Table 6 Summary of measurements and outcomes
From: LGBTQ + cultural competency training for health professionals: a systematic review
Author (Year), Country | Measurement Instrument with Reliability and/or Validity | Training Target | Key Finding | Effect Size | Reported Impact of LGBTQ + Cultural Competency Trainings | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
Cultural Competence Constructs | Outcomes unrelated to Cultural Competence Constructs | ||||||||||
Knowledge | Skill | Attitude | Behavior | Confidence/ Preparedness | Self-Efficacy | Comfort Level | |||||
Barrett et al. (2021), USA [53] | Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) [123] with reported validity | knowledge about LGBTQ + communities | Increased perceived knowledge about LGBTQ + communities (Mean ± SD: 5.3 ± 0.7 → 6.1 ± 1.2, p = 0.003) | g = 0.83 (Large) | ⇑⇑ | → | ⇑⇑ | ||||
Attitudinal awareness regarding LGBTQ + people | No significant change in attitudinal awareness regarding LGBTQ + people (Mean ± SD: 6.7 ± 0.4 → 6.8 ± 0.4, p = 0.33) | g = 0.25 (Small) | |||||||||
Clinical preparedness to work with LGBTQ + patients | Enhanced clinical preparedness to work with LGBTQ + patients (Mean ± SD: 4.1 ± 1.3 → 5.2 ± 1.1, p = 0.001) | g = 0.91 (Large) | |||||||||
Author-developed survey No report about reliability or validity | Knowledge about LGBTQ + health in dermatology | Increased objective/factual knowledge about LGBTQ + health in dermatology and (Mean ± SD: 16.9 ± 2.7 → 18.5 ± 3.1, p = 0.048) | g = 0.54 (Medium) | ||||||||
Bristol et al. (2018), USA [54] | The Ally Identity Measure tool [124] (3 subscales: knowledge and skills, openness and support, and awareness of oppression) with reported reliability with a Cronbach’s alpha of 0.76 to 0.88) | Attitudes toward LGBTQ + persons (openness toward LGBTQ + people and support toward LGBTQ + individuals) | No significant change in mean scores in the openness and support subscale (Mean ± SD: 24.9 ± 4.3 → 26.6 ± 4.1, p = 0.062) | g = 0.41 (Small) | ⇑⇑ | ⇑⇑ | → | ||||
Knowledge of the LGBTQ + community and LGBTQ + health | Improved mean scores in the knowledge subscale (Mean ± SD: 23.6 ± 5.3 → 29.2 ± 4.6, p < 0.05) | g = 1.12 (Large) | |||||||||
Skills to work with LGBTQ + patients | Improved mean scores in the skills subscale (Mean ± SD: 23.6 ± 5.3 → 29.2 ± 4.6, p < 0.05) | g = 1.12 (Large) | |||||||||
Awareness of oppression of LGBTQ + communities | Increased mean scores in the oppression awareness subscale (Mean ± SD: 15.5 ± 2.4 → 16.8 ± 2.6, p < 0.05) | g = 0.52 (Medium) | |||||||||
Craig et al. (2015), Canada [55] | Adapted from the Lesbian, Gay, Bisexual Knowledge and Attitudes Scale for Heterosexuals (LGB-KASH) [125] with reported reliability with a Cronbach’s alpha of 0.89 | Knowledge about LGB youth | Mean scores of participants’ self-assessed knowledge increase (3.59 out of 4) and self-assessed improvement in skills (3.44 out of 4) | ↑ | ↑ | ↑ | |||||
Skills to work with LGB youth | |||||||||||
Intention to support LGB youth | After training, participants’ responses for intention to support LGB youth as “Yes” and “No” were 79.5% and 20.5% respectively | ||||||||||
Donaldson et al. (2019), USA [56] | Lesbian, Gay, Bisexual Adapted from the Knowledge and Attitudes Scale for Heterosexuals (LGB-KASH) [125] No report about reliability or validity | Knowledge of the LGBTQ + community and health for LGBTQ + veterans | Increased perceived and objective/factual knowledge about the LGB community (Mean ± SD: 4.36 ± 1.40 → 5.70 ± 0.86, p < 0.001) | g = 1.17 (Large) | ⇑⇑ | → | → | ||||
Increased perceived and objective/factual knowledge about the transgender community (Mean ± SD: 4.32 ± 1.36 → 5.75 ± 1.16, p < 0.001) | g = 1.11 (Large) | ||||||||||
Lesbian, Gay, Bisexual Knowledge and Attitudes Scale for Heterosexuals (LGB-KASH) [125] with reported reliability with a Cronbach’s alpha of 0.91 Attitudes Toward Transgender Individuals Scale (ATTIS) [126] with reported reliability with a Cronbach’s alpha of 0.91 | Attitudes toward LGBTQ + people | No significant difference between pre- and post-assessments | |||||||||
Adapted from Johnson and Federman (2014) [127] with reported reliability with a Cronbach’s alpha of 0.44 to 0.85) | Skills to work with LGBTQ + people | No significant difference between pre- and post-assessments | |||||||||
Donisi et al. (2020), Belgium, Italy, Poland, UK [57] | Author-developed survey No report about reliability or validity | Knowledge of the LGBTQ + community and LGBTQ + health | Increased objective/factual knowledge about the LGBTQ + community and LGBTQ + health (Median/IQR: 5/4.0–6.0 → 7/5.0–8.0, p < 0.001) | ⇑⇑ | → | ||||||
Attitudes toward LGBTQ + people and working with LGBTQ + patients | Improved attitude scores without statistical significance. A “willingness” score was lower than “acknowledgement” and “self-competence” scores | ||||||||||
Felsenstein (2018), USA [58] | Author-developed survey with reported validity | Knowledge of the LGBTQ + community and LGBTQ + health | Increased objective/factual knowledge about the LGBTQ + community and LGBTQ + health (Mean ± SD: 6.3 ± 2.8 → 9.6 ± 2.7, p = 0.033) | g = 1.14 (Large) | ⇑⇑ | ↑ | |||||
