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Access to Health Care at the Margins: Implications for Older Sexual Minority Women with Disabilities

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dc.contributor.authorWestcott, Jordan Bailoren
dc.contributor.committeechairFullen, Matthew C.en
dc.contributor.committeememberWelfare, Laura Everharten
dc.contributor.committeememberKniola, David Johnen
dc.contributor.committeememberGrimes, Tameka O.en
dc.contributor.committeememberChan, Christianen
dc.contributor.departmentEducation, Community Collegeen
dc.date.accessioned2023-05-06T08:00:14Zen
dc.date.available2023-05-06T08:00:14Zen
dc.date.issued2023-05-05en
dc.description.abstractCounselors are called to address barriers to human growth and development through advocacy (ACA, 2014), such as those posed by inequitable health care access for socially disadvantaged groups (CDC, 2013; IOM, 2011). Health care contributes to positive health outcomes (Healthy People 2020) and is therefore an important component of advancing health equity among marginalized populations, such as older sexual minority women (SMW) with disabilities. Despite evidence of disparate health care access and health outcomes, no research to date has explored the health needs or health care experiences of disabled older SMW. This study therefore sought to address this gap in the literature by: identifying current levels of health care access and barriers among older SMW with disabilities; exploring predictors of health care access among older SMW with disabilities; and identifying protective factors, such as social support and resilience, that moderate the relationship between health care access barriers and health outcomes. Results obtained from a sample of 208 respondents provided baseline data about health care access and barriers among older SMW with disabilities. Generally, respondents had a place to receive health care, but few had access LGBTQIA+-specific health services despite indicating that this type of health care was important to them. Only about half had accessed mental health services in the last six months, and people who had accessed mental health care perceived it to be easier to access than people who had not. Respondents most highly endorsed external barriers related to cost of health care, and they reported higher health care stereotype threat related to age and disability compared to gender and sexuality. External barriers to health care were predictive of most health care access indicators (e.g., utilization of general and specific health services, as well as health outcomes). Among internal barriers, sexuality- and disability-related health care stereotype threat emerged as predictors of health care access and health outcomes respectively. Similarly, acceptability of health services, accessibility of health services, and affordability of health services were specific external barrier categories that appeared to influence health care access and outcomes among older SMW with disabilities. Neither resilience nor social support moderated the relationship of external access barriers to physical or mental health outcomes. However, resilience had a significant independent relationship with physical health outcomes, and both resilience and social support had significant independent relationships with mental health outcomes. These findings illustrate the structural factors related to health care access and outcomes for older SMW with disabilities, as posited by health equity frameworks (Braveman, 2014). The most influential internal barriers related to health care stereotype threat, which may develop in response to minority stressors specific to health care settings. The findings of this study support lifespan perspectives on LGBTQIA+ health (Fredriksen-Goldsen, Simoni et al., 2014), as well as minority stress processes (Meyer, 2003), as frameworks for understanding LGBTQIA+ health in later life. Implications for counselors, counselor educators, community organizations, and policies are discussed.en
dc.description.abstractgeneralLGBTQIA+ older adults are at increased risk of negative health outcomes, but helping professions have limited resources for understanding their health care needs at present. Because nearly half of older sexual minority women (SMW) have disabilities, this study examined health care access and outcomes among older SMW with disabilities. This is relevant to counseling given the field's focus on social justice, advocacy, and equity, as well as the interconnected nature of physical and mental health. Across different ways of measuring health care access, external barriers related to health care systems and societal injustice were related to whether older SMW with disabilities could access health care. Health care stereotype threat, or internalized stigma related to experiences in health care, predicted health care access and health among disabled older SMW as well. These findings suggest that poor health care utilization and poorer health outcomes among older SMW with disabilities are the result of structural oppression rather than individual choices, which requires systemic interventions to correct. More research is needed to determine how counselors and other helping professionals can enhance strengths to support health among older SMW with disabilities.en
dc.description.degreeDoctor of Philosophyen
dc.format.mediumETDen
dc.identifier.othervt_gsexam:36745en
dc.identifier.urihttp://hdl.handle.net/10919/114946en
dc.language.isoenen
dc.publisherVirginia Techen
dc.rightsIn Copyrighten
dc.rights.urihttp://rightsstatements.org/vocab/InC/1.0/en
dc.subjectsexual minorityen
dc.subjectsexual minority womenen
dc.subjecthealth equityen
dc.subjecthealth care accessen
dc.subjectsexual orientationen
dc.subjectdisabilityen
dc.subjectagingen
dc.titleAccess to Health Care at the Margins: Implications for Older Sexual Minority Women with Disabilitiesen
dc.typeDissertationen
thesis.degree.disciplineCounselor Educationen
thesis.degree.grantorVirginia Polytechnic Institute and State Universityen
thesis.degree.leveldoctoralen
thesis.degree.nameDoctor of Philosophyen

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