An experimental study using a sexual strategies explanation to reduce homophobia toward gay men among lay people and healthcare professionals in China

Introduction

Homophobic discrimination and stigmatization, especially from healthcare professionals, are important stressors for gay men. Homophobia may be partly rooted in seeing some gay men having casual sex and many sexual partners as a signal of mental problems. Sexual Strategies Theory (SST) suggests that such sexual behavior is a result of different sexual strategies men and women tend to adopt and is unrelated to sexual orientation per se. This study aimed to investigate (1) the effectiveness of providing an SST explanation for gay men's sexual behavior in reducing homophobia among both lay persons and healthcare professionals; (2) differences in homophobia between healthcare professionals and lay people and also between medical and non-medical professionals.

Methods

The main analyses included 492 heterosexual participants recruited online via Chinese social media and sample services in 2021. Of these, 227 were healthcare professionals (128 medical, 99 non-medical) and 265 were lay people. The participants were randomly assigned into an experimental group given the SST explanation (n = 126), an active control group given a Minority Stress (MS) explanation (n = 184), and a control group (n = 182). After the manipulation, homophobia, knowledge about homosexuality, professional homophobic attitude, gay affirmative practice, and contact with gay men were assessed.

Results

The results of factor analysis suggested dividing homophobia into Oppressing Homophobia (Oppressing HP) describing believing that gay men should have fewer rights and Pathologizing Homophobia (Pathologizing HP) describing believing that the sexual behavior of gay men is a signal of mental problem. Importantly, the SST explanation reduced Pathologizing HP while the MS explanation reduced Oppressing HP. Healthcare professionals reported more Oppressing HP than lay people, and medical professionals conducted less gay affirmative practice than non-medical professionals.

Conclusion

An SST explanation can potentially reduce some aspects of homophobia among both healthcare professionals and lay people. Also, worryingly, Chinese healthcare professionals, especially medical professionals, reported more homophobia than lay individuals.

A Moderation Analysis of Perfectionism, Cultural Sensitivity, and Counselors-In-Training Attitudes Toward Non-Dominant Sexual Identities

The purpose of this study was to explore the moderating effect of maladaptive perfectionism on the relationship between cultural sensitivity and counselors-in-training attitudes toward non-dominant sexual identities. A total of 209 counseling graduate students participated in the study. Results showed that cultural sensitivity predicted attitudes toward individuals who identify with a non-dominant sexual identity after controlling for age. Also, a regression analysis demonstrated that maladaptive perfectionism is a moderator in the relationship between cultural sensitivity and attitudes toward individuals who identify with a non-dominant sexual identity among counselors-in-trainings. Implications in the counseling and education field and suggestions for future research are discussed.

Affirmative Competence and Practices of Mental Health Professionals with LGB clients: An Ibero-American Study

There are not many studies about affirmative competence and practices among mental health professionals working with Lesbian, Gay, and/or Bisexual (LGB) clients. Thus, the objectives of this research are to assess the levels of affirmative competence and practices of professionals in Ibero-American countries. The sample consists of 630 mental health professionals from various countries whose ages range from 22 to 75 years old, with a mean age of 41.46 years. The study utilizes the following measures: a socio-demographic questionnaire, the Sexual Orientation Counselor Competency Scale, and the Affirmative Practice Questionnaire. Results show that mental health professionals who present higher levels of Affirmative Competence are those who have higher levels of education and training on LGBT topics, show left-wing political affiliations, self-identify as LGB, and have no religious affiliations. Regarding Affirmative Practices, it was found that single participants show lower practices, and more studies are needed to better understand this result. Regression models demonstrate that Affirmative Practices and Competences are predicted by the hypothesized variables, namely, religious and political beliefs, and training/education. Hence, this study indicates that mental health professionals could undergo some type of academic or professional training and/or possess experience in regard to working with LGB clients, in order to enhance their approach when working with this population.

LGBT-Competence in Social Work Education: The Relationship of School Contexts to Student Sexual Minority Competence

This study examined the relationship between master of social work programs' (MSW) support of lesbian, gay, bisexual, and transgender people (LGBT-competence) and the sexual minority competence (LGB-competence) of social work students. Data were gathered from a sample of MSW program directors, faculty members, and students (N = 1385) within 34 MSW programs in the United States. A series of hierarchical linear models tested if a MSW program's LGBT-competence was associated with the LGB-competence of its students. Results showed a significant relationship between organizational LGBT-competence and individual LGB-competence within schools of social work, and that programs with greater LGBT-competence also had students who felt more competent to work with sexual minorities. These findings suggest schools of social work can take substantive action at an organizational level to improve the professional LGB-competence of future social workers. Implications for social work education are discussed.

The Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS): Establishing a New Interdisciplinary Self-Assessment for Health Providers

These three studies provide initial evidence for the development, factor structure, reliability, and validity of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS), a new interdisciplinary LGBT clinical self-assessment for health and mental health providers. Research participants were voluntarily recruited in the United States and United Kingdom and included trainees, clinicians, and educators from applied psychology, counseling, psychotherapy, and primary care medicine. Study 1 (N = 602) used exploratory and confirmatory factor analytic techniques, revealing an 18-item three-factor structure (Clinical Preparedness, Attitudinal Awareness, and Basic Knowledge). Study 2 established internal consistency for the overall LGBT-DOCSS (α = .86) and for each of the three subscales (Clinical Preparedness = .88, Attitudinal Awareness = .80, and Basic Knowledge = .83) and 2-week test-retest reliability (.87). In study 3 (N = 564), participant criteria (sexual orientation and education level) and four established scales that measured LGBT prejudice, assessment skills, and social desirability were used to support initial content and discriminant validity. Psychometric properties, limitations, and recommendations are discussed.

Educational Program to Improve Provider Knowledge, Attitudes, and Behavior in Lesbian, Gay, Bisexual, and Transgender Self-Disclosure

Lesbian, gay, bisexual, and transgender (LGBT) individuals have long been subject to discrimination. This has led to the fear of victimization and the overall avoidance of health care services and increasing health disparities in this group. Health care providers, including nurses who have limited knowledge, poor attitudes, and behavior, have been shown to significantly dilute the patient-provider relationship. This reduces self-disclosure and increases likelihood of poor outcomes of the LGBT individual. An educational program was developed to focus on health care providers (n = 8) knowledge, attitudes, and behavior in LGBT self-disclosure. A pretest, posttest methodology was used to assess the aforementioned concepts using a 29-item sexual orientation counselor competency scale. All measured concepts showed clinical significance with highest being self disclosure, which revealed both clinical and statistical significance from (SD) 1.0 to 1.63, a 63% increase. The implications of these findings on the current and future practice of health care providers and nurses support cultural competency training for both practicing health care professionals and students in educational curriculums.

An Interdisciplinary Approach to Lesbian, Gay, Bisexual, and Transgender Clinical Competence, Professional Training, and Ethical Care: Introduction to the Special Issue

There are exigent reasons to foster lesbian, gay, bisexual, and transgender (LGBT) competence, training, and ethical care for health professionals within an interdisciplinary paradigm. LGBT individuals experience serious health and psychosocial disparities; moreover, these inequalities can be amplified when other aspects of diversity such as race, ethnicity, age, gender, religion, disability, and socioeconomic status intersect with sexual orientation and gender identity (Institute of Medicine [IOM], 2011). While the origins of LGBT health and psychosocial disparities are manifold, deficiencies in professional training, ethical care, and clinical competence are underlying contributors (IOM, 2011). In addition, LGBT clinical competency advancements are often siloed within the various health care disciplines-thus advances by one group of health professionals often have limited impact for those practicing in different health and human service fields. This special issue explores LGBT clinical competence, professional training, and ethical care within an interdisciplinary context and, to our knowledge, represents the first attempt to address LGBT clinical competence from a multidisciplinary health care perspective.

Sexual and Gender Minority Health Curricula and Institutional Support Services at U.S. Schools of Public Health

Limited research has examined the ways in which public health training programs equip students to address health disparities affecting the lesbian, gay, bisexual, and transgender (LGBT) community and other sexual and gender minority (SGM) populations. This study outlines the availability of public health curricula on SGM health topics, and the prevalence of LGBT and SGM-inclusive institutional support services across CEPH-accredited U.S. schools of public health. Content analysis of all course offerings related to gender and sexuality revealed a limited focus on sexual and gender minority health: just 4.7% of courses contained keywords indicating that LGBT or SGM health topics were covered. Similar analysis of institutional support services available at U.S. schools of public health found that only 25% of schools had LGBT student organizations, and just 19% had an office of diversity that specifically advertised LGBT or SGM-inclusive programming or services on the institution's Web site. Finally, only two of 52 schools offered an educational certificate centered on LGBT health. These findings illustrate a significant need for enhanced curricular content and institutional support services that equip public health students to address SGM health disparities. Improvement in this area may encourage future health care professionals to work to reduce these disparities, to improve SGM persons' experiences in health care settings, and to generate further research in this area.

Implementing an ally development model to promote safer schools for LGB youth: a trans-disciplinary approach

Lesbian, gay, and bisexual (LGB) students experience ongoing bullying, harassment, and lack of safety in school. Specialized instructional support personnel (SISPs), such as school counselors, school social workers, and school psychologists, are in a unique position to advocate for LGB students and to implement an ally development model. The purpose of this article is to describe the current climate for LGB students, to discuss the current barriers facing SISPs in advocating for change, and to provide a model of ally development for use at each level of the K-12 system.

Is there an emotional cost of completing high school? Ecological factors and psychological distress among LGBT homeless youth

This study explored the nexus of home and school climate on the psychological distress of lesbian, gay, bisexual, and transgender (LGBT) homeless youth, as well as their experiences during high school. Of the LGBT homeless youth (N = 89) surveyed, 39.3% reported not completing high school. Most participants did not seek support from school staff nor did they report attending a school with a Gay-Straight Alliance. Significantly higher levels of psychological distress were found among high school graduates and those reporting LGBT harassment at home; however, harassment experienced at school was not statistically related to psychological distress. Findings are discussed.