Author-developed survey No report about reliability or validity | Perceived preparedness to work with LGBTQ + patients | After training, 72% of staff reported that they were more prepared to provide care to LGBTQ + patients | |||||||||
Frasca et al. (2019), USA [59] | Adapted from Hayes et al. (2015) [128] No report about reliability or validity | Comfort in HIV prevention topics | Improved comfort level taking a sexual history with LGBTQ + patients (Mean 3.5 → 4.3, p < 0.05), initiating a safe sex discussion with LGBTQ + patients (Mean 3.0 → 4.2, p < 0.05), and initiating a PrEP discussion (Mean 2.5 → 4.1, p < 0.05) | ↑ | ⇑⇑ | ||||||
Confidence in managing sexual health issues with LGBTQ + patients | 95% of respondents agreed they felt better prepared to diagnose and manage real-life patients with similar complaints | ||||||||||
Gendron et al. (2013), USA [60] | Author-developed survey No report about reliability or validity | Awareness of aging LGBTQ + people’s healthcare issues | Increased awareness of LGBTQ + persons’ healthcare issues (Mean ± SD: 0.52 ± 0.50 → 0.93 ± 0.26, p < 0.001) | g = 1.08 (Large) | ⇑⇑ | ⇑⇑ | |||||
Level of comfort working with an LGBTQ + older adult | Improved comfort level working with LGBTQ + older adults (Mean ± SD: 4.41 ± 0.98 → 4.62 ± 0.77, p < 0.001) | g = 0.24 (Small) | |||||||||
Grova et al. (2021), USA [61] | The Ally Identity Measure tool [124] (3 subscales: knowledge and skills, openness and support, and awareness of oppression) with reported reliability with a Cronbach’s alpha of 0.76 to 0.88) | Knowledge of the LGBTQ + community and LGBTQ + health | Training had a significant effect on an improvement in knowledge and skills (p = 0.024) | ω2 = 0.2 (Large) | ⇑⇑ | ⇑⇑ | ⇑⇑ | ||||
Skills to work with LGBTQ + patients | Training had a significant effect on an improvement in knowledge and skills (p = 0.024) | ω2 = 0.2 (Large) | |||||||||
Attitudes toward LGBTQ + persons (openness toward LGBTQ + people and support toward LGBTQ + individuals) | Training had a significant effect on an improvement in openness and support (p = 0.042) | ω2 = 0.044 (Small) | |||||||||
Awareness of oppression of LGBTQ + communities | Training did not have a significant effect on an improvement in awareness of oppression | ||||||||||
Hanssmann et al. (2008), USA [62] | Adapted survey from the Cultural Competency Self-Assessment Questionnaire [129] No report about reliability or validity | Knowledge about clinically and culturally competent care for transgender patients | Showed a 0.6-point increase in perceived knowledge about care for transgender patients (p < 0.05) | ⇑⇑ | |||||||
Hanssmann et al. (2010), USA [63] | Adapted survey from the Cultural Competency Self-Assessment Questionnaire [129] with reported reliability with a Cronbach’s alpha of 0.45 to 0.79) Reported this tool is not validated | Knowledge of transgender and gender non-conforming communities, service delivery/practice, resources, and linkages for the communities | Increased perceived knowledge about the provision of care to transgender and gender non-conforming patients (Mean ± SD: 2.26 ± 0.53 → 1.79 ± 0.53, p < 0.05) | g = 0.88 (Large) | ⇑⇑ | ⇑⇑ | |||||
Behavior consciousness of transgender and gender non-conforming communities | Improved behavior consciousness of working with transgender and gender non-conforming clients (Mean ± SD: 2.42 ± 0.66 → 1.68 ± 0.66, p < 0.05) | g = 1.11 (Large) | |||||||||
Hardacker et al. (2014), USA [64] | Author-developed survey No report about reliability or validity | Knowledge of the LGBTQ + elder community and health for LGBTQ + older adults | Increased objective/factual knowledge about the LGBTQ + elder community in the nursing home/home health care group (Mean ± SD: 62.5 ± 18.2 → 67.3 ± 15.6, p < 0.01) | g = 0.28 (Small) | ⇑⇑ | ||||||
Increased objective/factual knowledge about the LGBTQ + elder community in the hospital/educational setting group (Mean ± SD: 82.3 ± 18.6 → 89.8 ± 12.5, p < 0.01) | g = 0.48 (Small) | ||||||||||
Increased objective/factual knowledge about health disparities for LGBTQ + older adults in the nursing home/home health care group (Mean ± SD: 55.9 ± 21.1 → 66.8 ± 22.7, p < 0.01) | g = 0.49 (Small) | ||||||||||
Increased objective/factual knowledge about health disparities for LGBTQ + older adults in the hospital/educational setting group (Mean ± SD: 73.5 ± 21.1 → 90.4 ± 13.6, p < 0.01) | g = 0.97 (Large) | ||||||||||
Henry (2017), USA [65] | The Sexual Orientation Counselor Competency Scale (SOCCS) [130] with reported validity | Knowledge of the LGBTQ + community | Increased perceived knowledge about the LGBTQ + community (SD 0.46 → 0.63) | ↑ | ↑ | ↑ | |||||
Skills to work with LGBTQ + patients | Enhanced self-assessed skills to work with LGBTQ + patients (SD 0.994 → 1.006) | ||||||||||
Attitudes toward LGBTQ + patients | Improved attitudes toward LGBTQ + patients (SD 0.765 → 0.989) | ||||||||||
Holman et al. (2020), USA [66] | Author-developed survey with reported reliability with pretest Cronbach’s alpha of 0.84 and posttest Cronbach’s alpha of 0.76 | Knowledge of the LGBTQ + elder community and unique concerns and needs for LGBTQ + older adults | Increased objective/factual knowledge about the LGBTQ + older adults and their specific needs and concerns (Mean ± SD: 4.32 ± 2.86 → 7.56 ± 1.61, p < 0.001) | g = 1.34 (Large) | ⇑⇑ | → | ⇓⇓ | ||||
