Healthcare Provider and Community Adult Knowledge and Beliefs about Adolescent Sexual and Reproductive Health
Sexual and gender minority (SGM) youth face discrimination and health/healthcare disparities in American society (Mustanski, Birkett, Greene, Hatzenbuehler, & Newcomb, 2014a). Researchers have demonstrated connections between discriminatory beliefs (e.g., homophobia), beliefs about environmental etiology of SGM, and SGM moral condemnation among United States adults (Wood & Bartkowski, 2004). Previous research has not established whether pediatric healthcare providers share attitudes and beliefs with other U.S. adults. To address SGM youth’s healthcare disparities, one important step is to understand pediatric healthcare providers’ SGM-specific attitudes and beliefs, what factors influence providers’ beliefs, and how providers’ beliefs differ from the greater community. Our study surveyed a national sample of community adults (n=258) and a sample of pediatric healthcare providers (n=103). The primary aim was to validate three novel measures in both samples: a measure assessing knowledge about sexual minority health risks, a measure assessing SGM etiology beliefs, and a measure assessing moral condemnation of SGM identities. We expected etiology beliefs and moral condemnation to contain separate sexual minority (SM) and gender minority (GM) factors when subjected to exploratory and confirmatory factor analyses. This study’s secondary and tertiary aims examined associations between SM knowledge, SGM etiology beliefs, moral condemnation, and homophobia in our community adult and pediatric healthcare provider samples. We anticipated healthcare providers would demonstrate more SM health risk knowledge, more biological etiology beliefs, and less moral condemnation. Our measures demonstrated good psychometric properties. Contrary to expectations, the etiology and moral condemnation measures were unidimensional for all SGM behaviors and identities. Providers demonstrated more SM health risk knowledge than community adults, but this knowledge was not statistically explained by the quantity of participants’ self-reported SGM-specific prior training. Providers and community adults demonstrated similar etiology beliefs, which were associated with moral condemnation and self-reported religiosity. Moral condemnation was lower in the provider sample, and was associated with spirituality, religiosity, previous interaction with SM individuals, and the presence of a SGM friend or family member. This study lays groundwork for future research designed to better understand pediatric healthcare providers’ SGM-specific knowledge and beliefs and to, ultimately, improve healthcare provision for at-risk SGM youth.