Queer Health in Nebraska: Patient Perspectives and Provider Education

Factors impacting underutilization of healthcare by the LGBTQ+ community include anxiety surrounding receipt of sub-standard care or refusal of care following identity disclosure, often fueled by providers who are not adequately prepared to provide care to the community. This dissertation attempted to understand the unique drivers of care avoidance or underutilization among LGBTQ+ Nebraskans, the impact of dedicated LGBTQ+ health education on medical students self-perceived knowledge, competence, and attitudes, and the current landscape of existing LGBTQ+-related health education in medical schools in the United States. Underutilization of care by the LGBTQ+ community is often driven by anxiety and fear surrounding dismissal of concerns and identity, as well as feeling that providers are insufficiently prepared to provide treatment from both a clinical and community-knowledge perspective. Following a full-day LGBTQ+ Inclusive Care Curriculum Enhancement Seminar, fourth-year medical students showed statistically significant increases in self-report basic knowledge and clinical preparedness, and there is some indication that exposure to humanities courses during undergraduate education results in the holding of lower prejudicial attitudes towards the LGBTQ+ community. Finally, the scoping review of other health education programs in medical schools across the United States helped identify education modalities that could be easily incorporated into existing curriculum at the study site. These studies help to fill a major gap in research in health research for Nebraskan LGBTQ+ residents and LGBTQ+ health education. Findings point to an existing need to better prepare future clinicians in the provision of culturally-competent care. A critical need exists for medical students to receive foundational education in medical humanities and population health, as well as exposure to marginalized communities. This can be accomplished by ensuring Standardized Patient Experiences include individuals with lived experience as opposed to volunteers acting out scenarios, as well as patient panels and community outreach. These recommendations align with findings from all three studies and highlights the importance of the interpersonal and relationship-building parts of care provision, as well as understanding how stigma and Social Drivers of Health impact health behavior and outcomes.