Adapted survey from (LaMar & Kite, 1998) [131] with reported reliability with pretest Cronbach’s alpha of 0.94 and posttest Cronbach’s alpha of 0.80 | Attitudes toward LGBTQ + elders | No significant change in attitudes toward LGBTQ + older adults (Mean ± SD: 4.42 ± 1.56 → 4.27 ± 1.88, p = 0.678) | g = 0.04 (Trivial) | ||||||||
Author-developed survey No report about reliability or validity | Perceived preparedness to work with LGBTQ + older adults | Decreased perceived preparedness to work with LGBTQ + elders (Mean ± SD: 1.87 ± 0.84 → 1.43 ± 0.50, p = 0.001) | g = 0.61 (Medium) | ||||||||
Hughes et al. (2016), USA [67] | Author-developed survey No report about reliability or validity | Knowledge or awareness related to the LGBTQ + elder community and unique concerns and needs for LGBTQ + older adults | 75% of respondents agreed that their understanding of the unique needs of LGBTQ + older adults increased | ↑ | ↑ | ||||||
Preparedness to provide services to LGBTQ + older adults | 86% of respondents agreed that they felt better prepared to work with LGBTQ + elders | ||||||||||
Ingraham et al. (2016), USA [68] | Author-developed survey No report about reliability or validity | Knowledge about the barriers to healthcare of overweight and obese LB women | In both academic and clinic format programs, increased knowledge about LB women’s healthcare avoidance based on body size (participants’ response as “agree” 73% → 95%, p < 0.05 in academic format training and 77% → 100%, p < 0.05 in clinic format training) | ⇑⇑ | → | ||||||
Attitudes toward barriers to healthcare of overweight and obese LB women | In both academic and clinic format programs, did not show statistically significant improvement in attitudes about asking patients’ sexual identity (p = 0.18 in academic format training and p = 0.2 in clinic format training) | ||||||||||
Jadwin-Cakmak et al. (2020), USA [69] | Adapted from Strong and Folse (2015) [132], Kelley et al. (2008) [133] and Maher and Bower (2015) [134] No report about reliability or validity | Knowledge of the LGBTQ + community and LGBTQ + youth health | Increased objective/factual knowledge about LGBTQ + youth health (Mean ± SD: 7.22 ± 0.71 → 7.82 ± 0.80, p = 0.009) | g = 0.79 (Medium) | ⇑⇑ | ⇑⇑ | → | ||||
Adapted from Strong and Folse (2015) [132], Kelley et al. (2008) [133]and Maher and Bower (2015) [134] with reported reliability with pretest Cronbach’s alpha of 0.92 and 6-month follow-up Cronbach’s alpha of 0.91 | Attitudes toward LGBTQ + youth | Improved attitudes toward LGBTQ + youth (Mean ± SD: 3.45 ± 0.20 → 3.64 ± 0.17, p = 0.003) | g = 1.03 (Large) | ||||||||
Author-developed survey No report about reliability or validity | LGBTQ + affirming individual practices | No significant change in participants’ reported use of LGBTQ + youth’s preferred names or pronouns (Mean ± SD: 4.72 ± 0.23 → 4.76 ± 0.34, p = 0.657) | g = 0.14 (Trivial) | ||||||||
LGBTQ + affirming clinic-level practices and perceived clinic environment | Improved clinic-level practices (Mean ± SD: 7.22 ± 1.64 → 9.95 ± 1.43, p = 0.001) | g = 1.78 (Large) | |||||||||
No significant changes in clinics’ endorsement of environmental changes for LGBTQ + youth (Mean ± SD: 0.98 ± 0.04 → 1.00 ± 0, p = 0.082) | g = 0.99 (Large) | ||||||||||
Kaiafas and Kennedy (2021), USA [70] | The Ally Identity Measure tool [124] (3 subscales: knowledge and skills, openness and support, and awareness of oppression) with reported validity and reliability with a Cronbach’s alpha of 0.76 to 0.88 | Knowledge of the LGBTQ + community and LGBTQ + health | Improved mean scores in the knowledge and skills subscale (Mean ± SD: 21.78 ± 8.91 → 28.22 ± 7.47, p = 0.001) | g = 0.79 (Medium) | ⇑⇑ | ⇑⇑ | ⇑⇑ | ||||
Skills to work with LGBTQ + patients | Improved mean scores in the knowledge and skills subscale (Mean ± SD: 21.78 ± 8.91 → 28.22 ± 7.47, p = 0.001) | g = 0.79 (Medium) | |||||||||
Attitudes toward LGBTQ + persons (openness toward LGBTQ + people and support toward LGBTQ + individuals) | Increased mean scores in the openness and support subscale (Mean ± SD: 20.17 ± 6.95 → 23.69 ± 7.59, p = 0.04) | g = 0.48 (Small) | |||||||||
Awareness of oppression of LGBTQ + communities | No significant change in mean scores in the oppression awareness subscale (Mean ± SD: 13.28 ± 3.81 → 14.14 ± 4.06, p = 0.36) | g = 0.22 (Small) | |||||||||
Kauth et al. (2016), USA [71] | Author-developed survey No report about reliability or validity | Knowledge of the LGBTQ + veteran community and their health | Post training, 94% of respondents (15 out of 16) reported a high level of knowledge (very knowledgeable) about LGBTQ + veteran community and their health | ↑ | |||||||
Kilicaslan and Petrakis (2023), Australia [72] | Author-developed survey No report about reliability or validity | Knowledge of the LGBTQ + community and their unique needs | After the training, 15.95% of respondents (18 out of 113) strongly agreed that they had adequate knowledge, and 52.21% of respondents (59 out of 113) agreed | ↑ | |||||||
