Transphobia Among Students Majoring in the Helping Professions

Interpersonal Transphobia Within Nursing: A Critical Concept Exploration

Transphobic perceptions negatively impact health care access and outcomes among transgender and gender-diverse people and challenge nurses' capacity to maintain ethical practice standards. The concept of transphobia has not been well defined in the literature or nursing. Using a critical realist lens, this concept exploration sought to define interpersonal transphobia through a review of purposefully selected literature. Attributes included discrimination and prejudice, while antecedents were cisnormativity, erasure, and stigma. Nurses can help reduce transphobia by seeking education and practicing gender-affirming care, including transgender people in research, and advocating for equitable policies and procedures.

Creating the Chinese version of the transgender attitudes and beliefs scale

BACKGROUND

Trans persons' physical and mental health is easily affected by the attitude of those around them. However, China currently lacks a valid psychometric instrument to investigate people's attitudes toward trans persons. Therefore, this study modifies the English version of the Transgender Attitudes and Beliefs Scale (TABS) to suit the Chinese context. It subsequently examines the reliability and validity of the Chinese version of the TABS.

METHODS

This study recruited 1164 university students, aged 18-25 years, from 7 regions of China. SPSS26.0 and AMOS24.0 were used for data statistical analysis. Critical ratio method and correlation coefficient method were used for item analysis. Exploratory factor analysis and confirmatory factor analysis were used to test the structural validity of the Chinese version of Transgender Beliefs and Attitudes Scale, and the internal consistency reliability of the scale was tested.

RESULTS

The TABS-C contains 26 items with 3 factors. The Cronbach's alpha was 0.957 for the total scale and 0.945, 0.888, and 0.885 for the 3 factors. The half-point reliability of the scale was 0.936, and the retest reliability was 0.877. The Pearson correlation coefficients for the 3 factors and the total scale score ranged from 0.768 to 0.946.

CONCLUSION

The TABS-C has reliable psychometric properties and is suitable for usage among college students in the Chinese context.

Cultural Competence and Social Work: Sexual and Gender Diversity in Two Universities in the South of Europe

This study aims to analyze cultural competence through the knowledge and attitudes regarding LGBT people held by the students of social work at two universities in southern Spain (N = 512). An ex post facto correlational study has been conducted. The Sex Education and Knowledge about Homosexuality Questionnaire, the Modern Homonegativity Scale and the Negative Attitudes toward Transgender People Scale have been applied to gather information. Data analysis was carried out using frequencies, descriptive statistics, correlations and inferential statistics. The findings show that men, religious, and politically conservative people reported higher levels of homonegative and transphobic attitudes than women, non-religious and politically more liberal people. There is also a lack of specific knowledge on the reality of and specific legislation regarding LGBT people. There is a need to continue to examine and to progress in the training of future social workers in cultural competence, incorporating the contributions of feminist theory.

Transgender Attitudes and Beliefs Scale-Spanish (TABS-S) Version: Translation and Initial Evaluation of Psychometric Properties

Although the field of transprejudice studies has been growing, the literature suggests a need for quality assessments in languages other than English. To address this need, our study translated the Transgender Attitudes and Beliefs Scale (TABS) and evaluated its psychometric properties for use with Spanish-speaking populations. We recruited participants (N = 605) from American and Spanish samples. Results of the confirmatory factor analysis showed adequate fit, confirming the three-factor structure of TABS-Spanish Version (TABS-S). Correlations with existing measures provided evidence for its convergent and discriminant validity. Known-groups validity of the TABS-S was evidenced through confirming previous findings that females show less transgender prejudice than males. Moreover, the internal consistency of the TABS-S scores was high for the total scale (α = .96) and subscales (α = .87-.96). Overall, there is preliminary evidence to suggest that the TABS-S is a valid and reliable scale appropriate for use with Spanish-speaking populations.

Nursing pre-licensure and graduate education for LGBTQ health: A systematic review

BACKGROUND

Lesbian, gay, bisexual, transgender, and queer plus (LGBTQ) people experience discrimination and health disparities compared to heterosexual cisgender people. Clinicians report discomfort and insufficient preparation for providing care to LGBTQ people and nursing has been slow to integrate LGBTQ health into curricula.

