Breast Health Behavior Among Lesbians: The Role of Health Beliefs, Heterosexism, and Homophobia

ABSTRACT

The Health Belief Model was used as a conceptual framework for exploring how health beliefs and perceptions of heterosexism and homophobia in health care relate to lesbians' breast health behaviors, including use of breast exams and mammograms, visits to health care providers, and use of complementary/alternative care. A total of 173 exclusively homosexual women completed survey measures assessing health beliefs, experiences of heterosexism/homophobia, and health maintenance behaviors as these related to breast health. Findings indicated that women perceived heterosexism and homophobia from providers to influence the amount of discussion they had with providers and, to a lesser extent, care received, frequency of service use, and health outcomes. Perceptions of heterosexism and homophobia in health care settings significantly contributed, beyond routine health beliefs, to women's use of breast self-exams, visitation to health care providers, and use of complementary/alternative care. Implications for culturally competent care are discussed.

KEYWORDS:

• Breast cancer
• breast self-exams
• breast health
• Health Belief Model
• heterosexism
• homophobia
• lesbians
• sexual orientation

Notes

¹Sixteen women who did not provide their age were included in overall analyses but not in age-stratified analyses.

1. Although recent research and media coverage have questioned efficacy of breast self-exam in reducing cancer mortality (Kosters & Gotzsche, 2008), the issue remains controversial, and evidence suggests that self-exam increases detection of cancers (e.g., Goldstein, 2008; Lam, Chan, Chan, Mak, Chan, Chong, Leung, & Tang, 2008).

2. Although surveys addressed a range of health behaviors, analyses for the present paper included only those measures pertinent to breast health. Unless specific citations are provided, measures were developed by the author.

3. Because our study included women sampled at nightclubs, and alcohol consumption may be associated with health outcomes, between-groups t-tests and nonparametric median tests were used to assess whether separate analyses were warranted. No differences were observed between participants sampled from nightclubs (n = 75) and other participants (n = 98) in age, education, income, baseline or frequency of mammograms, having visited a health care provider in the past year, frequency of breast exams, or frequencies of reported symptoms/diagnoses.