Attitudes toward LGBTQ + persons | After the training, 15.95% of respondents (18 out of 113) strongly agreed that they had adequate attitude, and 52.21% of respondents (59 out of 113) agreed | ||||||||||
Lelutiu-Weinberger et al. (2016), USA [73] | Adapted from the Sexual Orientation Provider Competency Scale [130] with reported reliability with a Cronbach’s alpha of 0.90 Adapted from the Clinical Skills and Attitudes Scale [135] originally developed for medical students. No reported about reliability or validity | Knowledge of clinical issues for transgender patients | No significant change in perceived knowledge about clinical issues for transgender patients (Mean ± SD: 26.0 ± 6.2 → 25.4 ± 6.3, p > 0.05) | g = 0.09 (Trivial) | → | ⇑⇑ | ⇑⇑ | → | |||
No significant change in awareness of transphobic practices (Mean ± SD: 9.2 ± 4.0 → 14.0 ± 7.0, p < 0.18) | g = 0.86 (Large) | ||||||||||
Adapted from the Sexual Orientation Provider Competency Scale [130] with reported reliability with a Cronbach’s alpha of 0.90 | Skills to work with transgender clients | Increased self-assessed skills in working with transgender patients (Mean ± SD: 22.1 ± 6.7 → 28.5 ± 8.4, p < 0.01) | g = 0.84 (Large) | ||||||||
Adapted from the Attitudes toward Transgender Patients Scale [135] Adapted the Modern Homophobia Scale [136] with reported reliability with a Cronbach’s alpha of 0.93 | Attitudes toward transgender patients | Decreased negative attitudes toward transgender patients (Mean ± SD: 19.6 ± 7.9 → 17.1 ± 8.4, p < 0.05) | g = 0.31 (Small) | ||||||||
No significant change in transphobia scores (Mean ± SD: 25.0 ± 6.8 → 25.2 ± 7.4, p > 0.05) | g = 0.03 (Trivial) | ||||||||||
Adapted from the Contemplation Ladder [137, 138] with reported reliability with a Cronbach’s alpha of 0.30 to 0.76 | Readiness to provide care to transgender patients | No significant change in readiness to care for transgender patients without statistical significance (Mean ± SD: 8.6 ± 2.3 → 9.3 ± 1.8, p > 0.05) | g = 0.34 (Small) | ||||||||
Direct observation by the author | Clinic environment change | At the follow-up environmental surveillance, the author identified elements, including LGBTQ + inclusive magazines and brochures, in the waiting area | |||||||||
Leyva et al. (2014), USA [74] | Author-developed survey with reported validity and reliability with a Cronbach’s alpha of 0.75 Lower scores indicate positive changes | Knowledge of the LGBTQ + elder community and unique concerns and needs for LGBTQ + older adults | Increased perceived knowledge about LGBTQ + older adults and their needs and concerns (Mean ± SD: 20.14 ± 4.01 → 18.19 ± 3.17, p < 0.001) | g = 0.54 (Medium) | ⇑⇑ | ⇑⇑ | ⇑⇑ | ||||
Attitudes toward LGBTQ + elders | Improved attitudes toward LGBTQ + older adults (Mean ± SD: 9.13 ± 2.88 → 8.30 ± 2.43, p = 0.005) | g = 0.21 (Small) | |||||||||
Skills to work with LGBTQ + older adults | Increased self-assessed skills to work with LGBTQ + older adults (Mean ± SD: 15.28 ± 3.24 → 12.17 ± 3.00, p < 0.001) | g = 0.99 (Large) | |||||||||
Long et al. (2022), USA [75] | Adapted survey from the Jefferson Scale of Physician Empathy [139] and the Jefferson Scale of Patient’s Perceptions of Physician Empathy [140] with no reported reliability or validity | Understanding (empathy) the LGBTQ + people | Post event, 87.5% of respondents agreed that they could better understand their LGBTQ + patients’ emotions, feelings, and concerns | ↑ | ⇑⇑ | ⇑⇑ | |||||
Gay Affirmative Practice scale [122] with reported validity and reliability with a Cronbach’s alpha of 0.99 (belief questions) and 0.96 (practice questions) | Belief in appropriate feelings and behaviors when caring for LGBTQ + patients | Participants showed higher belief scores than those who did not attend the event (Mean 71.38 versus 63.90, p = 0.024) | g = 0.46 (Small) | ||||||||
LGBTQ + affirming practices | Participants showed higher practice scores than those who did not attend the event (Mean 70.05 versus 56.12, p < 0.001) | g = 0.81 (Large) | |||||||||
McGarry et al. (2002), USA [76] | Author-developed survey (Lower scores indicate positive changes) No report about reliability or validity | Preparedness to care for lesbian and gay patients | Increased preparedness to care for lesbian and gay patients (Mean ± SD: 2.35 ± 0.95 → 1.88 ± 0.70, p < 0.001) | g = 0.56 (Medium) | ⇑⇑ | → | |||||
Comfort level working with lesbian and gay clients | No significant change in comfort level working with lesbian clients (Mean ± SD: 2.19 ± 0.99 → 1.94 ± 0.74, p = 0.06) | g = 0.29 (Small) | |||||||||
No significant change in comfort level working with gay patients (Mean ± SD: 2.08 ± 0.92 → 1.86 ± 0.53, p = 0.07) | g = 0.31 (Small) | ||||||||||
Oblea et al. (2022), USA [77] | The Ally Identity Measure tool [124] (3 subscales: knowledge and skills, openness and support, and awareness of oppression) with reported validity and reliability with a Cronbach’s alpha of 0.79 to 0.91) | Attitudes toward LGBTQ + persons (openness toward LGBTQ + people and support toward LGBTQ + individuals) | Increased mean scores in the openness and support subscale (Mean ± SD: 3.92 ± 0.64 → 4.11 ± 0.64, p < 0.001) | g = 0.24 (Small) | ⇑⇑ | ⇑⇑ | ⇑⇑ | ||||
