Cultural competency and microaggressions in the provision of care to LGBT patients in rural and appalachian Tennessee

Purpose: Lack of provider training in lesbian, gay, bisexual, and transgender (LGBT) cultural competence may diminish healthcare access. Culturally competent providers may enact microaggressions when providing LGBT patient care, especially in sociopolitically conservative areas. Our study examined LGBT cultural competence and microaggressions among healthcare providers in rural Tennessee.

Methods: Providers (n = 85) completed a self-report survey on LGBT cultural competence. Post-survey, we invited respondents to provide an interview to contextualize quantitative findings and identify barriers to LGBT patient care (n = 6).

Results: Most quantitative respondents disagreed that they preferred not to care for LGBT patients (85.9%) or that they would refuse care to LGBT patients (92.9%). Only half felt competent to provide LGBT patient care (54.1%). Fewer oncology than primary care providers felt competent treating LGBT patients, and more physicians than nurses reported their training did not adequately address LGBT issues. Qualitatively, interviewees reported serving patients "equally", yet described discomfort with LGBT patients and LGBT microaggressions in clinical practice.

Principal conclusions: While many providers felt competent to provide LGBT patient care, they described behaviors and attitudes that may contribute to LGBT healthcare inequities.

Practice implications: Provider training must address how microaggressions negatively influence patient-provider interactions and LGBT patient care.