PURPOSE

Conduct a systematic review to examine and critically appraise peer-reviewed literature on nursing student knowledge, skills, and attitudes (KSAs) regarding LGBTQ health and the development/evaluation of LGBTQ health content in nursing curricula.

METHODS

A systematic review was conducted (N = 1275 articles from PubMed, LGBT Health, CINAHL, ERIC, and Health Source-Nursing/Academic Edition).

FINDINGS

Twenty articles met inclusion criteria. Twelve studies described curricular interventions; however, there were few validated tools to evaluate content coverage or KSAs. Four themes emerged specific to LGBTQ health content inclusion.

DISCUSSION

While an emerging science of LGBTQ nursing education has been identified, more work is needed to build and evaluate a comprehensive curricular approach for full programmatic integration of LGBTQ health.

CONCLUSION

As nursing programs build LGBTQ content into nursing curricula, care must be taken to integrate this content fully with the depth of curricular content in population health, social determinants of health, social justice, intersectionality, cultural competence, and political advocacy.

TWEETABLE ABSTRACT

Greater integration of LGBTQ health content into nursing education should be a priority for nursing education.

Educating "Helping" Professional Students to "Help" Trans People Navigate Their Health Care Needs: A Review of Recent Literature

In the 2015 United States Trans Survey, trans people overwhelmingly indicated that training health-care providers about trans health is an urgent policy priority within the US. This literature review examines the types of educational training interventions health professional schools have developed from 2015-2020 focused on trans health. This review revealed that the fields of medicine and interprofessional education have created the majority of interventions, which tend to increase students' knowledge, comfort, and confidence working with trans patients. Schools of counseling, social work, and public health are not adequately developing curriculum and interventions that prepare students in health professional schools to work with trans people. Recommendations include schools of medicine developing more faculty expertise in trans medicine, professional organizations requiring trans content on licensure exams, state licensure boards requiring continuing education in trans health, and health professional schools increasing the use of trans standardized patients and trans panels.

A discriminational attitude and behavior in the healthcare field: Homophobia level in healthcare professionals working in primary health services and the affecting factors

PURPOSE

To investigate the homophobia level among the healthcare professionals working in primary healthcare services and the affecting factors.

DESIGN AND METHODS

This descriptive and cross-sectional study conducted between November 2018 and April 2019, included 184 healthcare professionals.

FINDINGS

The mean total score of the Hudson and Ricketts Homophobia Scale was 103.55 ± 30.47. There was a statistically significant difference between the marital status of the healthcare professionals, what they felt during the care/treatment of lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals, level of knowledge about such individuals, willingness to know more about them, and the status of having LGBTI acquaintances and the median homophobia score.

PRACTICE IMPLICATIONS

The results will be beneficial for LGBTI individuals, who have problems in communicating with primary healthcare personnel, to benefit from the services effectively.

Religious-based negative attitudes towards LGBTQ people among healthcare, social care and social work students and professionals: A review of the international literature

There is a dearth of research on how negative religious attitudes towards LGBTQ people inform professional practice. This paper reports on a scoping review of 70 selected studies from 25 different countries. It explores key issues and knowledge gaps regarding the delivery of services to LGBTQ adults by religious healthcare, social care and social work organisations and/or practitioners with faith-based objections to LGBTQ people and their lives. The review identified four main themes: (1) a close connection between religious affiliation and negative attitudes towards LGBTQ people, among both students and professionals; (2) a heightening effect of religiosity, particularly among Christian and Muslim practitioners/students; (3) educators' religious attitudes informing curriculum design and delivery, and some highly religious students resisting and/or feeling oppressed by LGBTQ-inclusivity, if present; (4) examples of practice concerns raised by professionals and lay LGBTQ people. The article considers the ethical, practical, educational and professional standards implications, highlighting the need for further research in this area.

