Effectiveness of a multidimensional web-based intervention program to change Brazilian health practitioners' attitudes toward the lesbian, gay, bisexual and transgender population

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.

The Mastery of Competencies for the Care of LGBT+ People by Different Health Professionals

This study aims to compare the mastery of competencies in assisting the LGBT+ population of Brazilian health professionals. Data collection occurred in a face-to-face and virtual manner, in the first semester of 2018. The health professionals answered a socio-demographic and functional questionnaire, in addition to the questionnaire Measurement of Training Needs for Health Care for the LGBT+ Public. The data was analyzed using Mann-Whitney and Chi-square tests. The project research was submitted to and approved by the IMED Research Ethics Committee (CAAE 69116917.6.0000.5319). The sample (n= 380) was made up mostly of psychologists (42.3%), female (81%), heterosexual (73.2%), aged between 26 and 35 years (36%), Catholic (41%), living in the south region (36.9%), and working in the profession for ten years or more (34.3%). Skills gaps on the LGBT+ theme was identified, especially in topics such as "approach to the patient's sexuality," "interference of religious beliefs in care," "care with the genitalia and breast of the trans individual," among others. Professionals trained in psychology and non-heterosexuals had a greater mastery of the theme than the others. The fragmentation of knowledge and skills hinders the full and equal access to the health system, and continued educational actions are recommended.

Who are the sexual and gender minorities who frequently interact with children and their association with healthcare

This study aimed to examine the sociodemographic profile of sexual and gender minorities who regularly interact with children and investigate whether such frequent interactions are associated with healthcare factors. This cross-sectional study utilized data from the LGBT+ Health Survey in Brazil, conducted online and anonymously from August to November 2020 with 958 participants. Regular interaction with children was defined as living with children or engaging in bi-weekly face-to-face meetings with children residing in different households. Healthcare factors encompass having a professional or reference service, feeling comfortable in discussing personal issues, and receiving worse quality medical or hospital care. The statistical analysis used the Poisson regression with robust variance. The prevalence of interaction with children was 5.3%. We observed a statistically higher prevalence among cisgender women (13.4%) and Black/brown and other non-white people (7.9%) after adjusting for age. The results showed a positive association only between regular interaction with children and worse-quality medical or hospital care received (PR=6.00; 95%CI 1.22-29.67). These findings highlight a persistent stigma and prejudice within healthcare services.

Trans health training objectives: A scoping review

BACKGROUND

Transgender individuals are discriminated against in health care environments and consistently experience poorer health outcomes than their cisgender counterparts. Enhancing physician training in transgender-specific health is critical to closing the transgender health gap.

METHODS

We conducted a scoping review to identify transgender health training objectives in Internal Medicine and Internal Medicine Subspecialty residency programmes in Canada and the United States. A systematic search was conducted from 1946 to 15 February 2022. Studies were eligible for inclusion if they were written in English, included transgender training objectives, and were aimed at resident physicians in Internal Medicine or Internal Medicine Subspecialty training programmes in Canada or the United States.

FINDINGS

We found 4048 papers, of which 11 were included for analysis. Transgender health training objectives were synthesised into five themes, including (1) terminology, physiology, and gender presentation, (2) gender-affirming care and communication, (3) hormonal and surgical management, (4) routine health management and maintenance, and (5) equity, diversity, and inclusion in clinical care. The majority of objectives pertained to equity, diversity, and inclusion in clinical care, namely, respectful communication and non-judgemental care of transgender patients.

DISCUSSION

Our findings provide a comprehensive overview of published transgender health objectives in Canada and the United States and highlight existing gaps in postgraduate medical education for Internal Medicine and Subspecialty programmes.

CONCLUSIONS

We argue a need for standardisation of transgender-related residency training and suggest that postgraduate Internal Medicine programmes can utilise this review as a framework to begin enhancing transgender health education for their residents.

