Mediation Models of Perceived Medical Heterosexism, Provider-Patient Relationship Quality, and Cervical Cancer Screening in a Community Sample of Sexual Minority Women and Gender Nonbinary Adults

Abstract

Purpose: Sexual minority women (SMW) are vulnerable to cervical cancer, yet there is a dearth of research on potential mediators of cervical cancer disparities. Medical heterosexism, which involves sexual orientation-based discrimination in medical contexts, and provider-patient communication quality and trust in providers may be important factors influencing the cancer prevention decisions of SMW. The purpose of this study was to examine how provider-patient communication quality, trust in providers, and perceived medical heterosexism are associated with cervical cancer screening among SMW.

Methods: A dual-mode, one-time cross-sectional survey was administered to a community sample of SMW (N = 150), ages 21-53, in Richmond, Virginia, from December 2017 to February 2018.

Results: It was hypothesized that provider-patient communication quality and trust in providers would mediate the relationship between perceived medical heterosexism and cervical cancer screening outcomes. The hypothesis was supported; trust in providers (b = 0.05, p = 0.001, 95% confidence interval [CI] 0.02-0.08) and provider-patient communication quality (b = 0.06, p = 0.003, 95% CI 0.02-0.10) were positively associated with future screening intention, and their total indirect effect mediated the relationship between perceived medical heterosexism and intention (b = -0.03, 95% CI -0.05 to -0.02, β = -0.25, 95% CI -0.39 to -0.15). Similarly, the total indirect effect of provider-patient communication quality mediated the relationship between perceived medical heterosexism and odds of routine screening (b = -0.03, 95% CI -0.06 to -0.01).

Conclusion: These findings point to the need for cancer prevention and control strategies for SMW to target provider education and policy interventions that improve SMW's relationships with their providers and improve cervical cancer screening rates.

Keywords: Papanicolaou test; health communication; reproductive health services; sexual and gender minorities; social discrimination.