International healthcare professionals' competence in caring for LGBTQ+ children and young people: a combined qualitative and quantitative approach.
TL;DR
Clinicians are motivated to provide inclusive care but system-level support, structured education and skills-based training are required to translate intent into competent, inclusive clinical practice.
Abstract
Objective
To evaluate healthcare professionals' attitudes, knowledge and clinical preparedness in caring for lesbian, gay, bisexual, transgender, queer/questioning; the + denoting inclusion of all identities (LGBTQ+) children and young people across international healthcare settings.
Design
Mixed-methods study incorporating quantitative self-assessment of clinical competency using the LGBT-Development of Clinical Skills Scale (LGBT-DOCSS) and qualitative free-text responses exploring educational needs and perceived barriers to providing inclusive care, hosted on the Don't Forget The Bubbles platform.
Participants
771 healthcare professionals; 770 included after removal of one duplicate. MAIN OUTCOME MEASURES Self-reported attitudes, knowledge and clinical preparedness using LGBT-DOCSS composite scores and qualitative coding of free-text responses examining contextual drivers of clinicians' confidence and practice.
Results
Respondents were largely experienced clinicians (66% with ≥10 years in healthcare). Mean total LGBT-DOCSS Score was 5.42/7 (SD 0.80). Attitudinal scores were high (mean 6.54, SD 0.88), while basic knowledge (5.40, SD 1.26) and clinical preparedness in particular (4.31, SD 1.29) were lower. Education-related preparedness items scored the lowest, particularly regarding transgender and gender-diverse care (2.92, SD 1.69). Qualitative analysis identified two themes: barriers to inclusive care, which encompassed structural constraints, cultural norms and emotional or psychological barriers; and desire for competence, which encompassed recognition of knowledge gaps, need for transgender-specific training and desire for practical, lived-experience-informed education.
Conclusions
Healthcare professionals report positive attitudes but limited knowledge and preparedness. Clinicians are motivated to provide inclusive care but system-level support, structured education and skills-based training are required to translate intent into competent, inclusive clinical practice.