Dissident Genders and Sexualities in the Occupational Therapy Peer-Reviewed Literature: A Scoping Review

IMPORTANCE

The lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other dissident gender and sexuality (LGBTQIA+) population is prone to experiencing violence and social deprivation. Although occupational therapy research and practice has addressed populations experiencing various forms of discrimination, few studies have focused on the LGBTQIA+ population as an area of concern.

OBJECTIVE

To map, characterize, and analyze peer-reviewed journal articles related to the LGBTQIA+ population in the occupational therapy literature.

DATA SOURCES

We searched for journal articles published up to December 2021 indexed in the Virtual Health Library, CINAHL, SciELO Citation Index, SCOPUS, and Web of Science.

STUDY SELECTION AND DATA COLLECTION

We used Arksey and O'Malley's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) extension for scoping reviews. Included articles articulated occupational therapy practice, education, research, and theoretical analysis in relation to LGBTQIA+.

FINDINGS

Forty-three articles published from 1987 to 2021 met the inclusion criteria. They included 28 research articles, 9 reflection articles, 3 experience reports, and 3 literature reviews.

CONCLUSIONS AND RELEVANCE

Articles primarily offered general recommendations and possible professional contributions. More studies that seek to ascertain the effectiveness and limitations of occupational therapy practice with the LGBTQIA+ population are needed. With its diverse theoretical and methodological assumptions, occupational therapy can offer support so that professionals can alleviate these people's suffering in oppressive conditions and contribute to a more just society. What This Article Adds: This scoping review provides an overview of academic publications in occupational therapy on the LGBTQIA+ population, identifies dominant topics and gaps in this context, and points to ways to advance occupational therapy's contributions and actions that consider the needs and demands of people of dissident genders and sexualities.

She came to me for care, why would I say no? Survey results of advanced practice nurses caring for transgender and gender diverse patients

BACKGROUND

Literature has recognized deficient knowledge of transgender or gender diverse (TGD) patient needs that can negatively affect health care. Prior research on education has shown little progress responsive to TGD health care needs from nursing. Findings from this demonstrate some improvement, however slight. This study examined the education of family nurse practitioners (FNPs) providing care to TGD patients.

PURPOSE

The purposes of this study were to describe the relationship between location of practice and TGD patient care and to identify emerging themes related to the care of TGD individuals.

METHODS

Surveys were sent to 3,500 FNPs. Surveys were completed by 356.

RESULTS

No significant results were found between location of practice and TGD patient care or between location of education and TGD curricular inclusion. Statistical significance was found between inclusion of TGD content and participants' year of graduation. Those graduating in or after 2011 were more likely to report receiving content. Themes emerged in four areas related to practice area, role, location, and education. This study highlights inadequacy of curricular inclusion of TGD health needs. Findings underscored ways FNPs sourced best practices to provide health care to TGD people.

IMPLICATIONS FOR CLINICAL PRACTICE

These findings provide additional support for the need to educate FNPs to reduce barriers for TGD persons in accessing affirming health care.

Intergroup Contact, Intergroup Anxiety, and Anti-Transgender Prejudice: An Examination Using Structural Equation Modeling

This cross-sectional study applied the intergroup contact theory in the context of transgender prejudice and examined the relationships between quality and quantity of contact and explicit and implicit anti-transgender prejudice. Additionally, the study assessed the possible mediating role of intergroup anxiety in the relationship between intergroup contact and anti-transgender prejudice. Structural equation modeling was used to examine the proposed relationships, controlling for gender, religiosity, and political conservatism. Data were collected from an online sample of 354 participants (males: n = 168; females: n = 186). As hypothesized, greater quantity of contact was uniquely related to less implicit anti-transgender prejudice, whereas greater quality of contact was uniquely related to less explicit and implicit anti-transgender prejudice. Intergroup anxiety mediated the relationships between quality of contact and implicit and explicit anti-transgender prejudice but did not mediate the relationship between quantity of contact and implicit anti-transgender prejudice.

