Date of Degree

6-2022

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Sarit A. Golub

Committee Members

Danielle Berke

Cheryl Carmichael

Brittany Charlton

Subject Categories

Health Psychology | Social Psychology | Women's Health

Keywords

LGBTQ health, social identity threat, sexual and reproductive health, OB/GYN care, gender essentialism, pronatalism

Abstract

Lesbian, gay, bisexual, pansexual and queer (LGBPQ) cisgender women (CW) experience a number of health inequities compared to heterosexual cisgender women related to sexual and reproductive health. Heterosexist health care cultures may signal social identity threat for LGBPQ-CW that may undermine their health care engagement and outcomes. In three online studies, I examined the effects of two heterosexist cultures (i.e., gender essentialism and pronatalism) as well as two potentially identity-safe alternatives (i.e., gender diversity and reproductive/sexual autonomy) on the identity threat and health care engagement experiences of LGBPQ-CW in OB/GYN care.

In Study 1 (n = 213), I used a within-subjects experimental design to pilot test fictional health clinic materials in the form of digital intake forms and posters. In Studies 2 and 3, I used a between-subjects experimental design to examine how health clinic materials representing the different constructs of interest affected health care engagement intentions at a hypothetical clinic through the mediators of anxiety, trust, and belonging. In Study 2 (n = 265), gender cue condition (gender essentialism vs gender diversity) predicted trust and belonging, which in turn predicted health care engagement intentions. This indirect effect was moderated by identity centrality, such that gender essentialism cues produced more identity threat for those higher in with sexual identity centrality. In Study 3 (n = 264), reproduction cue condition (pronatalism vs reproductive/sexual autonomy) predicted trust and belonging, which in turn predicted health care engagement intentions. This indirect effect was moderated by parenthood attitudes, such that pronatalism cues produced more identity threat for those with more negative attitudes towards parenthood. Exploratory sociodemographic patterns are discussed.

The present work enhances our understanding of how heterosexist ideologies perceptible in OB/GYN care environments, namely gender essentialism and pronatalism, undermine LGBPQ-CW health care engagement in sexual and reproductive health care. Gender diversity and reproductive/sexual autonomy may be useful frameworks for creating identity-safe alternatives to heterosexist cultures to promote LGBPQ-CW well-being in health care settings.

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