“The Idea of Categorizing Makes Me Feel Uncomfortable”: University Student Perspectives on Sexual Orientation and Gender Identity Labeling in the Healthcare Setting
As healthcare settings are increasingly adding sexual orientation and gender identity (SO/GI) to routinely collected patient demographic information, it is important to understand how patients conceptualize and label these identities. This study explored university students’ perspectives on and experiences with choosing SO/GI labels in the healthcare setting. We employed a mixed-method approach, collecting survey data on self-identified SO/GI labels across various contexts and conducting focus groups centered around experiences of SO/GI data collection and labeling in healthcare. Thirty-four graduate and undergraduate university students completed the survey and participated in six one-time focus groups. While many participants indicated that their self-identified SO/GI labels were consistent across contexts/relationships, 47% indicated that they used different labels to describe their SO or GI depending on the context. The focus group discussions revealed ways in which participants struggled to label their SO/GI on forms: They reported that (1) their authentic SO/GI labels were not among the commonly listed labels or (2) they felt that labeling their SO/GI identities was problematic. Participants reported that choosing a label that did not fit their lived experience was not only inaccurate, but could also feel painful and alienating. These findings hold implications for the collection and interpretation of patient SO/GI information, both for epidemiological purposes and for patient-centered care.
KeywordsSexual orientation Gender identity Fluidity Labeling Categorization
The authors did not receive any external funding to support this research. The authors acknowledge the contributions of Nicky Knepp and Lauren Nadler to data collection and analysis.
- Bourdon, J. L., Saunders, T. R., & Hancock, L. C. (2018). Acknowledgement and support matter: A brief report on gender identity and sexual orientation at a large, urban university. Journal of American College Health, 66, 809–812. https://doi.org/10.1080/07448481.2018.1432627.CrossRefPubMedGoogle Scholar
- Bry, L. J., Mustanski, B., Garofalo, R., & Burns, M. N. (2017). Management of a concealable stigmatized identity: A qualitative study of concealment, disclosure, and role flexing among young, resilient sexual and gender minority individuals. Journal of Homosexuality, 64, 745–769. https://doi.org/10.1080/00918369.2016.1236574.CrossRefPubMedGoogle Scholar
- Butler, J. (1990). Gender trouble: Feminism and the subversion of identity. New York, NY: Routledge.Google Scholar
- Cahill, S., Singal, R., Grasso, C., King, D., Mayer, K., Baker, K., & Makadon, H. (2014). Do ask, do tell: High levels of acceptability by patients of routine collection of sexual orientation and gender identity data in four diverse american community health centers. PLoS ONE, 9, e107104. https://doi.org/10.1371/journal.pone.0107104.CrossRefPubMedPubMedCentralGoogle Scholar
- Centers for Medicare and Medicaid Services. (2015). 42 CFR Parts 412 and 495 [CMS-3310-FC and CMS-3311-FC], RINs 0938-AS26 and 0938-AS58. Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 3 and Modifications to Meaningful Use in 2015 through 2017. https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-25595.pdf. Accessed 22 Jan 2019.
- Corwin, A. I. (2009). Language and gender variance: Constructing gender beyond the male/female binary. Electronic Journal of Human Sexuality, 12. http://www.ejhs.org/Volume12/Gender.htm. Accessed 22 Jan 2019.
- Davis, H. F. (2018). Beyond trans: Does gender matter? New York: New York University Press.Google Scholar
- Deutsch, M. B., Green, J., Keatley, J., Mayer, G., Hastings, J., & Hall, A. M. (2013). Electronic medical records and the transgender patient: Recommendations from the World Professional Association for Transgender Health EMR Working Group. Journal of American Medical Informatics Association, 20, 700–703. https://doi.org/10.1136/amiajnl-2012-001472.CrossRefGoogle Scholar
- Dichter, M. E., Ogden, S. N., & Scheffey, K. L. (2018). Provider perspectives on the application of patient sexual orientation and gender identity in clinical care: A qualitative study. Journal of General Internal Medicine, 33, 1359–1365. https://doi.org/10.1007/s11606-018-4489-4.CrossRefPubMedGoogle Scholar
- GLAAD. (2017). Accelerating Acceptance 2017: A Harris Poll survey of Americans’ acceptance of LGBTQ people. https://www.glaad.org/files/aa/2017_GLAAD_Accelerating_Acceptance.pdf. Accessed 22 Jan 2019.
- Greaves, L. M., Barlow, F. K., Lee, C. H. J., Matika, C. M., Wang, W., Lindsay, C. J., … Sibley, C. G. (2017). The diversity and prevalence of sexual orientation self-labels in a New Zealand national sample. Archives of Sexual Behavior, 46, 1325–1336. https://doi.org/10.1007/s10508-016-0857-5.CrossRefPubMedGoogle Scholar
- Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. http://www.nationalacademies.org/hmd/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx. Accessed 22 Jan 2019.
- Katz-Wise, S. L., Reisner, S. L., Hughto, J. W., & Keo-Meier, C. L. (2016). Differences in sexual orientation diversity and sexual fluidity in attractions among gender minority adults in Massachusetts. Journal of Sex Research, 53, 74–84. https://doi.org/10.1080/00224499.2014.1003028.CrossRefPubMedGoogle Scholar
- Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Philadelphia, PA: W. B. Saunders.Google Scholar
- National LGBT Health Education Center, & National Association of Community Health Centers. (2014). Taking routine histories of sexual health: A system-wide approach for health centers, 2015. https://www.lgbthealtheducation.org/wp-content/uploads/COM827_SexualHistoryToolkit_August2014_v7.pdf. Accessed 22 Jan 2019.
- Nestle, J., Howell, C., & Wilchins, R. (2002). Genderqueer: Voices from beyond the sexual binary. Los Angeles, CA: Alyson Books.Google Scholar
- Office of the National Coordinator for Health Information Technology. (2015). 45 CFR Part 170, RIN 0991-AB93. 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Based Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications. https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-25597.pdf. Accessed 22 Jan 2019.
- Ott, M. Q., Corliss, H. L., Wypij, D., Rosario, M., & Austin, S. B. (2011). Stability and change in self-reported sexual orientation identity in young people: Application of mobility metrics. Archives of Sexual Behavior, 40, 519–532. https://doi.org/10.1007/s10508-010-9691-3.CrossRefPubMedGoogle Scholar