Unveiling Gender Dysphoria Experiences in Turkish Young Adults: Challenges, Perspectives, and Implications in Health Care Settings

Purpose

Gender dysphoria (GD) emerged as a focal area in child and adolescent development research. While the intricacies of diagnosis and interventions for GD intertwine with diverse socio-cultural challenges, a notable dearth of knowledge exists about the experiences of transgender (TG) individuals during their formative years in Turkey. This study aims to unveil these experiences, shedding light on the challenges, perspectives, and implications in health care settings.

Patients and Methods

Our study encompassed 125 participants: 62 TGs under clinical follow-up, and a control group of 63 cisgender individuals. Surveys tailored to TG participants addressed early GD experiences, gender-typed activity participation, and psychosocial challenges from childhood through adolescence. Additionally, both cohorts contributed to a survey on attitudes towards community-based interventions, allowing for a comparative analysis of their perspectives.

Results

TGs identified their GD around age 10.77. Female-to-male TGs showed more involvement in traditionally male-associated activities, whereas male-to-female engaged more in female-associated domestic role-plays (p<0.001). Over a third (37.09%) faced ostracization or bullying due to GD, 45.16% encountered verbal abuse, and 12.90% reported physical violence. Additionally, 40.32% had undergone treatment for depression and anxiety disorders. Most participants supported awareness initiatives, advocating for open gender expression, and normalizing the experiences of TG youth. Furthermore, 88.71% of TGs emphasized the importance of enhancing the expertise of professional groups, such as medical and mental health practitioners, in GD matters, a sentiment echoed by 68.25% of cisgender participants (p=0.030). While medical interventions were the least favored strategy at 32.80% overall, 46.78% of TGs supported it, compared to 19.05% of controls (p=0.010).

Conclusion

Our study underscores the challenges faced by TG individuals during development. Early recognition, societal awareness, enhanced training in professional healthcare environments, and comprehensive support are crucial for fostering acceptance and reducing adversity among children and adolescents navigating GD.

Continuing education with a holistic approach to the Brazilian LGBT+ population through use of the m-health App

AIM

This article aims to discuss the development of a continuing education course for health care professionals to provide competent healthcare assistance to the Brazilian LGBT+ population and the implementation of this course using a m-Health solution.

BACKGROUND

There is a scarcity of continuing education courses in the Brazilian context that update provides evidenced-informed education to ensure health care professional competence in the delivery of health care to LGBT+ individuals.

METHODS

Based on Bloom's taxonomy, with a main focus on the cognitive domain, the course "Ally: A Holistic Approach to the LGBT+ Individual'' was developed in five months. This was based on the Nurse's Health Education for LGBT Seniors (HEALE), the Curriculum Implementation and Institutional Climate manual, Changes to Improve Healthcare for LGBT People, Gender Nonconforming or Born with DSD" and the National Comprehensive Health Policy for LGBT+ People, among others.

RESULTS

Comprising six modules: i) human sexuality; ii) equitable care and appropriate terminology; iii) public health policy for the LGBT+ population; iv) cultural skills for health professionals; v) aging and health care for the LGBT+ population; and vi) mental health of LGBT+ people. Content validity indexing was established using an expert panel and was Ally was supported by a m-Health Solution called "Over the Rainbow'' and totals of 60 h of education.

CONCLUSIONS

This m-Health solution and continuing education course for health professionals can be an opportunity to change health professionals' practice to offer more equitable health care for the LGBT+ population.

The Interactions Between Vulnerabilities for HIV and Syphilis among Cisgender and Transgender People Who Use Drugs

