Asking sexual orientation and gender identity on health surveys: Findings from cognitive interviews in the United States across sexual orientations and genders.

Questions assessing sexual orientation and gender identity (SOGI) are not consistently asked on U.S.-based health surveys and, as a result, sexual and gender minority (SGM) people are often invisible, obscuring insight into their health. The purpose of this study was to explore how people across different sexual orientations and genders preferred to be asked about SOGI on U.S.-based health surveys. Using in-depth cognitive interviews with 14 non-SGM (cisgender heterosexual men and women) and 30 SGM participants (cisgender sexual minority people as well as transgender and gender diverse people of any sexual orientation), we identified four major themes relating to SOGI disclosure: (1) purpose for asking, (2) context of information collection, (3) distrust of the government, and (4) fear. While many participants were open to disclosing SOGI information on a federal health survey, non-SGM and SGM participants questioned the survey's purpose and expressed governmental distrust. However, unlike non-SGM participants, SGM participants indicated that they might change their answers depending on the survey context. SGM participants indicated they would be more willing to disclose SOGI information in a personal medical context or for a local community survey rather than a federal health survey. Further, unlike non-SGM participants, SGM participants expressed fear for their safety when disclosing SOGI information. Our study suggests that concerns regarding SOGI disclosure and what is disclosed differ between non-SGM and SGM people. Some SGM people may change their answers or not respond to SOGI questions depending on context and perceived safety. These findings have health and research implications as efforts are made to enhance understanding of SGM health and the health needs of SGM people by augmenting the use of SOGI questions.