PhD in Nursing Science Program

Predictors of Disclosure of Sexual Identity to Health Care Providers

Dissertation under the direction of Professors Janet S. Carpenter and Nancy Wells 

Disclosure of sexual identity to healthcare providers is key for clinicians and researchers gaining access to and addressing the needs of lesbians and gay men. Because of limited information available about disclosure among lesbian and gay populations and the need to identify facilitators and barriers to disclosure of sexual identity to healthcare professionals, a questionnaire has been developed that identifies perceived facilitators and barriers. Following a pilot study in which qualitative and quantitative techniques were used to develop the Disclosure Questionnaire (DQ), this study focused on refinement of the questionnaire, establishing its psychometric properties, and identifying predictors to disclosure of sexual identity within the healthcare setting.

Results of "think aloud" interviews with 13 lesbians and gay men were used to refine the 30-item DQ that was then used to measure facilitators and barriers to disclosure of sexual identity to healthcare providers. A total of 353 lesbians and gay men responded to a survey that included the Disclosure Questionnaire (DQ), a demographic sheet, and Form A of the Multidimensional Health Locus of Control (MHLC) Scales. Cronbach’s alpha for the DQ in this population was .95 and the MHLC Scales ranged from .61 to .73. Logistic regression analysis indicated that the DQ and certain demographic variables predicted disclosure of sexual identity to healthcare providers correctly 72.5% of the time (p = <.001). In a linear regression model, 31% of the variance in disclosure was explained by the DQ and certain demographic variables (p = <.001)

Although results of this study may not directly affect practice, the results can be used to begin the process of creating a safe healthcare environment so that disclosure can take place. The identification of specific facilitators to disclosure will help to shape future intervention research as well as clinical practice. Likewise, the identification of barriers may prevent healthcare providers from inadvertently alienating lesbian and gay clients.