In Brazil, transgender people are most affected by HIV, and crack cocaine addiction may contribute to social vulnerability and exposure to sexual and violence-related risks. This cross-sectional study comprised 2393 individuals seeking addiction treatment, consisting of 43 trans women, 1995 cisgender men, and 355 cisgender women. Records of rapid test results for HIV and syphilis and screening responses of trans women were compared to both cisgender groups using a logistic regression model to identify associated risk factors. HIV prevalence was higher in the transgender group (39.5%) than in cis women and men (5.9% and 3.6%, respectively). Our study showed an eightfold higher chance of a positive HIV test among transgender individuals who used drugs (OR: 8.79, p < .01, 95% CI: 3.90-19.78) compared to cisgender people who used drugs. A lifetime history of syphilis infection was more common in transgender people (60.0%) and cis women (32.8%) than in cis men (9.5%). Active syphilis was also more common in the transgender population (OR: 5.46, p < .01, 95% CI: 2.63 11.32). In our sample, 44.2% of transgender individuals had a history of at least one suicide attempt in their lifetime. Our results showed that transgender women were at higher risk of crack cocaine use (OR: 5.51, p < .01, 95% CI: 2.16-14.06) than cisgender men and women. The study showed that trans women had a higher prevalence of syphilis and HIV, and a greater chance of being homeless. The synergy of these vulnerabilities may have led to our findings of high psychotic symptoms and a history of suicide attempts in transgender individuals.

Gesundheitliche Themen von LSBTIQ+Personen in der ärztlichen Ausbildung in Deutschland

AIMS

Lesbian, gay, bisexual, trans, intersex and queer (LGBTIQ +) persons continue to experience discrimination and disadvantage in many areas of life, including healthcare. Studies indicate that LGBTIQ+persons show high rates of chronic physical and mental illness on the one hand, and report negative experiences with health care providers on the other hand. The aim of this work is to point towards barriers and the provision of inadequate health care for LGBTIQ+persons, and to draw attention to relevant gaps in medical education in Germany, needing to be followed by specific actions.

METHODS

For these purposes, both scientific evidence for the disadvantage of LGBTIQ+persons within the health care system and important innovative interventions in the education of medical personnel are presented and discussed.

RESULTS

A variety of different - in terms of scope, format, and content - training programs have already been tested and established, mainly in English-speaking regions of the world. In contrast, medical training in Germany lacks such programs.

CONCLUSIONS

Raising awareness and expanding the training of medical students to include LGBTIQ+health topics is of great importance in Germany.

Need for Inclusive Consideration of Transgender and Gender Diverse People in E-Health Services: A Systematic Review

Many transgender and gender diverse (TGD) people use the internet to find ways out of isolation, network, and share information on health-related topics. Thus, e-health services could reduce the health burden of TGD people and facilitate access to health care. Following the PRISMA guidelines, we conducted a systematic review on e-health approaches that could improve trans health care (i.e., services directly for TGD people or training programs for health care professionals, HCPs) and their effectiveness, acceptability, and feasibility. We searched PubMed, Web of Science, and PubPsych databases for publications from January 2000 to June 2021 with final updates before publication. The systematic review identified e-health services across 27 studies from 8 different countries. Few studies evaluated e-health services exclusively for TGD people. However, use of an e-health service was found to be effective and beneficial: TGD people improved in health-related outcomes, and HCPs improved in professional expertise. Service users find e-health services helpful and easy to integrate into their daily lives. Recommendations for further development of e-health services in trans health care are provided. In the future, given the rapidly evolving e-health research and care field, new treatment approaches for TGD people should be subject to ongoing evaluation and development.

CONCEPÇÕES DE GÊNERO E PROFISSIONAIS DO CENTRO DE REFERÊNCIA DE ASSISTÊNCIA SOCIAL

Para uma atuação técnica qualificada nas políticas públicas é fundamental que as/os profissionais atentem às suas concepções de gênero. Essas influenciam suas práticas e interferem no relacionamento com as/os usuárias/os, podendo ser discriminatórias e reforçar desigualdades sociais. Gênero refere-se às construções sociais que normatizam a subjetividade e a sexualidade. Investigações sobre atuação profissional com viés de gênero na assistência social que abordem localidades menores são escassas. Este estudo objetivou compreender as concepções de gênero de profissionais de nível superior que trabalham no Centro de Referência de Assistência Social. Para isso, foram feitas entrevistas semiestruturadas, submetidas à análise temática, com 14 profissionais da psicologia e do serviço social que atuam em municípios do interior do Rio Grande do Sul. Os resultados indicaram práticas que reforçam a família e o espaço doméstico como atribuições da mulher, e dificuldade das participantes na identificação e intervenção em situações de violência contra a mulher. Sugere-se, portanto, que sejam feitas pesquisas sobre a atuação técnica e intervenções abordando a temática de gênero e violência.

