Addressing Health Disparities Among Rural Lesbians: Implications for Faculty Practice and Nursing Education

Lesbians have historically lived in obscurity, especially in rural areas of the United States where homophobia is greater than in urban areas. This profoundly affects many lesbians, but perhaps none more than those at midlife and older who grew up in a rural area in the mid-twentieth century. A sample of 16 rural lesbians, ages 45-62, was qualitatively examined. Four clusters of data emerged around “feeling different” and rejected by parents, health care providers, and educators. Data analysis revealed how delays in participants’ sexual identity and emotional developments occurred because of the homophobic environments of their childhoods. Those experiences cause these women to approach health care with caution and reluctance. This caution may further increase the health disparities experienced by lesbians and acknowledged in Healthy People 2020.

Findings from the research have been utilized to improve understanding and communication with sexual minority women who seek health care at faculty practice sites. Findings also were introduced into the classrooms of MSN and DNP students at two Deep Southern universities in an effort to increase sensitivity and awareness to the plight of lesbians who seek health care in an often homophobic environment. This information provides an entre’ to introduce students to the practice principles recommended by the Gay and Lesbian Medical Association.

Faculty practitioners should carefully examine personal attitudes and biases before entering into therapeutic contracts with lesbian patients and must model acceptance for gay and lesbian individuals. Faculty can assume advocacy roles by supporting campus networks like SPECRUM, and by becoming involved in off-campus sexual minority issues. Development of continuing education about lesbian health issues is needed.

The women in the study indicated that health data entry systems lag behind in acknowledgment of alternative sexual and gender identities. Practicing faculty members can assume leadership roles in developing intake forms and EHR templates that offer both sexual orientation and gender identity alternatives. Research implications included the need for investigation into the issues of lesbians of color, the integration of lesbian issues with traditional theories used by nurses, and the impact of health policy on the lives of lesbians.