Knowledge of the LGBTQ + community and LGBTQ + health | Improved mean scores in the knowledge subscale (Mean ± SD: 3.14 ± 0.78 → 3.73 ± 0.76, p < 0.001) | g = 0.67 (Medium) | |||||||||
Skills to work with LGBTQ + patients | Improved mean scores in the skills subscale (Mean ± SD: 3.14 ± 0.78 → 3.73 ± 0.76, p < 0.001) | g = 0.67 (Medium) | |||||||||
Awareness of oppression of LGBTQ + communities | Increased mean scores in the oppression awareness subscale (Mean ± SD: 4.175 ± 0.65 → 4.38 ± 0.60, p < 0.001) | g = 0.26 (Small) | |||||||||
Pachankis et al. (2022), USA, Canada, Uganda [96] | The Sexual Orientation Counselor Competency Scale (SOCCS) [130] with reported reliability with Cronbach’s alpha of 0.83 to 0.91 | Clinical skills in LGBTQ-affirmative cognitive behavioral therapy | The intervention group showed relative improvements in self-reported LGBTQ + cultural competence compared to the control group (p < 0.001) Intervention group (Mean ± SE: 3.31 ± 0.17 → 5.05 ± 0.15) Control group (Mean ± SE: 3.30 ± 0.19 → 3.14 ± 0.18) | g = 1.23 (Large) | ⇑⇑ | ⇑⇑ | |||||
The Multidimensional Cultural Humility Scale (MCHS) [141] with reported reliability with Cronbach’s alpha of 0.68 to 0.75 | Cultural humility when working with LGBTQ + clients | The intervention group did not show relative improvements in LGBTQ + cultural humility (p > 0.05) Intervention group (Mean ± SE: 76.48 ± 0.90 → 77.34 ± 0.88) Control group (Mean ± SE: 75.28 ± 0.83 → 75.76 ± 1.03) | g = 0.48 (Small) | ||||||||
Author-developed survey No report about reliability or validity | Knowledge of minority stress theory | The intervention group showed relative improvements in minority stress knowledge compared to the control group (p < 0.001) Intervention group (Mean ± SE: 7.02 ± 0.19 → 8.05 ± 0.21) Control group (Mean ± SE: 7.15 ± 0.19 → 7.04 ± 0.26) | g = 1.14 (Large) | ||||||||
Author-developed survey No report about reliability or validity | Knowledge of general cognitive behavioral therapy and LGBTQ-affirmative cognitive behavioral therapy skills | The intervention group showed relative improvements in LGBTQ-affirmative cognitive behavioral therapy knowledge compared to the control group (p < 0.001) Intervention group (Mean ± SE: 5.36 ± 0.24 → 6.77 ± 0.30) Control group (Mean ± SE: 5.48 ± 0.21 → 5.46 ± 0.26) | g = 1.38 (Large) | ||||||||
Author-developed survey with reported reliability of Cronbach’s alpha of 0.77 to 0.85 | Self-reported familiarity with the LGBTQ-affirmative cognitive behavioral therapy skills | The intervention group showed relative improvements in LGBTQ-affirmative skills familiarity compared to the control group (p < 0.001) Intervention group (Mean ± SE: 18.30 ± 0.76 → 24.34 ± 0.66) Control group (Mean ± SE: 19.00 ± 0.66 → 19.70 ± 0.76) | g = 5.03 (Large) | ||||||||
LGBTQ-affirmative kills use | The intervention group showed relative improvements in LGBTQ-affirmative skills use compared to the control group (p < 0.001) Intervention group (Mean ± SE: 16.77 ± 0.67 → 22.93 ± 0.72) Control group (Mean ± SE: 17.53 ± 0.66 → 18.46 ± 0.77) | g = 4.99 (Large) | |||||||||
Author-developed simulated practice assessment | LGBTQ-affirmative cognitive behavioral therapy skills | The intervention group showed relative improvements in LGBTQ-affirmative cognitive behavioral therapy skills compared to the control group (p < 0.001) Intervention group (Mean ± SE: 0.11 ± 0.0.2 → 0.24 ± 0.03) Control group (Mean ± SE: 0.12 ± 0.02 → 0.14 ± 0.02) | g = 0.12 (Trivial) | ||||||||
Pelts and Galambos (2017), USA [78] | The Components of Attitudes Toward Homosexuality Scale [131] with reported reliability with a Cronbach’s alpha of 0.79 to 0.91 | Attitude toward lesbian and gay older adults | Improved attitudes toward caring for lesbian and gay clients (Mean ± SD: 85.45 ± 12.04 → 87.66 ± 11.54, p < 0.001) | g = 0.19 (Trivial) | ⇑⇑ | ||||||
Pepping et al. (2018), Australia [79] | The Modern Homonegativity Scale [142] with reported reliability with a Cronbach’s alpha of 0.85 | Reduction of homonegativity | Decreased homonegativity (Mean ± SD: 17.83 ± 5.64 → 16.37 ± 4.60, p < 0.004) | g = 0.29 (Small) | ⇑⇑ | ⇑⇑ | ⇑⇑ | ||||
Adapted the Modern Homonegativity Scale with reported reliability with a Cronbach’s alpha of 0.88 | Reduction of trans-negativity | Decreased trans-negativity (Mean ± SD: 17.28 ± 5.82 → 16.05 ± 4.74, p < 0.001) | g = 0.23 (Small) | ||||||||
The Lesbian, Gay, and Bisexual Affirmative Counseling Self-Efficacy Inventory (LGB-CSI) [143] with reported reliability with a Cronbach’s alpha of 0.96 (knowledge), 0.95 (advocacy), 0.92 awareness, 0.89 (relationship), and 0.81 (relationship) | Knowledge of the LGBTQ + community and LGBTQ + mental health | Increased perceived knowledge about the LGB people and their mental health (Mean ± SD: 32.51 ± 12.52 → 45.99 ± 13.46, p < 0.004) | g = 1.04 (Large) | ||||||||
Increased perceived knowledge about the transgender people and their mental health (Mean ± SD: 29.27 ± 12.73 → 43.74 ± 14.44, p < 0.004) | g = 1.07 (Large) | ||||||||||
Advocacy skills for LGBTQ + patients | Improved self-assessed advocacy skills to work with LGB patients (Mean ± SD: 16.12 ± 7.60 → 21.76 ± 7.85, p < 0.004) | g = 0.73 (Medium) | |||||||||
