Purpose: Using Andersen's Behavioral Model of Health Services Utilization, we examined the associations between negative experience in a health care setting and subsequent reductions in health care utilization among African American sexual minority women (SMW).
Methods: The data were collected as part of a larger study exploring health and health care experiences of a volunteer sample of African American SMW (n=226). We examined predisposing, enabling, and need factors as predictors of a negative experience and changes in health care utilization.
Results: More than one-third of the sample reported a negative health care experience in the past 5-years. One fourth of those reporting a negative experience attributed it to discrimination including race/ethnicity (70.4%), gender (58.2%), and sexual orientation (46.2%). (The categories were not mutually exclusive). Reduction in health care utilization (i.e., didn't see a doctor next time when they were ill) following the negative experience was common (34%). Predisposing (younger age), enabling (lack of insurance, part-time employment, and no regular provider), and need factors (living with a chronic illness) predicted experiencing a negative event. In multivariate analysis, health care factors (quality of health care, negative experience due to discrimination) and patient factors (passive coping response) were factors associated with reduced health care utilization.
Conclusion: Problems in the patient-provider relationship were a significant factor in decreasing healthcare use among SMW. Anderson's model helped to inform our understanding of who might be at risk of experiencing a negative experience but not subsequent changes in health care utilization. Modifiable variables related to the health care environment and patient coping responses predicted changes in health care use.
Keywords: African American; health care utilization; lesbian and bisexual women (LB); patient-provider interactions.