Systematic review of instruments measuring homophobia and related constructs

Measures of Health Care Providers' Knowledge, Clinical Skills, or Prejudice Toward Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Sexual and Gender Minority Populations: A Scoping Review

Purpose: Assessing health care providers' knowledge, clinical skills, and prejudice toward lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority populations (LGBTQIA+) can help identify areas for improvement in health care provider training. The aim of this study was to map the range of studies that report measures of health care providers' knowledge, clinical skills, or prejudice toward LGBTQIA+ populations. Methods: A scoping review adopting the Joanna Briggs Institute methodology was conducted. Electronic database searches were conducted in CINAHL via EBSCO Host, Epistemonikos, LILACS via Virtual Health Library Regional Portal, PubMed, Scopus, and Web of Sciences. The samples of other reviews were screened. Studies that validated, translated, and/or cross-culturally adapted measures of the knowledge, clinical skills, and prejudice of health care providers and students toward LGBTQIA+ individuals were selected. Scholars were consulted to ensure that no relevant studies were missing. Data were extracted by two independent reviewers and presented in tabular form along with narrative summaries. Results: This scoping review identified 27 measures that have been validated, translated, and/or adapted with health care providers or students as the target population, distributed across 33 studies. Conclusions: Psychometric studies involving LGBTQIA+ patients and health care professionals have increased in recent years, with North American countries being the most frequent location. However, a growing number of studies are being conducted in Latin American countries such as Brazil and Colombia.

Testing the Effectiveness of an Intervention to Improve Romanian Teachers' LGBT+-Related Attitudes, Cognitions, Behaviors, and Affect: Protocol for a Randomized Controlled Trial

BACKGROUND

Repeated stigmatization due to group membership constitutes a recurrent stressor with negative impact on physical and mental health (minority stress model). Among European countries, Romania ranks low on LGBT+ (lesbian, gay, bisexual, and transgender people. The "+" represents individuals whose identities do not fit typical binary notions of male and female [nonbinary]) inclusion, with 45% of Romanian LGBT+ respondents reporting discrimination in at least 1 area of life in the year preceding the survey. Importantly, while all LGBT+ people might experience minority stress, younger sexual minority individuals are more prone to the detrimental impacts of stigma on their mental and physical health. As such, interventions are necessary to improve the inclusion climate within schools, where young people spend most of their time. Until now, most interventions addressing this topic have been conducted on undergraduate students in Western countries, with no studies conducted in countries that have widespread anti-LGBT+ attitudes.

OBJECTIVE

This paper describes the research protocol for a randomized controlled trial investigating whether LGBT+ stigma and bias among Romanian school teachers can be reduced using an internet-based intervention focusing on education and contact as primary training elements.

METHODS

A sample of 175 school teachers will be randomly assigned to either the control or experimental group. The experimental group participants will receive the intervention first and then complete the outcome measures, whereas the control group will complete the outcome measures first and then receive the intervention. The 1-hour multimedia intervention is developed for internet-based delivery under controlled conditions. It includes 2 interactive exercises, 2 recorded presentations, animations, and testimonies from LGBT+ individuals. Data for attitudinal, behavioral, cognitive, and affective measures will be collected during the same session (before or after the intervention, depending on the condition). We also plan to conduct a brief mixed methods follow-up study at 6 to 8 months post participation to investigate potential long-term effects of training. However, due to attrition and lack of experimental control (all participants will have completed the intervention, regardless of the condition), these data will be analyzed and reported separately using a mixed methods approach.

RESULTS

This paper details the protocol for the teacher intervention study. Data collection began in December 2022 and was completed by February 2023. Data analysis will be performed upon protocol acceptance. Follow-up measures will be completed in 2024. Results are expected to be submitted for publication following analysis in the spring of 2024.

CONCLUSIONS

The findings of this study will establish the effectiveness of an internet-based intervention intended to lessen anti-LGBT stigma and sentiment in a nation where these views have long been prevalent. If successful, the intervention could end up serving as a resource for Romanian teachers and guidance counselors in high schools.

TRIAL REGISTRATION

ISRCTN 84290049; https://doi.org/10.1186/ISRCTN84290049.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54254.

