Identifying Latent Patterns and Predictors of Health Behaviors and Healthcare Barriers among LGBT Older Adults

Abstract Background Health behaviors are multi‐dimensional and associated with various barriers to healthcare. With no previous research having investigated patterns of health behaviors in conjunction with healthcare barriers among lesbian, gay, bisexual, and transgender (LGBT) older adults, we aim to identify latent classes of the behavior and barrier patterns, to examine differences in physical and psychological health‐related quality of life (HRQOL) by the specified latent classes, and to explore predictors of the class membership. Method Three‐step latent class analysis with survey weights was conducted using baseline data of the Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS, N = 2,450). Health behavior and healthcare barrier indicators were analyzed in four dimensions: risk‐taking behavior, health‐promoting behavior, preventive care, and healthcare barriers. Result The best empirical and substantive fit was determined with four classes consisting of (1) healthy behaviors and minimal barriers (C1, 39%), (2) unhealthy behaviors and high barriers (C2, 31%), (3) healthy behaviors and healthcare system barriers (C3, 19%), (4) Very healthy self‐care behaviors, low preventive care use, and moderate barriers (C4, 11%). Compared to C1, C3 had lower physical HRQOL and C2 had lower physical and psychological HRQOL. C4 did not differ in HRQOL from C1. Modifiable predictors of C2 include more day‐to‐day discrimination and lower mastery and social support. Conclusion Efforts to lower healthcare barriers are warranted in addition to interventions to strengthen social support and to reduce marginalization. Positive relationships between LGBT older adults and healthcare need to be established via trust‐building and cultural competency.