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© 2010 Jorja Jamison © 2010 Jorja Jamison PSYCHOMETRIC VALIDATION OF THE MULTIDIMENSIONAL DISCLOSURE TO HEALTH CARE PROVIDERS SCALE (MD-HCPS) BY JORJA JAMISON DISSERTATION Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Educational Psychology in the Graduate College of the University of Illinois at Urbana-Champaign, 2010 Urbana, Illinois Doctoral Committee: Associate Professor Lydia P. Buki, Chair Associate Professor Ramona F. Oswald Professor Dale E. Brashers Professor Hua Hua Chang Abstract A substantial body of research has identified many health disparities in the gay and lesbian populations, along with a myriad of physical, social, and institutional factors that influence these disparities. The sexual orientation disclosure interaction is a critical component of the health care visit for lesbians and gay men that may significantly explain and predict engagement in the system, and ultimately, may contribute to these health disparities. However, the construct of disclosure has been poorly defined and measured by health care researchers. The purpose of this study was to further develop the preliminary Multidimensional Disclosure to Health Care Providers Scale (MD-HCPS) to assess gay men and women’s experiences disclosing sexual orientation to health care providers. Data were gathered from 667 participants across the U.S. using online survey methodology. Based on item analyses and exploratory factor analyses, the number of items was reduced from 119 to 62 in five subscales. Further, twelve factors were identified within the five subscales (Disclosure Attitudes and Beliefs, Initiation of Disclosure, Disclosure Communication, Positive Acknowledgment of Disclosure, and Negative Acknowledgment of Disclosure). Results also provided empirical evidence for the theoretical model on which the scale is based. Coefficient alphas for the factors ranged from .43 to .91. Five of the twelve factors had adequate reliability (.80 or greater). The remaining factors need further revision to increase their reliability. Despite its limitations, this measure has great potential to further our understanding of the influence of disclosure on health seeking behaviors of gay men and lesbians. This, in turn, can help to improve the quality of life of gay and lesbian individuals, a population that has traditionally been neglected in the literature. ii To gay and lesbian individuals everywhere, who bravely navigate disclosing on a daily basis. iii Acknowledgments I would like to acknowledge the following people who contributed to this research project, in addition to my committee members Lydia Buki, Ramona Oswald, Dale Brashers, and Hua Hua Chang. Robin Burhke and Margo Michaels were instrumental with their advice about finding my research path. I am very thankful to members of the Thesis and Dissertation Support Group at the University of Illinois, especially Jennifer Mayfield, Vetisha McClair, Anita Hund, and Tysza Gandha, without whose help I never would have finished this project. During the data analyses phase, Hsin-ya Liao’s statistics help was indispensible. I also thank many friends and family members who offered unwavering support: Virginia Thomas, Mary Barker, Jorja Davenport, Bill Barker, Mary Russell, Sherry Lagerstam, Kevin Johnson, Brandon Bowersox, and Melinda Miller are particularly notable. Finally, I thank the doctor I saw 13 years ago who planted the seed of this study when she asked all the wrong questions and didn’t understand any of my answers. iv Table of Contents List of Tables ...............................................................................................................vii List of Figures................................................................................................................x Chapter 1 Introduction .................................................................................................1 Chapter 2 Literature Review ........................................................................................6 Health Disparities Among Gay Men and Lesbians...........................................6 Disclosure of Sexual Orientation to Health Care Providers ..........................................................................................................13 History of the Construct of Disclosure............................................................24 Review of the Measurement of Disclosure to Health Care Providers .................................................................................................30 The Draft Preliminary Multidimensional Disclosure to Health Care Providers Scale (MD-HCPS)......................................................35 Purpose of the Study........................................................................................41 Chapter 3 Methodology...............................................................................................44 Participants......................................................................................................44 Measures ..........................................................................................................46 Procedure .........................................................................................................47 Analyses............................................................................................................49 Chapter 4 Results ........................................................................................................53 Characteristics of the Participants..................................................................53 MD-HCPS Refinement ....................................................................................59 Final Preliminary MD-HCPS........................................................................ 135 Chapter 5 Discussion................................................................................................. 138 Unique Contributions of the Study ............................................................... 139 Limitations of the Current Study.................................................................. 144 Implications for Future Research and Interventions ................................... 146 Suggestions for Further MD-HCPS Refinement .......................................... 149 References.................................................................................................................. 152 Appendix A Disclosure Measures Included in Analysis........................................... 164 Appendix B Draft Preliminary Multidimensional Disclosure to Health Care Providers Scale (MD-HCPS)................................................................ 168 Appendix C Sociodemographic Questionnaire ........................................................ 182 Appendix D Organizations Contacted for Survey ................................................... 189 v Appendix E Informed Consent and Debriefing Information Provided to Participants............................................................................................ 202 Appendix F Final Draft Preliminary Multidimensional Disclosure to Health Care Providers Scale (MD-HCPS) ......................................... 206 Appendix G Author Vita........................................................................................... 215 vi List of Tables Table Page 1 Demographic Characteristics of Participants ...................................................54 2 Distribution of Identifiability Variable..............................................................56 3 Sexual Orientation Characteristics of Participants ...........................................57 4 Health-Related Demographics of Participants ..................................................58 5 Initial Item Skewness, Kurtosis, Means, and Standard Deviations .........................................................................................63 6 Disclosure Attitudes and Beliefs (DAB) Inter-Item and Initial Item-Total Correlations ..................................................................81 7 Initiation of Disclosure (ID) Inter-Item and Initial Item-Total Correlations .....................................................................................................87 8 Disclosure Communication (DC) Inter-Item and Initial Item-Total Correlations......................................................................... 91 9 Positive Acknowledgment of Disclosure (PAD) Inter-Item and Initial Item-Total Correlations......................................................................... 93 10 Negative Acknowledgment of Disclosure (NAD) Inter-Item and Initial Item-Total Correlations..........................................................................94 11 Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy and Bartlett’s Test of Sphericity........................................................................98 12 Initial Eigenvalues, Percentages of Variance, and Cumulative Percentages for Significant Factors of DAB Subscale .......................................99 13 Summary of Rotated Factor Loadings, Communalities, Eigenvalues, and Percentages of Variance for Promax Oblique Principal Axis Two-Factor Solution on MD-HCPS DAB Subscale ................................................................................................101 14 Summary of Rotated Factor Loadings, Communalities, Eigenvalues, and Percentages of Variance for Promax Oblique Principal Axis Three-Factor Solution on MD-HCPS DAB Subscale
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