Disgust sensitivity mediates the link between homophobia and sexual orientation obsessive-compulsive symptoms

Previous research has shown that intrusive thoughts in obsessive-compulsive disorder (OCD) often focus on emotionally significant aspects of individuals' lives (e.g., values and beliefs). The current study sought to expand our understanding of OC symptoms related to sexual orientation (SO-OC symptoms) by investigating the roles of homophobia (i.e., negative attitudes, affect, and behaviors toward individuals with a same-gender orientation) and disgust propensity and sensitivity. A total of 592 self-identified heterosexual college students were recruited to complete measures of homophobia, disgust propensity and sensitivity, and SO-OC symptoms. Results of separate parallel mediation analyses indicated that the relationships between homophobic affect/attitudes and avoidance/aggression on one hand, and SO-OC symptoms on the other, were partially mediated specifically by disgust sensitivity, after controlling for gender. Theoretical and clinical implications are discussed, including how homophobia can be conceptualized as a disgust response in the treatment of SO-OC symptoms, as well as how other constructs of potential interest (sexual and moral disgust, religiosity, conservative sexual ideology) can be examined in future research.

Peers and Homophobic Attitudes in Adolescence: Examining Selection and Influence Processes in Friendships and Antipathies

Homophobic attitudes and behavior are a widespread problem among adolescents, but what the role of peer relationships such as friendships and antipathies is in shaping these attitudes remains unclear. Therefore, this study examined to what extent homophobic attitudes are influenced by friends' and foes' homophobic attitudes, and whether homophobic attitudes serve as a selection criterion for the formation of friendships and antipathies. Participants came from three Dutch high schools across two waves (wave 1 November 2014, wave 2 March/April 2015, ages 11-20, N = 1935, 51.5% girls). Stochastic actor-oriented models were estimated for testing hypotheses. The results showed that adolescents adjusted their homophobic attitudes to their friends' homophobic attitudes, but homophobic attitudes were not consistently related to friendship selection. Further, findings indicated that being dissimilar in homophobic attitudes increased the likelihood to dislike cross-sex peers. Together, the findings suggest that adolescents' homophobic attitudes were to some extent subject to peer influence, but homophobic attitudes did not steer who adolescents befriended or disliked.

Using Scenarios for Measuring the Affective and Behavioral Components of Attitudes Toward Lesbians and Gay Men: Validation of the SABA Scale

Attitude-change research requires sound attitude measures adequately predicting behavior. Most existing attitude measures focus on the cognitive (and some on the affective) attitude component (while neglecting the behavioral component). The present research introduces the SABA, a brief scale that consists of Scenarios measuring the Affective and Behavioral components of Attitudes toward lesbians and gay men. In two studies with student and non-student samples (n₁ = 66, n₂ = 202), we developed a 25-item scale and reduced it by performing exploratory factor analysis. Confirmatory factor analysis yielded two factors (affective and behavioral) for each version (SABA-L for attitudes toward lesbians, SABA-G for attitudes toward gay men). The reduced scales each contained five scenarios showing good reliability. High convergent validity and discriminant validity were shown using explicit and implicit attitude measures in a multitrait-multimethod analysis. Further, SABA scores correlated with the Modern Homonegativity Scale (MHS) and the Attitudes Toward Lesbians (ATL) and Gay Men Scale (ATG), but-as predicted-not with social anxiety and the Homopositivity Scale. The SABA's criterion and incremental validity were demonstrated in predicting attitude-related behavior better than the MHS. SABA scores showed established associations and differences in antigay attitudes based on age, religiousness, male role norms, authoritarianism, openness (SABA-G only), and sexual orientation, confirming (known-group) validity. Further, the SABA correlated less with the motivation to act without prejudice than the MHS, the ATL, and the ATG. Thus, outperforming existing attitude scales, the SABA appears to be a psychometrically sound instrument to measure attitudes toward lesbians and gay men.

Attitudes Toward Lesbians and Gay Men Scale: validation in Brazilian physicians

Objective:

To perform the cross-cultural adaptation of the original North American version of the Attitudes Toward Lesbians and Gay Men Scale (ATLG) for use in Brazil, and to evaluate the psychometric properties of the adapted instrument in a sample of Brazilian heterosexual physicians.