The Binary Order of Things: A Discursive Study of Nursing Students' Talk on Providing, and Learning About, LGBT Patient Care

Against the backdrop of the healthcare inequities and maltreatment facing LGBT patients, recommendations have been made for the inclusion of LGBT health topics in nursing curricula. Based on data collected in focus group discussions with South African nursing students, we complicate the assumption that training focused on health-specific knowledge will effectively reform providers' prejudicial practices. Findings reveal ambivalence: silence and discrimination versus inclusive humanism. Participants drew on discourses of ignorance, religion, and egalitarian treatment to justify their inadequacy regarding LGBT patients; while doing so, however, they deployed othering discourses in which homophobic and transphobic disregard is rendered acceptable, and "scientifically" supported through binary, deterministic views of sexuality and gender. Such "expert" views accord with Foucault's notion of "grotesque discourse." We conclude with a discussion of the findings' implications for nursing education; we call for the recognition and teaching of binary ideology as a form of discursive violence over LGBT lives.

Factors Associated with Transphobia: A Structural Equation Modeling Approach

Our study examined factors associated with transphobia with a particular focus on the interrelations between religious fundamentalism and contact to impact transphobia. We used an online sample of U.S. adults (Mean age = 38.91 years, SD = 12.58 years; n = 400) to conduct a partially latent variable SEM analysis and tested the direct effects of religious fundamentalism, contact, and gender on transphobia and the indirect effects of religious fundamentalism on transphobia through contact. We additionally tested for gender differences in the structural relations of the variables through a multi-group analysis. Results showed a statistically significant effect of religious fundamentalism, contact, and gender on transphobia. Religious fundamentalism also had a statistically significant indirect effect on transphobia through contact. Gender differences were also found for the effects of religious fundamentalism on contact and on transphobia. We conclude with implications for research and practice.

Attitudes Toward Transgender People Among Medical Students in South Korea

Introduction

Interventions aimed at changing knowledge, attitudes, and beliefs of resident physicians and medical students have been made to incite a significant positive increase in attitudes, comfort, and knowledge toward the lesbian, gay, bisexual, and transgender (LGBT) community, as well as increased levels of competency among participants.

Aim

To use insights from the attitudes of medical students toward transgender people and demonstrate that adding lectures on transgenderism would make the medical school curricula more comprehensive and trans-inclusive by improving overall attitudes toward the LGBT community.

Methods

A total of 49 medical students completed the preintervention survey with the Genderism and Transphobia Scale and Attitudes Toward Transgendered Individuals Scale, and then took a class on transgenderism, whereas 39 individuals completed the 4-week postintervention survey following the same measures.

Main Outcome Measure

Three items of survey were demographic characteristics, the Genderism and Transphobia Scale, and the Attitude Toward Transgender Individuals Scale.

Results

Although there was no significant difference in mean score between the preintervention and postintervention surveys, those who had minority individuals as peers and those who had previous LGBT-related education showed significantly positive attitudes than those without after the lecture. As a result of analyzing all the data from the pre/postintervention surveys, being of the female gender and having minority individuals as peers positively affected attitude.

Conclusion

Although there was no significant attitude change after the lecture, those who had previous LGBT-related education showed significantly positive attitudes at pre/postintervention surveys than those without. These findings suggest that raising awareness and education should be continued for a positive attitude toward more vulnerable groups such as the LGBT. Given the lack of studies on transgenderism that involve students in the medical profession in South Korea, this study shows the necessity of curricula creation of transgenderism education. This study aims to serve as a basis for curricula creation and student guidance that will help creating more positive attitudes toward sexual and gender minorities.

Lee SR, Kim M-A, Choi MN, et al. Attitudes Toward Transgender People Among Medical Students in South Korea. Sex Med 2021;9:100278.

Measuring Explicit Prejudice and Transphobia in Nursing Students and Professionals

Trans* people frequently report attitudes of prejudice/transphobia in health professionals. Conversely, health professionals indicate the lack of adequate training to care for these people and its impact on the quality of care provided.

OBJECTIVE

Our objective was to evaluate the explicit prejudices/transphobia of health students and professionals and compare them with the general population in Tenerife.

METHODS

A descriptive cross-sectional study was carried out with the Genderism and Transphobia Scale (GTS) and the Negative Attitude towards Trans* people Scale (EANT) with a total of 602 participants.

