Rural primary care providers’ attitudes towards sexual and gender minorities in a midwestern state in the USA

Introduction: Lesbian, gay, bisexual, and transgender (LGBT) individuals experience poorer health outcomes compared to their heterosexual and cisgender counterparts. Rural residents might be particularly vulnerable due to their geographic isolation and residence in a setting that potentially holds more conservative norms. Data on the attitudes of rural providers in the United States towards this community are currently limited. The purpose of this study was to describe existing attitudes of primary care providers in rural Michigan towards each LGBT subpopulation, and to identify independent correlates of these attitudes.

Methods: From May-July, 2017, a modified Dillman mail-out method was used to collect data from 113 rural primary care providers. The non-incentivized paper-based survey included five validated Attitudes Toward LGBT People Scales to assess feelings, thoughts and predicted behaviors towards gay men, lesbian women, bisexual men, bisexual women, and transgender persons. Kruskal-Wallis tests were performed to assess global differences in the attitude scores for each subpopulation across strata of demographic characteristics and past clinical experiences. Multivariable linear regression models were formulated to identify independent correlates of attitudes towards each subpopulation.

Results: Ages ranged from 25-73 years (mean=49), and the majority were non-Hispanic white (92.92%), and female (71.68%). More than three-fourths indicated being religious to varying extents (80.53%). Approximately half (54.87%) received education specific to LGBT health during their professional degree program, and most (88.50%) believed it should be required. Generally favorable attitudes were noted towards each LGBT subpopulation. Increasing levels of religiosity were associated with less favorable attitudes, whereas having received education specific to LGBT health, and believing it should be required were associated with more favorable attitudes.

Conclusions: Improving attitudes of rural providers towards LGBT individuals may positively influence the provision of high-quality healthcare. Ensuring the delivery of culturally competent services will require multi-level systemic changes. Ongoing trainings and novel interventions to enhance provider education and cultural competence could prove beneficial.