Date of Award

Summer 8-2023

Document Type


Degree Name

Doctor of Philosophy (PhD)




Virginia Consortium Program in Clinical Psychology

Committee Director

Kristin E. Heron

Committee Member

Richard W. Handel

Committee Member

Abby L. Braitman

Committee Member

Robin J. Lewis


Sexual minority women (SMW) experience greater mental and physical health concerns when compared to heterosexual women. Three key areas of health SMW report these disparities are: mental health, binge eating/body size, and sexual and reproductive health. SMW also report difficulties accessing healthcare in these three areas. An exploratory sequential mixed methods design was utilized to assess barriers and facilitators to healthcare access for young SMW. Study 1 included 20 semi-structured interviews with SMW, resulting in themes of barriers and facilitators identified by participants. These themes were converted into scale items. In Study 2, an expert panel of mental and physical health professionals, researchers, and SMW provided feedback on the scale. The revised scale, along with measures of healthcare barriers and health outcomes, was completed by 188 SMW via an online survey. Exploratory factor analysis (EFA) was conducted for the barriers scale items, resulting in three barriers scales: Weight Stigma, General/Environmental, and Discrimination. EFA was also conducted for the facilitator items, resulting in a single scale. The Barriers-Weight Stigma and Barriers- General/Environmental scales were both valid and reliable, and the Barriers- Discrimination and the Facilitator scales were reliable. The Barriers-Weight Stigma scale emerged as the primary barrier factor and had the strongest validity and reliability. The Barriers scales were significantly associated with a variety of health outcomes. Future research should continue to assess barriers to healthcare for SMW and how to reduce these barriers.


The VIRGINIA CONSORTIUM PROGRAM IN CLINICAL PSYCHOLOGY is a joint program of Eastern Virginia Medical School, Norfolk State University, and Old Dominion University.


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