Associations Between Non-discrimination and Training Policies and Physicians' Attitudes and Knowledge About Sexual and Gender Minority Patients

A Comparison of Physicians From Two Hospitals

Jennifer M. Jabson; Jason W. Mitchell; S. Benjamin Doty


BMC Public Health. 2016;16(256) 

In This Article


The HEI aims to reduce discrimination and improve the healthcare milieu for the purpose of reducing health disparities experienced by gender and sexual minorities and improving quality of their healthcare. Our findings provide a first step, of many required, toward understanding possible associations between the criterion leader designation and physician attitudes and knowledge. Unfortunately, our results suggest that, at least in the case of the HEI criterion leader facility included in this study, fulfilling the four core criteria and earning the criterion leader designation may not produce the changes intended by the HEI and criterion leader designation. This is worrisome because the HEI criterion leader designation is used to promote 'safe', gender and sexual minority patient-centered healthcare environments to gender and sexual minority patients. However, if the education mandated by the fourth core criteria does not influence physicians' attitudes and knowledge, gender and sexual minority patients could be directed to healthcare environments that may not have any more knowledge or better attitudes than healthcare settings without the HEI criterion leader designation. Rigorous evaluations need to be conducted across multiple facilities to further assess the impact on healthcare facilities of fulfilling the HEI four core criteria.

Physicians are not islands and they practice in social and political contexts that shape their experiences. Consequently it is inadequate for future work to focus exclusively on physicians' attitudes and knowledge while ignoring the complex multi-level factors that influence medical practice and healthcare for SGM patients. Future work in this area should involve innovative, rigorous, multi-level assessment of patient-, provider-, system-, and policy-level factors that influence implementation of SGM affirming healthcare practice. For instance, Bronfenbrenner posits a multi-level ecological model where individual, dyadic, and community and policy contribute to physician's knowledge, attitudes, and willingness to practice culturally appropriate care to sexual minority and gender minority patients.[37] And while there is a paucity of empirical evidence that describes the synergistic, accumulative, effect of the hierarchical levels, this could be a strong theoretical approach to use for future studies in this area. Another possible strategy recommended by McNair and colleagues involves the development, widespread implementation, and subsequent evaluation of informative, evidence-based guidelines for primary care with SGM patients.[1] Establishing guidelines and accompanying policy that mandates their use could significantly improve SGM affirming healthcare and could ultimately improve outcomes and reduce disparities in health.