Outcomes of LGBTQ culturally sensitive training among civilian and military healthcare personnel

Psychometric Properties and Cultural Adaptation of the Polish Version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT- DOCSS-PL)

People from the LGBT+ community often face unique healthcare disparities, including barriers to accessing appropriate and respectful care. The purpose of this study was to test the psychometric properties of the Polish-language version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT- DOCSS-PL). Before testing its psychometric properties, the LGBT-DOCSS was translated and adapted from the original English version into Polish. Subsequently, we tested the instrument's psychometric properties on a sample of 415 participants. In addition, internal consistency of the questionnaire was checked with confirmatory factor analysis (CFA). Cronbach's alpha together with discriminative power index were uses as internal consistency measures. There were more female than male participants (58%). More than 57% of the participants were heterosexual and the average age of the respondents was approximately 30 years. The internal consistency of the Polish version and its domains was strong with an overall Cronbach's alpha of 0.789. The alpha ranges for each subscale domains were between 0.780-0.824. The McDonald's omega coefficient was 0.86. The Polish version of the LGBT-DOCSS-PL has good properties of factorial validity.

The Experiences of LGBTQ Healthcare Professionals within Military Medical Culture

BACKGROUND

Creating a positive workplace culture affects patient outcomes and force readiness. An inclusive workplace culture is especially important for lesbian, gay, bisexual, transgender, and queer (LGBTQ) military healthcare professionals, who have historically faced discrimination within the United States military. While research has examined LGBTQ service members' experiences in the military as a whole, there is a gap in the professional literature regarding LGBTQ healthcare workers' experiences within military medicine.

METHODS

This qualitative phenomenological study explored the experiences of ten LGBTQ military healthcare professionals. We interviewed each participant for one hour. Our research team then coded each interview and came to a consensus on how to organize these codes into emerging themes. We used reflexivity and member checking to increase the credibility of our results.

RESULTS

Four themes emerged from our data analysis: (1) implicit bias; (2) explicit bias; (3) response to discrimination; and (4) recommendations for improving workplace culture. The participants described both the underlying and outright discrimination they faced at work. They made recommendations for reducing this discrimination through education, training, and increased leadership representation.

CONCLUSIONS

Our results revealed that LGBTQ healthcare professionals continue to face discrimination in the workplace. This discrimination must be addressed to create an inclusive workplace environment within military medicine, which will enhance force readiness.

LGBTQ + cultural competency training for health professionals: a systematic review

BACKGROUND

Health disparities experienced by LGBTQ + individuals have been partially attributed to health professionals' lack of cultural competence to work with them. Cultural competence, the intricate integration of knowledge, skills, attitudes, and behaviors that improve cross-cultural communication and interpersonal relationships, has been used as a training framework to enhance interactions between LGBTQ + patients and health professionals. Despite multiple published LGBTQ + cultural competency trainings, there has been no quantitative appraisal and synthesis of them. This systematic review assessed articles evaluating the design and effectiveness of these trainings and examined the magnitude of their effect on cultural competence outcomes.

METHODS

Included studies quantitatively examined the effectiveness of LGBTQ + cultural competency trainings for health professionals across all disciplines in various healthcare settings. 2,069 citations were retrieved from five electronic databases with 44 articles meeting inclusion criteria. The risk of bias in the included studies was assessed by two authors utilizing the Joanna Briggs Institute critical appraisal checklists. Data extracted included study design, country/region, sample characteristic, training setting, theoretical framework, training topic, modality, duration, trainer, training target, measurement instrument, effect size and key findings. This review followed the PRISMA statement and checklist to ensure proper reporting.

RESULTS

75% of the studies were published between 2017 and 2023. Four study designs were used: randomized controlled trial (n = 1), quasi-experimental pretest-posttest without control (n = 39), posttest only with control (n = 1) and posttest only without control (n = 3). Training modalities were multiple modalities with (n = 9) and without simulation (n = 25); single modality with simulation (n = 1); and with didactic lectures (n = 9). Trainings averaged 3.2 h. Ten studies employed LGBTQ + trainers. The training sessions resulted in statistically significant improvements in the following cultural competence constructs: (1) knowledge of LGBTQ + culture and health (n = 28, effect size range = 0.28 - 1.49), (2) skills to work with LGBTQ + clients (n = 8, effect size range = 0.12 - 1.12), (3) attitudes toward LGBTQ + individuals (n = 14, effect size range = 0.19 - 1.03), and (4) behaviors toward LGBTQ + affirming practices (n = 7, effect size range = 0.51 - 1.11).

CONCLUSIONS

The findings of this review highlight the potential of LGBTQ + cultural competency training to enhance cultural competence constructs, including (1) knowledge of LGBTQ + culture and health, (2) skills to work with LGBTQ + clients, (3) attitudes toward LGBTQ + individuals, and (4) behaviors toward LGBTQ + affirming practices, through an interdisciplinary and multi-modal approach. Despite the promising results of LGBTQ + cultural competency training in improving health professionals' cultural competence, there are limitations in study designs, sample sizes, theoretical framing, and the absence of longitudinal assessments and patient-reported outcomes, which call for more rigorous research. Moreover, the increasing number of state and federal policies that restrict LGBTQ + health services highlight the urgency of equipping health professionals with culturally responsive training. Organizations and health systems must prioritize organizational-level changes that support LGBTQ + inclusive practices to provide access to safe and affirming healthcare services for LGBTQ + individuals.