Date of Award
2026
Degree Type
Dissertation
Degree Name
Doctor of Philosophy in Psychology
Department
Psychology
First Advisor
Mollie A. Ruben
Abstract
Statement of the Problem: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals face systemic health disparities that are perpetuated, in part, by the underdevelopment of evidence-based practices for sexual orientation and gender identity (SOGI) disclosure in primary care settings. Disclosure of SOGI can improve patient-provider communication, yet nondisclosure often functions as a protective strategy in environments where disclosure could lead to bias, discrimination, or harm. Professional guidelines recommend affirming verbal communication and environmental cues, but there is little experimental evidence examining whether these strategies impact SOGI disclosure, SOGI concealment, or patient experiences. Methodology: To address this gap, LGBTQ+ participants (N = 183) were randomly assigned to one of four experimental conditions in a 2 (office environment: affirming vs. standard) × 2 (verbal dialogue: affirming vs. standard) design. Participants completed a simulated telehealth primary care appointment, viewing pre-recorded provider videos paired with affirming or standard environmental cues and verbal dialogue. Participants’ self-report outcomes included satisfaction and future primary care SO & GI concealment intentions. Behavioral outcomes included nonverbal discomfort, nonverbal engagement, and verbal self-disclosure. Trained coders, blind to condition, rated nonverbal behaviors from video clips without sound, and verbal self-disclosure was coded from audio transcripts. Results: Office environment did not predict any primary outcomes. Participants exposed to affirming verbal dialogue reported greater verbal self-disclosure than those exposed to standard dialogue, and a trend toward increased nonverbal engagement was observed, though this did not survive correction for multiple comparisons. No interaction effects were observed across outcomes. Exploratory analyses suggested that participants with lower prior SO disclosure exhibited higher nonverbal engagement in affirming offices paired with affirming dialogue, whereas participants with higher prior SO disclosure showed stable engagement across conditions. Participants reporting greater everyday SO or GI concealment displayed higher primary care GI concealment in standard dialogue conditions, with attenuated effects under affirming verbal dialogue. Findings suggest that affirming verbal communication greatly affects LGBTQ+ patient engagement and self-disclosure. Verbal affirming dialogue may buffer the behavioral consequences of habitual concealment, particularly for patients with limited prior disclosure experience. Providers should prioritize affirming verbal communication to foster safe and comforting interactions, ultimately supporting improved engagement, disclosure, and health outcomes for LGBTQ+ patients.
Creative Commons License
This work is licensed under a Creative Commons Attribution-No Derivative Works 4.0 License.
Recommended Citation
Stage, Michelle A., "EXPLORING THE IMPACT OF AFFIRMING ENVIRONMENT AND PROVIDER LANGUAGE ON LGBTQ+ PATIENTS’ IDENTITY DISCLOSURE, IDENTITY CONCEALMENT, DISCOMFORT, ENGAGEMENT, AND SATISFACTION IN PRIMARY CARE" (2026). Open Access Dissertations. Paper 4553.
https://digitalcommons.uri.edu/oa_diss/4553