Older adult gay & bisexual male veterans' perception of access and cultural competence within the health care system

Previous research has consistently identified health disparities among minority groups, including members of the LGBTQ community. The role of the health care system itself in creating, sustaining, or confronting these disparities has received only modest attention. This qualitative dissertation study examines the experiences of older adult gay and bisexual cisgender male Veterans and their perception of provider cultural competence and the organizational climate of the systems in which they receive health care. An existing theoretical framework, the Origins of Health Care Disparities Model, was used in the conceptualization of this research. Case study method was used to guide the research process and subsequent data analysis. Eight participants (MdnAge = 73, Range = 65-82) from across the United States were interviewed remotely, and both within-case and crosscase themes were generated. Results showed most participants were hesitant about integrating their sexual orientation to their degrees. Participants emphasized the importance of a strong clinical relationship with providers and offered diverse opinions about the impact of previous homophobic incidents and their military background. They suggested strategies for medical providers to provide more culturally informed health care. Specifically, they expressed hope for greater representation of gay health care staff and increased training for doctors and medical trainees to work with older adult gay patients. They described a desire for decreased focus on their sexual behavior and that providers approach the clinical relationship holistically recognizing gay patients are individuals with unique identities, hobbies, and interests. Data-driven conclusions and recommendations are offered informed by the theoretical framework. Keywords: LGBTQ, Veteran, VA, gay, bisexual, cultural competence, health care, health disparity, aging, older adult, case study, clinical encounter