No abstract

The purpose of this article is to review the current literature describing primary care providers' (PCPs) attitudes related to lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people. LGBTQ individuals experience significant health disparities, and these inequities may be better understood via an ecological systems framework. PCPs' actual or perceived discriminatory attitudes can lead to suboptimal treatment or health outcomes for LGBTQ people. A review of the literature from 2005 through January 2017 was completed using the Cumulative Index for Nursing and Allied Health Literature and PubMed (Medline) databases. The purpose, sample, measure(s), design, findings, strengths, and weaknesses of each study were examined; and findings were synthesized, summarized, and critically appraised. Eight articles were eligible for review. There was significant heterogeneity in the studies' purposes, research questions, LGBTQ population(s) of focus, and findings. Many PCPs' attitudes toward LGBTQ people were positive, but a minority of each studies' participants had negative attitudes toward LGBTQ people. Stigma and health care barriers negatively affect LGBTQ health. Interventions must address LGBTQ health disparities at the individual, mesosytem, exosystem, and macrosystem levels. Research, education, and practice strategies all must be integrated across socioecological levels as components of a population-based approach to eliminate health disparities for LGBTQ persons.

Synopsis This paper reports findings from a qualitative study that explored the attitudes and beliefs concerning colorectal cancer screening (CRC) among patients and health care providers in Appalachian Kentucky. We report results from five focus groups; three with primary care providers and two with patients. Providers discussed patient characteristics, financial issues and health care delivery system factors as challenges to screening. Participants reported fear, embarrassment, financial issues, lack of perceived need, qualities of the test, lack of provider recommendation, and health care delivery barriers. Although there were some areas of agreement, there are marked differences between the perceptions of Appalachian health care providers and participants regarding colorectal cancer screening. This paper compares and contrasts those perceptions and provides suggestions for culturally competent practice and culturally relevant research to improve CRC screening in this vulnerable population.

Rural Appalachian women bear a disproportionate burden from many types of cancer yet often are underrepresented in cancer research. This paper uses two case studies to illustrate barriers faced and strategies used when recruiting hard-to-reach rural participants. Recruitment barriers include the population's competing demands and lack of trust of outsiders. Strategies employed include involving insider advocates, highlighting the positive experiences of early participants, spending extensive time in the community, and emphasizing potential community benefits of the study. We suggest recruitment strategies to better involve rural women and others who, by virtue of being "hard-to reach," often are overlooked.