RESULTS

We found a low mean level of explicit prejudice/transphobia, with little/no differences between occupation groups. Explicit transphobia was correlated with being a man, less educated, and heterosexual, and not personally knowing a trans* person. Men and women were less transphobic about trans* people whose identities coincided with their own.

CONCLUSION

All participants showed a low mean level of explicit transphobia. This result is not incompatible with unconscious prejudice, which may translate to discriminatory behaviors. Interventions to change negative attitudes are still needed, since even a small percentage of transphobic health professionals could exert a considerable negative impact on health care. In professionals without transphobic attitudes, the barriers identified by trans* people might be a problem due to the lack of specific training.

Impact of a Formative Program on Transgender Healthcare for Nursing Students and Health Professionals. Quasi-Experimental Intervention Study

BACKGROUND

The field of specific healthcare for transgender people has not been included in the official curriculum of professionals. This causes a lack of knowledge that can be presumed to become a barrier to healthcare. Currently, different methodologies are emerging to achieve meaningful learning for students and professionals. The objective of this study was to evaluate the increase in the level of knowledge of final-year nursing students, applying methodological strategies such as problem-based learning (PBL) and film-forum.

METHODS

59 nursing students were randomly assigned to two intervention groups (G1 = 31 and G2 = 28), and another 57 were assigned to the control group (without specific classes or workshops on the subject of the study). The intervention consisted of a specific training course on transgender issues (TGSC&W, TransGender Specific Course and Workshop), where the type of meaningful learning strategy used depended on the group (G1 = film-forum and G2 = PBL). The study was carried out at the Faculty of Nursing Nuestra Señora de Candelaria of the Canary Islands Health Service. The randomization was done by blindly choosing a computer-generated code.

RESULTS

The main outcome was based on 116 participants, comparing their level of knowledge before and after the workshop. The comparison by pairs shows that there were statistically significant differences (p = 0.000) between those undergoing the methodological interventions and the control group. Statistical significance between film-forum and PBL was not obtained (p = 1.000): Both methodologies increased the level of knowledge, but there was no significant difference between them. The means for satisfaction with the learning methodology used did not show statistically significant differences.

CONCLUSION

The workshop carried out was highly effective and significant in terms of increasing knowledge. No significant differences were observed in the level of knowledge, or in the degree of satisfaction, between the two methodologies used (PBL and film-forum).

Self-assessment of clinical competence with LGBT patients at a pediatric hospital

Hospital social workers were asked to complete the LGBT-DOCSS, a validated self-assessment of clinical competence, attitudes, and knowledge about working with lesbian, gay, bisexual (LGB), and transgender patients. As a group, they held positive attitudes about LGBT patients (Mean 6.9/7, SD .22) but were less confident about their knowledge (Mean 5.9/7, SD 0.96) and clinical preparedness (Mean 5.0/7, SD 1.24). In addition, providers felt significantly less competent about working with transgender than LGB patients. Factors that affected domains of self-assessed competence including experience working with LGB or transgender patients and the year training was completed.

A systematic review of the relationship between religion and attitudes toward transgender and gender-variant people

Background: Prejudice against transgender people is widespread, yet in spite of the prevalence of this negativity relatively little is known about the antecedents and predictors of these attitudes. One factor that is commonly related to prejudice is religion, and this is especially true for prejudice targets that are considered to be "value violating" (as is the case for transgender individuals). Method: In this paper, we present the findings of our systematic search of the literature on this topic and present the synthesized evidence. Our search strategy was conducted across five databases and yielded 29 studies (across 28 articles). Results: We found consistent evidence that self-identifying as with either being "religious" or as Christian (and to a lesser extent, being Muslim) was associated with increased transprejudice relative to being nonreligious (and to a lesser extent, being Jewish). Additionally, we found consistent evidence that certain forms of religiosity were also related to transprejudice - specifically religious fundamentalism, church attendance, and interpretations of the bible as literal (transprejudice was unrelated to religious education). Conclusion: Although this young, but important field of research is growing, more empirical exploration is needed to fully understand that nuances of the religion-transprejudice relationship.