Improving health through community engagement

Joshua G. Rosenberger, assistant professor of biobehavioral health at Penn State, studies the behavior of gay men in rural areas to better understand how to support these men to improve their health and well-being.

“Living in a rural area exacerbates the problems that gay men face,” Rosenberger explained. “This is primarily due to a lack of resources. Gay men living in rural areas are unlikely to have access to gay cultural organizations or to appropriate health and medical services.”

Many of the health disparities faced by all LGBTQ+ individuals are rooted in stigma and poor self-esteem, according to Rosenberger. When society stigmatizes a group of people or their behavior, their senses of self-worth and self-efficacy are damaged. This erosion of self-worth results in people being unable to achieve or ask for things they need.

Lack of Community

“Gay urban dwellers are much more likely to have access to ‘gay spaces’ like bars, bookstores, clubs, community groups, potlucks, and drop-in centers,” Rosenberger said. “These places and groups help people find a sense of community and belonging. This sense of community and belonging, in turn, helps protect against the health disparities faced by LGBTQ+ individuals.”

People learn about behavior and standards by participating in their community. Children learn to play and work together in the sandbox at the local park. Middle school students develop their fashion sense by reacting to how their peers dress. People learn relationship norms through talking and dating. For rural gay men, however, the lack of community spaces can lead to reduced opportunities to develop a healthy sense of themselves in the gay community and their belief in themselves.

Self-efficacy is a strong predictor of whether individuals feel confident in their ability to care for themselves in a healthy manner. Stigma erodes self-efficacy, and a sense of community and belonging can promote it.

Lack of appropriate health care

The lack of cultural resources extends to sexual health care. Research indicates that a gay man’s health can be compromised if he does not feel he can come out to his doctor. Because family history predicts risk for certain conditions, doctors routinely ask patients about their family histories. Similarly, one’s sexual behavior predicts risk for certain health problems. Doctors should be informed about their patients’ sexual behavior and health regardless of the patients’ sexual orientation, but this is uncommon among rural gay men.

Research shows that gay men are more likely to discuss sexual health with a doctor who they believe is also gay. Access to openly gay doctors, however, is rare in rural areas. Only a handful of America’s largest cities have health care practices specifically designed to serve LGBTQ+ individuals. Throughout medium-sized cities, towns, and rural areas, however, it can be difficult or impossible to identify gay doctors. This means that gay men are not having the conversations they need about their sexual health which can lead to men taking risks they do not understand or to health problems that remain undiagnosed.

How to reach rural gay men

Rosenberger has previously partnered with tech companies to help them design products that are informed by research. Examples of this work include integration of health videos into social networking platforms that are aligned with the “look and feel” of other digital materials delivered to the userbase. By delivering content, information, and interventions within the context of websites that people already visit and apps that people use, public health resources can reach many more individuals.

For Rosenberger, this is the key to reaching rural gay men and other hidden or isolated populations. The specifics of how to do this vary from website to website or app to app, but in each case, the company or organization providing a product or service needs to take time to understand the community it serves and the public health and social issues that community is facing.

“I conduct research directly with individuals, groups, or populations that have not received much academic study,” Rosenberger said. “I want to really understand the communities. When we understand people’s behaviors and concerns, we can provide them with meaningful information or tools. This is true for gay men who live in rural areas. This is true for minoritized women who live in cities. This is true for everyone who is marginalized.

“By building people’s sense of community and belonging,” Rosenberger continued, “we can help people connect and become their own advocates. When people feel supported and advocate for themselves, they become better able to engage in healthy behaviors. This is a great time to conduct this research. The emergence of telehealth and new technologies can support gay men’s health if health providers and companies take the time to understand the people we are serving.”