Condom-Protected Sex and Minority Stress: Associations with Condom Negotiation Self-Efficacy, "Passing" Concerns, and Experiences with Misgendering among Transgender Men and Women in Brazil

This cross-sectional exploratory study aims to verify associations between condom-protected sex, condom negotiation self-efficacy, self-esteem, and four minority stressors (experiences with misgendering, "passing" concerns, anticipated prejudice, and perceived prejudice) among transgender men (TM) and transgender women (TW). 260 individuals (192 TW and 68 TM) residing in two Brazilian states participated in the study. Data was collected online and in two hospital programs for transgender people and included sociodemographic data, condom-protected sex, the Trans-Specific Condom/Barrier Negotiation Self-Efficacy (T-Barrier) Scale, the Rosenberg Self-Esteem Scale, and four minority stressors. Measures that were significantly associated with condom-protected sex were tested as independent variables in a linear regression model. The main results suggest that lower condom negotiation self-efficacy, higher "passing" concerns, and higher experiences with misgendering were predictors of lower frequency of condom-protected sex. These negative outcomes were found among both TM and TW, which justifies their inclusion in public health policies. Structural strategies and clinical interventions are suggested to address condom negotiation self-efficacy and "passing" concerns in transgender populations.

Identity cues influence sexual minorities' anticipated treatment and disclosure intentions in healthcare settings: Exploring a multiple pathway model

The present work experimentally examines how identity cues that signal minority inclusion contribute to sexual minorities' (SM) healthcare visit expectations. We find that minority representation cues reduced SM's (N = 188) expectations of a healthcare provider's bias and increased perceived provider cultural competency which was, in turn, associated with lower anticipated identity-based devaluation and greater sexual orientation disclosure comfort. Providers' diversity-valuing statements had mixed effects highlighting the importance of more concrete indicators of inclusion in this context. This work suggests that a lack of identity safety cues in healthcare settings may contribute to disparate health outcomes for sexual minority populations.

Providing Care to LGBT Patients in Guyana: An Assessment of Medical Providers' Knowledge, Attitudes and Readiness to Learn

This study investigated the knowledge, attitudes and desire for continued education among Guyanese doctors with regards to LGBT health. It utilized a mixed methodology of quantitative, self-administered online surveys among 90 doctors, and qualitative semi-structured individual interviews with 8 other doctors. Descriptive and analytic calculations were performed on the quantitative data while thematic analysis was used for the qualitative data. The results show moderate knowledge levels regarding LGBT health, with deficits in awareness of LGBT health disparities; generally nondiscriminatory attitudes; and suboptimal education on LGBT health. Further training and pre-service curricular changes are necessary to address gaps and improve competency.

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.

Protocolo para Avaliar o Estresse de Minoria em Lésbicas, Gays e Bissexuais

Resumo O modelo do Estresse de Minoria (EM) propõe a existência de estressores específicos que levam pessoas lésbicas, gays e bissexuais (LGB) à posição de maior vulnerabilidade social. O EM é composto por homonegatividade internalizada, a ocultação da sexualidade e as experiências de estigma. Embora o modelo tenha recebido suporte empírico, não há instrumentos adaptados para sua avaliação no contexto brasileiro. Portanto, este estudo objetiva a adaptação transcultural e a produção de evidências de validade para o contexto brasileiro de um protocolo para avaliação do EM em LGBs (PEM-LGB-BR). A amostra foi de 1451 participantes que responderam a Escala de Homonegatividade Internalizada, a Escala de Revelação da Sexualidade e a Escala de Experiências de Estigma. As análises fatoriais exploratórias e confirmatórias sugerem a estrutura de três fatores do PEM-LGB-BR como a mais adequada. Tal resultado é coerente com a teoria, tornando o protocolo válido para ser utilizado no contexto brasileiro.

