Author ORCID Identifier
https://orcid.org/0000-0001-9461-2881
Date Available
7-20-2027
Year of Publication
2025
Document Type
Doctoral Dissertation
Degree Name
Doctor of Philosophy (PhD)
College
Education
Department/School/Program
Educational, School, and Counseling Psychology
Faculty
Dr. Joseph Hammer
Faculty
Dr. Sharon Rostosky
Abstract
Sexual orientation minorities (SO+) experience significant health disparities making culturally responsive primary care - a central access point in the U.S. healthcare system - critical to addressing these inequities. This dual-manuscript dissertation investigates the impact of SO+ perceptions of their primary care providers' (PCPs') cultural responsiveness on their engagement with primary care. The first manuscript presents a systematic literature review of barriers and facilitators to high-quality interactions between SO+ patients and PCPs. The results highlight the critical importance of cultural responsivity (i.e., cultural competence and humility) in fostering trust and improving healthcare engagement among SO+ individuals. The second manuscript is an empirical study utilizing Structural Equation Modeling to examine how SO+ individuals' (N = 208) perceptions of their PCPs' cultural competency, cultural
humility, and discriminatory behaviors relate to overall satisfaction with care, with trust in provider hypothesized to mediate this relationship. Findings revealed that both cultural competency and positive cultural humility significantly predicted satisfaction with care, while trust in the provider exhibited substantial conceptual and statistical overlap with affirming provider behaviors. Together, these manuscript findings aim to inform policy, shape best practices, and guide training programs that promote inclusive, equitable, and effective healthcare, not only within primary care but across the broader healthcare system.
Digital Object Identifier (DOI)
https://doi.org/10.13023/etd.2025.271
Recommended Citation
Miller, Melanie E., "Exploring the Impact of Sexual Orientation Minorities' Perception of their Primary Care Providers' Cultural Responsiveness in the U.S." (2025). Theses and Dissertations--Educational, School, and Counseling Psychology. 126.
https://uknowledge.uky.edu/edp_etds/126
