Maybe they had a bad day: how LGBTQ and BIPOC patients react to bias in healthcare and struggle to speak out

Abstract

Objective People who experience marginalization, including Black, Indigenous, People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender, Queer, Plus (ie, all other marginalized genders and sexual orientations) people (LGBTQ+) experience discrimination during healthcare interactions, which negatively impacts patient–provider communication and care. Yet, scarce research examines the lived experience of unfair treatment among patients from marginalized groups to guide patient-centered tools that improve healthcare equity. Materials and Methods We interviewed 25 BIPOC and/or LGBTQ+ people about their experiences of unfair treatment and discrimination when visiting healthcare providers. Through thematic analysis, we describe participants’ immediate reactions and longer-term consequences of those experiences. Results We identified 4 ways that participants reacted to discrimination in the moment: Fighting, Fleeing, Excusing, and Working Around Bias. Long-term consequences reflect 6 ways they coped: Delaying or Avoiding Care, Changing Healthcare Providers, Self-prescribing, Covering Behaviors, Experiencing Health Complications, and Mistrusting Healthcare Institutions. Discussion By describing how patients react to experiences of unfair treatment and discrimination, our findings enhance the understanding of health disparities as patients cope and struggle to speak out. To combat these problems, we identify 3 future directions for informatics interventions that improve provider behavior, support patient advocacy, and address power dynamics in healthcare. Conclusions BIPOC and LGBTQ+ patients’ perspectives on navigating unfair treatment and discrimination in healthcare offers critical insight into their experiences and long-term consequences of those experiences. Understanding the circumstances and consequences of unfair treatment, discrimination, and the impact of bias through this patient-centered lens is crucial to inform informatics technologies that promote health equity.

Associations between the Self-Reported Likelihood of Receiving the COVID-19 Vaccine, Likelihood of Contracting COVID-19, Discrimination, and Anxiety/Depression by Sexual Orientation

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Differences in Cardiovascular Health at the Intersection of Race, Ethnicity, and Sexual Identity

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Hepatitis C Knowledge, Attitudes, and Perceptions Among People With HIV in South Texas

“…Although no significant difference in knowledge score between both groups was found (Table 2), four factors were significantly predictive of greater HCV knowledge; (a) self-identification as LGBTQ was associated with a knowledge score increase of 9.2 points compared with self-identification as heterosexual, (b) a level of educational attainment beyond high school was associated with a knowledge score increase of 8.3 compared with high school or less educational levels, (c) ever being offered HCV treatment was associated with a knowledge score increase of 10.5 points compared with never being offered, and (d) receiving SUD services was associated with a knowledge score increase of 13.7 points compared with not receiving SUD services. LGBTQ individuals and those receiving SUD treatment belong to marginalized population groups subject to stigma and discrimination and may consequently be more proactive about self-advocacy inclusive of equipping themselves with health care knowledge (Apodaca et al, 2022).…”