The Needs of LGBTI People Regarding Health Care Structures, Prevention Measures and Diagnostic and Treatment Procedures: A Qualitative Study in a German Metropolis

(1) Background: Studies indicate that lesbian, gay, bisexual, transgender and intersex (LGBTI) people constantly face challenges and disadvantages in the health care system that prevent them from getting the best possible patient-centered care. However, the present study is the first to focus on LGBTI-related health in a major German metropolis. It aimed to investigate health care structures, prevention measures and diagnostic as well as treatment procedures that LGBTI individuals need in order to receive appropriate patient-centered health care and health promotion. (2) Methods: Following a participatory approach, five expert interviews with LGBTI people with multiplier function, i.e., people who have a key role in a certain social milieu which makes them able to acquire and spread information in and about this milieu, and three focus groups with LGBTI people and/or health professionals were conducted. Qualitative data were analyzed according to the principles of content analysis. (3) Results: The specific needs of LGBTI individuals must be recognized as a matter of course in terms of depathologization, sensitization, inclusion, and awareness. Such an attitude requires both basic knowledge about LGBTI-related health issues, and specific expertise about sufficient health care services for each of the minorities in the context of sex, sexual orientation and gender identity. (4) Conclusions: For an appropriate approach to LGBTI-centered health care and health promotion, health professionals will need to adopt a better understanding of specific soft and hard skills.

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).

Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: a systematic review

BACKGROUND

Lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals experience higher rates of health disparities. These disparities may be driven, in part, by biases of medical providers encountered in health care settings. Little is known about how medical, nursing, or dental students are trained to identify and reduce the effects of their own biases toward LGBTQ individuals. Therefore, a systematic review was conducted to determine the effectiveness of programs to reduce health care student or provider bias towards these LGBTQ patients.

METHODS

The authors performed searches of online databases (MEDLINE/PubMed, PsycINFO, Web of Science, Scopus, Ingenta, Science Direct, and Google Scholar) for original articles, published in English, between March 2005 and February 2017, describing intervention studies focused on reducing health care student or provider bias towards LGBTQ individuals. Data extracted included sample characteristics (i.e., medical, nursing, or dental students or providers), study design (i.e., pre-post intervention tests, qualitative), program format, program target (i.e., knowledge, comfort level, attitudes, implicit bias), and relevant outcomes. Study quality was assessed using a five-point scale.

RESULTS

The search identified 639 abstracts addressing bias among medical, nursing, and dental students or providers; from these abstracts, 60 articles were identified as medical education programs to reduce bias; of these articles, 13 described programs to reduce bias towards LGBTQ patients. Bias-focused educational interventions were effective at increasing knowledge of LGBTQ health care issues. Experiential learning interventions were effective at increasing comfort levels working with LGBTQ patients. Intergroup contact was effective at promoting more tolerant attitudes toward LGBTQ patients. Despite promising support for bias education in increasing knowledge and comfort levels among medical, nursing, and dental students or providers towards LGBTQ persons, this systematic review did not identify any interventions that assessed changes in implicit bias among students or providers.

CONCLUSIONS

Strategies for assessing and mitigating implicit bias towards LGBTQ patients are discussed and recommendations for medical, nursing, and dental school curricula are presented.

Healthcare Needs of and Access Barriers for Brazilian Transgender and Gender Diverse People

Transgender and gender diverse people (TGD) have specific healthcare needs and struggles with access barriers that should be addressed by public health systems. Our study aimed to address this topic in the Brazilian context. A hospital and web-based cross-sectional survey built with input from the medical and transgender communities was developed to assess TGD healthcare needs of and access barriers in two Brazilian states. Although services that assist this population have existed in Brazil since the 1990s, TGD have difficulty accessing these services due to discrimination, lack of information and a policy design that does not meet the needs of TGD. A history of discrimination was associated with a 6.72-fold increase in the frequency of health service avoidance [95% CI (4.5, 10.1)]. This article discusses the urgent necessity for adequate health policies and for the training of professionals regarding the needs of Brazilian TGD.