Improved self-assessed advocacy skills to work with transgender patients (Mean ± SD: 14.23 ± 7.42 → 19.74 ± 8.49, p < 0.004) | g = 0.69 (Medium) | ||||||||||
Awareness of health professionals’ own feelings about sexual orientation/gender identity and LGBTQ + patients | Increased awareness of health professionals’ own feelings about sexual orientation/gender identity and LGB patients (Mean ± SD: 19.28 ± 5.47 → 23.00 ± 4.41, p < 0.004) | g = 0.75 (Medium) | |||||||||
Increased awareness of health professionals’ own feelings about sexual orientation/gender identity and transgender patients (Mean ± SD: 18.57 ± 5.70 → 22.92 ± 4.77, p < 0.004) | g = 0.83 (Large) | ||||||||||
Assessment of mental health for LGBTQ + people | Enhanced mental health assessment for LGB individuals (Mean ± SD: 12.55 ± 4.44 → 15.70 ± 4.44, p < 0.004) | g = 0.71 (Medium) | |||||||||
Enhanced mental health assessment for transgender individuals (Mean ± SD: 11.78 ± 4.57 → 15.46 ± 4.57, p < 0.004) | g = 0.81 (Large) | ||||||||||
Capacity to form a therapeutic relationship with LGBTQ + patients | Improved a capacity to form a therapeutic relationship with LGB patients (Mean ± SD: 10.73 ± 3.50 → 12.64 ± 3.42, p < 0.004) | g = 0.55 (Medium) | |||||||||
Improved a capacity to form a therapeutic relationship with transgender patients (Mean ± SD: 9.51 ± 3.62 → 12.05 ± 3.44, p < 0.004) | g = 0.71 (Medium) | ||||||||||
Pratt-Chapman (2020), USA [80] | Cultural Competency Assessment (CCA) [144] with reported validity and reliability with a Cronbach’s alpha of 0.92 | Cultural awareness and sensitivity for LGBTQ + individuals | No significant change in cultural awareness and sensitivity for LGBTQ + patients (Mean ± SD: 28 ± 3.73 → 28.647 ± 4.80, p = 0.430) | g = 0.15 (Trivial) | → | ⇑⇑ | → | → | |||
Cultural behavior toward LGBTQ + persons | No significant change in cultural behavior toward LGBTQ + patients (Mean ± SD: 43.647 ± 10.48 → 48.294 ± 13.33, p = 0.055) | g = 0.38 (Small) | |||||||||
Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) [123] with reported validity and reliability with a Cronbach’s alpha of 0.86 | Attitude toward caring for LGBTQ + patients | Improved attitudes toward caring for LGBTQ + clients (Mean ± SD: 23.2 ± 4.67 → 24.8 ± 4.11, p = 0.046) | g = 0.35 (Small) | ||||||||
Clinical preparedness to work with LGBTQ + people | No significant change in clinical preparedness to work with LGBTQ + individuals (Mean ± SD: 13.5 ± 6.96 → 15.5 ± 6.71, p = 0.117) | g = 0.28 (Small) | |||||||||
Knowledge of the LGBTQ + community and LGBTQ + health | No significant change in perceived knowledge of the LGBTQ + community and LGBTQ + health (Mean ± SD: 12.063 ± 3.87 → 13.313 ± 2.75, p = 0.116) | g = 0.37 (Small) | |||||||||
Pratt-Chapman (2021), USA [81] | Gay Affirmative Practice scale [122] with no report about reliability or validity | Gay-affirming behaviors (baseline assessment only) | The lowest mean score from self-reported baseline gay-affirming behaviors was “I help clients identify their internalized homophobia” | ⇑⇑ | → | ⇑⇑ | |||||
Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) [123] with no report about reliability or validity Lower scores indicate greater competence | Clinical preparedness to work with LGBTQ + people | Improved clinical preparedness to work with LGBTQ + persons (Mean ± SD: 20.76 ± 5.514 → 15.51 ± 4.377, p < 0.001) | g = 1.04 (Large) | ||||||||
Knowledge of the LGBTQ + community and LGBTQ + health | Expanded perceived knowledge of the LGBTQ + community and LGBTQ + health (Mean ± SD: 7.58 ± 2.996 → 5.59 ± 1.930, p < 0.001) | g = 0.79 (Medium) | |||||||||
Attitude in caring for LGBTQ + patients | No significant change in attitudes toward caring for LGBTQ + patients (Mean ± SD: 8.43 ± 2.084 → 8.80 ± 3.7, p = 0.544) | g = 0.13 (Trivial) | |||||||||
Pratt-Chapman et al. (2022), USA [82] | Author-developed survey (QUIRKS: Queering Individual and Relational Skills and Knowledge Scales) Lower scores indicate more LGBTQ + affirming care No report about reliability or validity | Knowledge of affirming care for LGBTQ + patients | Expanded perceived knowledge of affirming care for LGBTQ + patients (Mean ± SD: 6.86 ± 3.44 → 5.86 ± 3.03, p = 0.043) | g = 0.31 (Small) | ⇑⇑ | → | ⇑⇑ | ⇑⇑ | |||
Clinical preparedness to provide affirming care to LGBTQ + people | Improved clinical preparedness to provide affirming care to LGBTQ + persons (Mean ± SD: 9.25 ± 3.99 → 3.13 ± 2.42, p = 0.006) | g = 1.88 (Large) | |||||||||
Clinical behaviors regarding welcoming LGBTQ + individuals | Improved clinical behaviors regarding welcoming LGBTQ + individuals (Mean ± SD: 4.23 ± 3.02 → 2.68 ± 3.14, p = 0.022) | g = 0.51 (Medium) | |||||||||
Attitude toward LGBTQ + care | No significant change in attitudes toward LGBTQ + care (Mean ± SD: 2.64 ± 2.09 → 2.27 ± 2.57, p = 0.502) | g = 0.16 (Trivial) | |||||||||
Environmental cues in clinic | Improved environmental cues in clinic (Mean ± SD: 2.55 ± 2.02 → 1.32 ± 1.84, p = 0.018) | g = 0.63 (Medium) | |||||||||
Rhoten et al. (2021), USA [83] | Author-developed survey No report about reliability or validity | Knowledge about the LGBTQ + community | Increased objective/factual knowledge about the LGBTQ + community (p < 0.001) | ⇑⇑ | ⇑⇑ | ⇑⇑ | ⇑⇑ | ||||