Methods:

Stages of cross-cultural adaptation were as follows: translation by two independent evaluators, translation synthesis, evaluation by the target population for semantic equivalence, pilot study with 42 physicians, and final instrument preparation involving 224 heterosexual physicians practicing medicine in the Federal District. Invitations containing a link to the study were sent to physicians via e-mail, social media and medical associations. Inclusion criteria were as follows: being a physician authorized to practice medicine in Brazil, practicing medicine in the Brazilian Federal District, and self-declared heterosexual, as stipulated in the original version of the ATLG scale. Exclusion criteria were not disclosed to potential participants to avoid inhibition and unwillingness to participate; respondents meeting exclusion criteria were removed from the sample during data analysis.

Results:

Exploratory and confirmatory factor analyses suggested a one-factor solution to be the most representative of the data, including all 20 items with high reliability (composite reliability coefficients =0.948).

Conclusion:

The ATLG scale is a suitable instrument to assess physicians’ attitudes toward homosexuals, with good validity and reliability evidence based on the sample studied.

Development of the Dimensional Inventory of Child Development Assessment (IDADI)

Abstract Child development is complex and includes multiple domains, such as cognition, communication and language, motor skills, socialization, and emotional development. The objective of this paper was to present the development process of the Dimensional Inventory of Child Development Assessment (IDADI) and evidence of its content validity. IDADI was conceived to assess child development of children from zero to 72 months of age through parental reports covering Cognitive, Motor (Gross and Fine), Communication and Language (Receptive and Expressive), Socioemotional and Adaptive Behavior domains. The development process involved: description of the theoretical foundation; development of the preliminary version of the instrument; expert item analysis; semantic analysis of the items by the target population; and a pilot study. The initial item pool had 2,365 items and the final version consisted of 524, after exclusions, modifications and additions. The stages of development led to changes in most of the items. This process is considered to have ensured IDADI’s content validity. Thus, it is believed that IDADI will contribute to child development assessment in Brazil in clinical and research contexts.

Socio-spatial Self-organizing Maps: Using Social Media to Assess Relevant Geographies for Exposure to Social Processes

Social media offers a unique window into attitudes like racism and homophobia, exposure to which are important, hard to measure and understudied social determinants of health. However, individual geo-located observations from social media are noisy and geographically inconsistent. Existing areas by which exposures are measured, like Zip codes, average over irrelevant administratively-defined boundaries. Hence, in order to enable studies of online social environmental measures like attitudes on social media and their possible relationship to health outcomes, first there is a need for a method to define the collective, underlying degree of social media attitudes by region. To address this, we create the Socio-spatial-Self organizing map, "SS-SOM" pipeline to best identify regions by their latent social attitude from Twitter posts. SS-SOMs use neural embedding for text-classification, and augment traditional SOMs to generate a controlled number of nonoverlapping, topologically-constrained and topically-similar clusters. We find that not only are SS-SOMs robust to missing data, the exposure of a cohort of men who are susceptible to multiple racism and homophobia-linked health outcomes, changes by up to 42% using SS-SOM measures as compared to using Zip code-based measures.

Relações entre Preconceito e Crenças sobre Diversidade Sexual e de Gênero em Psicólogos/as Brasileiros/as

