Investigating the association between experiencing discrimination in healthcare settings and avoidance of healthcare services among Pacific Rainbow+ in Aotearoa New Zealand

AIM: This study aims to investigate the relationship between experiences of discrimination (ethnic/race-based, gender and sexuality-based discrimination) in a healthcare setting, and healthcare services avoidance in Pacific Rainbow+ in Aotearoa New Zealand. METHODS: This study draws from a sample of Pacific Rainbow+ (Pacific cisgender sexuality minorities [n=239] and Pacific transgender and non-binary [n=126]) individuals taken from the Manalagi Survey. Multivariate logistic regression analyses were performed to test for a relationship between predictors based on respondent self-reported experiences, within a healthcare setting in Aotearoa New Zealand, of discrimination (race/ethnic discrimination or racism, sexuality and/or gender diversity-homophobia/transphobia and heterosexism) and outcome variables (avoiding healthcare and mental health services). RESULTS: Discrimination based on ethnicity/race was more highly reported by both cisgender sexuality minorities and the transgender and non-binary groups in our sample, with this typology of discrimination also associated with increased odds of healthcare services avoidance. Discrimination based on race/ethnicity was further associated with increased likelihood of mental health service usage. On average, cisgender sexuality-diverse respondents reported 1.15 instances of listed forms of discrimination, and this nearly doubled for transgender and non-binary respondents. Notably, when the overall number of discriminatory exposures increased by a single point, respondents had an approximate 60% odds ratio (OR) of healthcare avoidance. CONCLUSION: This study affirms findings of much research that describe discrimination (multiple forms) as a common experience for Rainbow+ individuals while seeking out healthcare services. Further, it reveals that these experiences have a predictive impact on the likelihood of Pacific Rainbow+ avoiding healthcare services. While this study's cross-sectional nature limits the ability to infer causality, these findings do underscore the importance of undertaking more intersectional research into the drivers and inhibitors of healthcare-seeking behaviours and healthcare service usage of Pacific Rainbow+ in Aotearoa New Zealand.