Crenças e Atitudes Corretivas de Profissionais de Psicologia sobre a Homossexualidade

Resumo Muitos profissionais da Psicologia no Brasil ainda consideram a homossexualidade um transtorno mental ou um desvio daquilo que se consideraria, apesar da ausência de evidências empíricas e dos aspectos bioéticos implicados nestes julgamentos. De acordo com a literatura, esses profissionais frequentemente praticam intervenções que visam mudar ou reparar a homossexualidade. Este estudo buscou avaliar as atitudes corretivas (AC) dos profissionais da Psicologia em relação a pacientes lésbicas, gays e bissexuais (LGB), através de um questionário online. A análise mostrou que 29,48% dos(as) profissionais exibem AC quando solicitado pelo(a) paciente, e 12,43% quando não. Além disso, elas estão mais frequentemente presentes em psicoterapeutas cognitivo/comportamentais e familiares/sistêmicos. As análises de regressão demonstraram que os preditores mais fortes de AC foram a crença de que a homossexualidade é uma patologia; a crença de que as crianças criadas por pais/mães homossexuais (gays ou lésbicas ou bissexuais) têm maiores chances de desenvolverem problemas no desenvolvimento; a crença de que homossexualidade/bissexualidade é produto de um sentimento de que se é inadequado(a) ou incompetente nas relações heterossexuais; a crença de que existe uma causa para a homossexualidade/bissexualidade dos(as) pacientes; o gênero do(a) psicoterapeuta; e o nível de crença atual em relação a alguma religião. A aplicação adequada de intervenções com a população LGB deveria se dar por meio de aceitação e apoio, avaliação abrangente, enfrentamento ativo, apoio social e a exploração e desenvolvimento da identidade enquanto parte da diversidade sexual.

What do physicians know about homosexuality? Translation and adaptation of Knowledge about Homosexuality Questionnaire

Objective:

To adapt the Knowledge about Homosexuality Questionnaire to Brazilian Portuguese, and to assess knowledge of heterosexual physicians on homosexuality.

Methods:

The following steps for cultural adaptation were made: translation by two independent evaluators, translation synthesis, and evaluation of semantic properties by the target population, followed by the development of a pilot study and administration of the instrument to 224 heterosexual physicians working in the Brazilian Federal District.

Results:

The mean number of correct answers in the questionnaire was 11.8 (SD=2.81) out of 18 items, i.e., 65.5%. Catholic and evangelical physicians gave a significant lower number of correct answers compared with those who believed in other religions or who did not believe in any religion (p=0.009), and 40% of sample did not know that homosexuality is not considered a disease.

Conclusion:

This study adapted the American instrument entitled Knowledge about Homosexuality Questionnaire and provided evidence for its validation in Brazil, revealing physicians' lack of knowledge about several aspects related to homosexuality. The findings of this study may help in guiding improvements in medical training and practice.

A Systematic Review of the Psychometric Properties of Composite LGBT Prejudice and Discrimination Scales

Prejudice and discrimination against LGBT individuals is widespread and has been shown to have negative consequences for sexual and gender minority persons' physical and psychological wellbeing. A recent and problematic trend in the literature is to compositely measure prejudice toward and discrimination against LGBT persons. As such, a review of the psychometric properties of scales assessing, in a combinatory fashion, negative attitudes and/or behaviors toward LGBT persons is warranted. In the current study, 32 scales were identified, and their psychometric properties were evaluated. Most of the scales reviewed did not provide sufficient information regarding item development and refinement, scale dimensionality, scale score reliability, or validity. Properties of the reviewed scales are summarized, and recommendations for better measurement practice are articulated.

Interlaced strands: Health psychology in Brazil from an autobiographic perspective

The presence of psychology in Brazilian Health Settings is closely related to two socio-political movements: for the creation of the Brazilian Unified Health System in 1990 and for Psychiatric Reform. Each had a multidisciplinary stance closely associated with a socially committed approach to healthcare delivery and connected with prior experiences that influenced its policies, among them the National AIDS Programme. These developments are told as a tale that interlaced autobiographical data and the long road to a universal healthcare system that shaped the relationship between psychology and health in the country.