Dissertations & Theses (Open Access)

Date of Award

Spring 5-2020

Degree Name

Doctor of Public Health (DrPH)

Advisor(s)

Vanessa R Schick, Phd

Second Advisor

Gretchen L Gemeinhardt, Phd, Mba, Fache

Third Advisor

J Michael Wilkerson, Phd, Mph

Abstract

Shared historical and social contexts influence a generational group’s needs, risk factors, and resiliency mechanisms. Sexual and gender minority (SGM) older adults have experienced structural exclusion and systematic discrimination throughout their lifetime. The minority stress model posits that SGM individuals experience stressors, like discrimination, unique to their social status which affect physical and mental health. SGM older adults experience worse physical and mental health outcomes than their heterosexual peers suggesting unique needs for SGM older adults. Research also points to resiliency mechanisms that offset the impact of stressors on SGM older adults. The examination of these needs and resiliency mechanisms help to better understand how to improve quality of life and health outcomes among SGM older adults.

To identify needs and resiliency mechanisms, a concurrent mixed method study was conducted with SGM older adults (50 years and older). First, a secondary data analysis of a statewide cross-sectional online survey examined the community needs of SGM older adults in Texas. A total of 104 SGM older adults completed the survey (7.63% of survey participants). Comparisons across gender and sexual identity were conducted using chi square and Fisher’s exact tests to probe for significant findings. Three categories of needs were identified: culturally sensitive healthcare, mental health and suicide, and social determinants of health. Second, primary data collection through focus groups and semi-structured interviews further explored community needs. Three one-hour focus groups were conducted with SGM older adults. Emerging needs for SGM women included the role of social support, pets, and religion/spirituality in health. Thirty- seven semi-structured interviews were then conducted to better understand these needs as well as the emerging resiliency mechanisms of SGM women and gender non-binary adults. Two resiliency mechanisms were identified from the interviews, social networks and religiosity or spirituality. Common themes were identified surrounding experiences influencing support networks types and their influence on health. Another important source of resiliency was an individual’s religiosity or spirituality. There were differences among those who reported conflict between their SGM and religious identity during their lifetime. These findings suggest implications for interventions tailored to specific SGM older adult populations to increase healthcare and social support resources especially for those experiencing isolation and/or conflict between SGM or religious identity.

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