The interaction of sexual orientation and provider-patient communication on sexual and reproductive health in a sample of U.S. women of diverse sexual orientations.
Ariella R Tabaac, Megan E Sutter, Sebastien Haneuse and 4 others
PMID 34023174WHAT IT FOUND
Provider encouragement of STI testing or sexual and reproductive health discussion was associated with more reported contraceptive use and less reported non-use, but also with more reported lifetime STI diagnosis.
Sexual minority women without such communication were 1.7 times as likely to report no method.
Key findings
01Provider encouragement of STI testing or discussion of sexual and reproductive health was associated with higher likelihood of past-year contraceptive use and lifetime STI diagnosis (RR 1.11 to 1.63), and with roughly 20% lower likelihood of not using a method.
02Completely heterosexual women with same-sex partners, mostly heterosexual women, and bisexual women were more likely than completely heterosexual women without same-sex partners to report provider STI testing encouragement; lesbian women did not significantly differ for that outcome but were less likely to report provider SRH discussion.
03Among sexual minority women, not reporting provider STI testing encouragement was associated with being 1.7 times as likely to report no contraceptive method in the past year, but this interaction was not significant in a sensitivity analysis using a mutually exclusive no-method variable.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was primarily White (94.8%) and came from nurses and children of nurses, so it may not represent all U.S. women, especially minoritized racial/ethnic groups. Temporal order cannot be established because provider communication and SRH outcomes were lifetime or retrospective self-report items. Provider communication was limited to ever encouraging STI testing or ever discussing SRH, not communication quality, trust, or discrimination. Sexual minority subgroups had to be combined for interaction analyses because small sizes produced unstable estimates. The no-method category was not mutually exclusive with other contraceptive methods, and a sensitivity analysis changed one interaction result. STI diagnosis was self-reported and not validated by medical records, so recall bias may underestimate diagnoses.
Declared interests
The authors declared no competing financial interests or personal relationships. The publication types list NIH extramural support.
The easy way to misread this
Do not read the higher reported lifetime STI diagnosis among women who received provider STI testing encouragement as evidence that communication causes STIs. The study is observational, temporal precedence cannot be determined, and the outcome may reflect more screening rather than more infection.