Resumo: Examinar as crenças de psicólogos/as sobre indivíduos e grupos atingidos pelo preconceito contribui para a preparação do/a profissional no atendimento a esse público. Neste estudo, investigou-se a relação entre preconceito e crenças sobre diversidade sexual e de gênero em psicólogos/as brasileiros/as. Um questionário online foi respondido por 497 profissionais, entre 22 e 69 anos (M = 34,52; DP = 9,57), ligados/as a 22 dos 23 Conselhos Regionais de Psicologia. Utilizou-se a Escala de Preconceito contra Diversidade Sexual e de Gênero Revisada para mensurar o preconceito e a Escala de Crenças sobre a Natureza da Homossexualidade para investigar crenças sobre homossexualidade, a qual foi replicada para também investigar crenças sobre bissexualidade e transexualidade. Observaram-se índices baixos de preconceito e a predominância de crenças psicossociais para compreender a diversidade sexual e de gênero. O tipo de crença que melhor explicou a ocorrência de preconceito foi de base psicológica, representado pelas atribuições causais de perversão, má resolução de conflitos com figuras parentais e abusos sexuais sofridos na infância. Além disso, embora com tamanhos de efeito pequenos, foram encontradas correlações positivas de preconceito com a perspectiva teórica da psicanálise e orientação psicanalítica, com a modalidade de avaliação psicológica e/ou psicodiagnóstico e com a área de atuação em neurociência do comportamento. Tendo em vista a população estudada, ainda que os índices tenham sido baixos, considera-se preocupante a manifestação de preconceito e, em especial, o fato de crenças psicológicas terem sido as que melhor explicaram os índices mais elevados de preconceito.

Development and Validation of the ADAS Scale and Prediction of Attitudes Toward Affective-Sexual Diversity Among Spanish Secondary Students

Violence against non-heterosexual adolescents in educational contexts remains a worrying reality, but no adequate attitudes toward affective-sexual diversity (AtASD) measure exists for Spanish adolescent students. We developed a 27-item scale including cognitive, affective, and behavioral aspects, which was completed by 696 secondary school students from the Madrid area. Factor analyses suggested a unidimensional model, Cronbach's alpha indicated excellent scale scores reliability, and item calibration under the item response theory framework showed that the scale is especially informative for homophobic attitudes. A hierarchical multiple regression analysis showed that variables traditionally related to AtASD (gender, age, religion, nationality, perceived parental/peer attitudes, direct contact with LGB people) also were so in our sample. Moreover, interest in sexuality topics and perceived center's efforts to provide AtASD education were related to better AtASD. Our scale was reliable and valid, and it may also prove useful in efforts to detect those students with homophobic attitudes and to guide interventions.

[A Brief Homophobia Scale in Medical Students From Two Universities: Results of A Refinement Process]

BACKGROUND

The process of evaluating measurement scales is an ongoing procedure that requires revisions and adaptations according to the characteristics of the participants. The Homophobia Scale of seven items (EHF-7) has showed acceptable performance in medical students attending to two universities in Colombia. However, performance of some items was poor and could be removed, with an improvement in the psychometric findings of items retained.

OBJECTIVE

To review the psychometric functioning and refine the content of EHF-7 among medical students from two Colombian universities.

METHODS

A group of 667 students from the first to tenth semester participated in the research. Theirs ages were between 18 and 34 (mean, 20.9±2.7) years-old, and 60.6% were females. Cronbach alpha (α) and omega of McDonald (Ω) were calculated as indicators of reliability and to refine the scale, an exploratory (EFA) and confirmatory factor analysis (CFA) was performed.

RESULTS

EHF-7 showed α=.793 and Ω=.796 and a main factor that explained 45.2% of the total variance. EFA and CFA suggested the suppression of three items. The four-item version (EHF-4) reached an α=.770 and Ω=.775, with a single factor that accounted for 59.7% of the total variance. CFA showed better indexes (χ²=3.622; df=1; P=.057; Root-mean-square error of approximation (RMSEA)=.063, 90% CI, .000-.130; Comparative Fit Indices (CFI)=.998; Tucker-Lewis Index (TLI)=.991).

CONCLUSIONS

EHF-4 shows high internal consistency and a single dimension that explains more than 50% of the total variance. Further studies are needed to confirm these observations, that can be taken as preliminary.

Validation Study of the Revised Version of the Scale of Prejudice Against Sexual and Gender Diversity in Brazil

In Brazil, there is a deficit of culturally adapted tools to assess prejudice against sexual and gender diversity with empirically demonstrable validity and reliability. Prejudice against non-heterosexual orientations is a strong problem within Brazilian culture and is particularly related to nonnormative expressions of gender. To address these issues, a scale was created. The objective of this article is to validate the revised version of this instrument developed for the specificities of Brazilian culture and establish its reliability. The revised version of Scale of Prejudice Against Sexual and Gender Diversity (PASGD) was completed by 8,184 undergraduate students from southern Brazil. Analysis was conducted using the item response theory (IRT) model for rating scale data, criterion validity, and confirmatory factor analysis (CFA). The scale showed good validity and reliability. The results indicate that the PASGD is a useful tool for assessing prejudice in the Brazilian context, adapted for the local Brazilian reality.