Attitude toward LGBTQ + people | Improved attitudes toward LGBTQ + persons (p < 0.001) | ||||||||||
Self-efficacy | Enhanced self-efficacy (p < 0.001) Only an increase in self-efficacy was significantly correlated with respondents’ improvement in behavioral intention from pretest to posttest (OR = 1.43, 95% CI: 1.22, 1.67, p < 0.001) | ||||||||||
Behavioral intentions | Improved behavioral intentions (p < 0.001) | ||||||||||
Rosa-Vega et al. (2020), USA [84] | Author-developed survey with reported validity and reliability with a Kuder-Richardson Formula 20 of 0.653 | Knowledge about transgender health and hormone treatments | Increased objective/factual knowledge about the transgender community (Mean: 72.49 → 85.91, p < 0.001) | ω2 = 0.11 (Medium) | ⇑⇑ | ||||||
Increased objective/factual knowledge about transgender health (Mean 50.79 → 66.53, p < 0.001) | ω2 = 0.26 (Large) | ||||||||||
Increased objective/factual knowledge about gender-affirming medications (Mean 45.06 → 70.28, p < 0.001) | ω2 = 0.40 (Large) | ||||||||||
Russell and Corbitt (2022), USA [85] | Author-developed survey No report about reliability or validity | Attitude toward LGBTQ + people | No significant change in attitudes toward LGBTQ + patients (Mean ± SD: 3.65 ± 1.289 → 3.74 ± 1.488, p > 0.05) | g = 0.06 (Trivial) | → | ⇑⇑ | |||||
Confidence in providing care to LGBTQ + patients | Increased confidence in providing care to LGBTQ + patients (Mean ± SD: 3.19 ± 1.11 → 4.11 ± 0.828, p < 0.001) | g = 0.95 (Large) | |||||||||
Schweiger-Whalen et al. (2019), USA [86] | Gay Affirmative Practice scale [122] with reported validity and reliability with a Cronbach’s alpha of 0.93 | Behaviors in practice when caring for LGBTQ + individuals | Improved the GAP (beliefs and behaviors) scores (Mean ± SD: 66.03 ± 6.27 → 70.61 ± 5.94, p < 0.001) | g = 0.75 (Medium) | ⇑⇑ | ⇑⇑ | ⇑⇑ | ||||
Beliefs about practice with LGBT + individuals | |||||||||||
Author-developed survey No report about reliability or validity | Knowledge of the LGBTQ + community and LGBTQ + health | Increased objective/factual knowledge about the LGBTQ + community and LGBTQ + health (Mean ± SD: 6.90 ± 2.18 → 10.18 ± 2.20, p < 0.001) | g = 1.49 (Large) | ||||||||
Seay et al. (2020), USA [87] | Author-developed survey No report about reliability or validity | Knowledge of the LGBTQ + community and LGBTQ + health | Increased objective/factual knowledge about the LGBTQ + community and LGBTQ + health (Mean ± SD: 9.6 ± 1.7 → 11 ± 1.0, p < 0.001) | g = 1.03 (Large) | ⇑⇑ | ⇑⇑ | ⇑⇑ | ||||
Adapted survey from the Modern Homonegativity Scale (MHS) [142] and the Physicians’ Attitudes Toward Lesbian, Gay, Bisexual, and Transgender Patients Scale (ATLGBTP) [145] with reported validity and reliability with a Cronbach’s alpha of 0.90 and 0.54 respectively | Attitude toward LGBTQ + patients | Improved attitudes toward LGBTQ + patients (Mean ± SD: 22.1 ± 1.8 → 22.8 ± 1.9, p = 0.019) | g = 0.38 (Small) | ||||||||
Decreased homonegativity (Mean ± SD: 23.6 ± 8.6 → 19.8 ± 6.5, p = 0.002) | g = 0.51 (Medium) | ||||||||||
Gay Affirmative Practice scale [122] with reported validity and reliability with a Cronbach’s alpha of 0.95 | LGBTQ + affirming clinical practices | Increased LGBTQ + affirming clinical practices (Mean ± SD: 51.3 ± 6.7 → 55.8 ± 7.3, p < 0.001) | g = 0.63 (Medium) | ||||||||
Shrader et al. (2017), USA [88] | Author-developed survey No report about reliability or validity | Knowledge of LGBTQ + terminology, cultural sensitivity, LGBTQ + health needs and health disparities | Increased objective/factual knowledge of LGBTQ + terminology, cultural sensitivity, LGBTQ + health needs and health disparities | ↑ | |||||||
Stevenson et al. (2020), USA [89] | Author-developed survey No report about reliability or validity | Knowledge about the endocrine treatment of transgender patients | Did not improve perceived knowledge about the endocrine treatment of transgender patients | ↓ | ↓ | ↓ | |||||
Skills to work with transgender clients | Decreased self-assessed communication skills with transgender patients | ||||||||||
Comfort level providing care to transgender patients | Decreased comfort level in providing compassionate, appropriate, and effective care to transgender patients | ||||||||||
Traister (2020), USA [90] | Knowledge of Lesbian, Gay, Bisexual, and Transgender People (KLGBT) questionnaire [132] with reported validity and reliability with a Cronbach’s alpha of 0.54 | Knowledge of the LGBTQ + community and LGBTQ + health | Increased objective/factual knowledge about the LGBTQ + community and LGBTQ + health (Mean ± SD: 14.18 ± 1.16 → 14.76 ± 0.70, p < 0.001) | g = 0.62 (Medium) | ⇑⇑ | → | |||||
Modified Attitudes Toward Lesbians and Gay Men (ATLG) scale [132] & Attitudes Toward Lesbian, Gay, Bisexual and Transgender Patients (ATLGBTP) scale [145] with reported validity and reliability with a Cronbach’s alpha of 0.95 and 0.54 respectively | Attitude toward LGBTQ + patients | No significant change in attitudes toward LGBTQ + persons (Mean ± SD: 3.86 ± 0.58 → 3.94 ± 0.59, p = 0.30) | g = 0.14 (Trivial) | ||||||||
