your support of me and my work has meant everything to me. It is because of you that I can truly say now that I believe in myself. Thank you to my committee who provided me with invaluable feedback, encouragement, and enthusiasm throughout the PhD process: Drs. Catherine Yanchula, Rosanne Menna, and Sherry Bergeron. To Dr. Cynthia Mathieson, my external examiner: I have been so inspired by your work… it was a true honour to have you present at my defense. I also want to thank Drs. Kathy Lafreniere and Greg Chung-Yan for the roles they had in supporting my training through sharing generously their time and advice. Barb, Penny, and Angela: there is no other word other than outstanding to describe the quality of your administrative support. Dr. Betty Barrett, you hold a special place in my heart. Throughout our time together, I have learned much about myself as a collaborator, contributor, and educator.

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