Mental Health Trainees' Explicit and Implicit Attitudes Toward Transracial Adoptive Families Headed by Lesbian, Gay, and Heterosexual Couples

We investigated 109 (79.8% female; 76% White, and 83.5% Heterosexual) mental health trainees' explicit and implicit attitudes toward heterosexual, lesbian, and gay White couples adopting and raising Black children. To determine explicit attitudes, we used a vignette depicting a Black child ready for adoption and three types of equally qualified White families who were headed by a heterosexual couple, gay couple, or lesbian couple. The trainees were asked to indicate which type of family they preferred to adopt the child. To determine implicit attitudes, we used the computer programed latency-based multifactor implicit association test (IAT) protocol. The IAT data were collected from each participant individually. Explicit data showed that over 80% of the participants indicated no strong preference in terms of which type of family should adopted the child. However, IAT data showed that the trainees implicitly preferred lesbian couples. Overall, the degree of congruence between explicit and implicit was very low. Implications for training were discussed.

Italian Validation of Homophobia Scale (HS)

Introduction

The Homophobia Scale (HS) is a valid tool to assess homophobia. This test is self-reporting, composed of 25 items, which assesses a total score and three factors linked to homophobia: behavior/negative affect, affect/behavioral aggression, and negative cognition.

Aim

The aim of this study was to validate the HS in the Italian context.

Methods

An Italian translation of the HS was carried out by two bilingual people, after which an English native translated the test back into the English language. A psychologist and sexologist checked the translated items from a clinical point of view. We recruited 100 subjects aged18–65 for the Italian validation of the HS. The Pearson coefficient and Cronbach's α coefficient were performed to test the test–retest reliability and internal consistency.

Main Outcome Measures

A sociodemographic questionnaire including the main information as age, geographic distribution, partnership status, education, religious orientation, and sex orientation was administrated together with the translated version of HS.

Results

The analysis of the internal consistency showed an overall Cronbach's α coefficient of 0.92. In the four domains, the Cronbach's α coefficient was 0.90 in behavior/negative affect, 0.94 in affect/behavioral aggression, and 0.92 in negative cognition, whereas in the total score was 0.86. The test–retest reliability showed the following results: the HS total score was r = 0.93 (P < 0.0001), behavior/negative affect was r = 0.79 (P < 0.0001), affect/behavioral aggression was r = 0.81 (P < 0.0001), and negative cognition was r = 0.75 (P < 0.0001).

Conclusions

The Italian validation of the HS revealed the use of this self-report test to have good psychometric properties. This study offers a new tool to assess homophobia. In this regard, the HS can be introduced into the clinical praxis and into programs for the prevention of homophobic behavior.

Avaliação do preconceito contra diversidade sexual e de gênero: construção de um instrumento

O Brasil carece de ferramentas para avaliar o preconceito contra a diversidade sexual e de gênero, sendo necessários instrumentos com boas evidências de validade e confiabilidade e, principalmente, adaptados para o contexto brasileiro. Uma vez que o preconceito está fortemente associado à cultura e que no Brasil o preconceito contra orientações não heterossexuais está especialmente relacionado com expressões de gênero discordantes das hegemônicas, este estudo propõe a criação de um instrumento construído para as especificidades do contexto brasileiro, com evidências de validade e confiabilidade. Participaram do estudo 800 sujeitos, moradores de áreas rurais e urbanas do sul do Brasil, os quais responderam ao questionário Escala de Preconceito contra Diversidade Sexual e de Gênero. Foram conduzidas análises a partir da Teoria de Resposta ao Item, de validade de critério e de correlação com outro instrumento que avalia o mesmo construto. A escala apresentou boas evidências de validade e fidedignidade, bem como contextualização para a realidade brasileira, sugerindo que se trata de uma ferramenta útil para avaliar o preconceito.