Ufomata et al. (2018), USA [91] | Author-developed survey No report about reliability or validity | Knowledge of the LGBTQ + community and LGBTQ + primary care | Increased objective/factual knowledge about primary care for LGBTQ + patients (Mean overall score 42% → 66%, p < 0.001) | ⇑⇑ | ⇑⇑ | ||||||
Perceived confidence in providing primary care to LGBTQ + patients | Increased confidence in implementing gender-neural practices (Mean ± SD: 3.10 ± 0.83 → 3.52 ± 0.57, p = 0.0062) | g = 0.59 (Medium) | |||||||||
No significant change in confidence in eliciting disclosure of gender identity (Mean ± SD: 3.39 ± 0.76 → 3.68 ± 0.60, p = 0.0999) | g = 0.42 (Small) | ||||||||||
Walia et al. (2019), USA [92] | Author-developed survey No report about reliability or validity | Knowledge of the LGBTQ + community and LGBTQ + adolescent health | Increased objective/factual knowledge about the LGBTQ + community and LGBTQ + adolescent health (Median/IQR: 5/4–6 → 6/4–7, p = 0.011) | ⇑⇑ | → | ||||||
Level of comfort working with LGBTQ + pediatric patients | No significant improvement in comfort in LGBTQ + culturally competent care (p > 0.05) | ||||||||||
Weeks et al. (2018), USA [93] | Author-developed survey with reported reliability and validity | Knowledge of the LGBTQ + community and LGBTQ + adolescent health | Increased objective/factual knowledge about the LGBTQ + community and LGBTQ + adolescent health (Mean ± SD: 15.11 ± 2.76 → 16.74 ± 2.29, p < 0.001) | g = 0.65 (Medium) | ⇑⇑ | ||||||
White-Hughto et al. (2017), USA [94] | Author-developed survey No report about reliability or validity | Willingness to provide gender-affirming care | Increased willingness to provide gender-affirming care from pre- to post-test (Mean ± SD: 4.20 ± 0.61 → 4.62 ± 0.49, p < 0.001) | g = 0.75 (Medium) | → | ⇑⇑ | ⇑⇑ | ||||
Increased willingness to provide gender-affirming care from pre-test to 3-month follow-up (Mean ± SD: 4.20 ± 0.61 → 4.57 ± 0.50, p < 0.001) | g = 0.66 (Medium) | ||||||||||
Transgender Knowledge, Attitudes and Beliefs (TKAB) scale [146] with reported validity and reliability with a Cronbach’s alpha of 0.96 | Cultural competence (Providers’ knowledge about transgender people and beliefs including transgender stigma and willingness to interact with transgender persons) | Increased cultural competence scores from pre- to post-test (Mean ± SD: 67.54 ± 11.64 → 70.15 ± 10.69, p = 0.03) | g = 0.23 (Small) | ||||||||
Increased cultural competence scores from pre-test to 3-month follow-up (Mean ± SD: 67.54 ± 11.64 → 71.21 ± 10.92, p = 0.01) | g = 0.33 (Small) | ||||||||||
Transgender Clinical Competence (TCC) scale [147] with reported validity and reliability with a Cronbach’s alpha of 0.75 to 0.81 | Clinical competence (Providers’ general healthcare knowledge and medical gender affirmation knowledge) | No significant change in objective/factual knowledge about general healthcare for transgender patients from pre- to post-test (Mean ± SD: 36.74 ± 4.29 → 37.76 ± 4.36, p = 0.08) | g = 0.24 (Small) | ||||||||
No significant change in objective/factual knowledge about general healthcare for transgender patients from pre-test to 3-month follow-up without statistical significance (Mean ± SD: 36.74 ± 4.28 → 37.71 ± 4.07, p = 0.09) | g = 0.23 (Small) | ||||||||||
Increased objective/factual knowledge about medical gender affirmation from pre- to post-test with statistical significance (Mean ± SD: 26.81 ± 3.00 → 29.09 ± 3.32, p < 0.001) | g = 0.71 (Medium) | ||||||||||
No significant change in objective/factual knowledge about medical gender affirmation from pre-test to 3-month follow-up without statistical significance (Mean ± SD: 26.81 ± 3.00 → 27.86 ± 2.97, p = 0.08) | g = 0.35 (Small) | ||||||||||
Adapted from Thomas and Safer (2015) [148] No report about reliability or validity | Self-efficacy to provide medical gender affirmation therapies (Initiating hormones to transgender men, initiating hormones to transgender women, and continuing hormones for transgender patients) | Increased scores of self-efficacies to initiate hormones for a transgender man from pre- to post-test (Mean ± SD: 2.21 ± 0.74 → 2.53 ± 0.76, p = 0.04) | g = 0.43 (Small) | ||||||||
Increased scores of self-efficacies to initiate hormones for a transgender woman from pre- to post-test with statistical significance (Mean ± SD: 2.38 ± 0.78 → 2.78 ± 0.55, p = 0.004) | g = 0.61 (Medium) | ||||||||||
From baseline to 3-month follow-up, no significant change in scores of self-efficacies to initiate hormones for a transgender man (Mean ± SD: 2.21 ± 0.74 → 2.46 ± 0.84, p = 0.06) | g = 0.32 (Small) | ||||||||||
From baseline to 3-month follow-up, increased scores of self-efficacies to initiate hormones for a transgender woman (Mean ± SD: 2.38 ± 0.78 → 2.75 ± 0.70, p = 0.01) | g = 0.49 (Small) | ||||||||||
Wyckoff (2019), USA [95] | Gay Affirmative Practice scale [122] with reported validity and reliability with a Cronbach’s alpha of 0.95 | Behaviors in practice when caring for gay and lesbian individuals | Improved the GAP behavior subscale score (Mean ± SD: 47.60 ± 15.75 → 58.07 ± 16.71, p < 0.05) | g = 0.64 (Medium) | → | ⇑⇑ | |||||
Beliefs about practice with gay and lesbian individuals | No significant change in the GAP belief subscale score (Mean ± SD: 64.10 ± 8.42 → 66.87 ± 8.15, p > 0.05) | g = 0.22 (Small) | |||||||||