Prior research describes significantly worse health outcomes experienced by lesbian, gay, bisexual, and transgender (LGBT) people relative to their heterosexual and cisgender counterparts. A prevalent research focus on urban LGBT populations has created a gap in understanding rural LGBT health care and outcomes from a holistic perspective. The present article provides a literature review focusing on the health and health care experiences of LGBT people living in rural areas and highlighting challenges and opportunities for growth in providing culturally competent rural health care. We conducted a systematic review that resulted in the inclusion of 58 articles focused on the health of rural LGBTQ people published between 1998 and February 2016. Findings clustered around 3 themes: (1) individual health outcomes and risk behaviors, (2) experiences of health care and interactions with the health care system, and (3) sociocultural factors at the intersection of rurality and health. Evidence-based recommendations for systemic change and interventions to promote health among rural LGBT people are provided.

Religion and spirituality are positive resources in the lives of many individuals (Pargament, Mahoney, Shafranske, Exline, & Jones, 2013). Although much of the existing research on the intersection of religious/spiritual and lesbian, gay, bisexual, transgender, and/or queer (LGBTQ) identities has focused on conflicts in these identities (Fontenot, 2013), a growing number of studies suggests that religious/spiritual LGBTQ people experience positive aspects similar to those emphasized in the general literature. We sought to extend previous findings by asking LGBTQ participants (N ϭ 314) to describe the positive aspects of identifying as both religious/spiritual and LGBTQ. Qualitative analysis revealed that the positive aspects were characterized by 5 themes: (a) Love and Acceptance for one's LGBTQ identity; (b) Deeper Meaning and Purpose due to having an LGBTQ perspective; (c) Empathy, Openness, and Compassionate Action rooted in LGBTQ identity and a passion to actively live religious/ spiritual values; (d) Positive Relationships with families, partners, and communities based in a shared religious/spiritual identity and authentic expression of LGBTQ identity; and (e) Spiritual Strength for coming out and coping with sexual or gender identity stigma and prejudice. Participants' responses suggest that religious/spiritual and LGBTQ identities interact in ways that synergistically enhance each other and may provide an important source of strength and support that can be mobilized in clinical practice.

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