Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Practitioners were surveyed about knowledge, preparedness, and attitudes toward treating LGBT clients. Multivariate analysis was used to compare LGBT–Development of Clinical Skills Scale scores and characteristics of respondents (N = 558). Type of degree, setting, experience, religiosity, and hours of education contributed to significant differences in knowledge and preparedness, but not attitudes. Findings suggest even minimal practitioner education has potential for improving equity and inclusion for LGBT population.
Primary Author and Speaker: Deborah J. Bolding
Additional Authors and Speakers: Angela Acosta, Brigitte Butler, April Chau, Brenna Craig, and Fiona Dunbar
Persons who identify as members of sexual or gender minority (SGM) populations often experience personal and structural barriers to quality healthcare which result in poorer health outcomes (IOM, 2011). Disparities are perpetuated by limited cultural competence, attitudes, and lack of education and training (Kuzma et al., 2019). Targeted education has increased the knowledge, skills and attitudes of physicians, nurses and other healthcare providers for working with the lesbian, gay, bisexual, and transgender (LGBT) population (Beck Dallaghan et al., 2018), but information about preparedness of occupational therapy (OT) practitioners for working with sexual and gender minority clients is limited.
PURPOSE: The purpose of this study was to identify OT practitioners self-reported knowledge, clinical preparedness and attitudes for working with LGBT clients using a tool with established reliability and validity, the LGBT-DOCSS (Bidell, 2017).
METHOD: Cross-sectional online survey data were collected from a volunteer sample of practitioners in Spring 2020. Participants (N = 558) were recruited via social media platforms, alumni associations, and snowball sampling. LGBT-DOCSS questions were scored for each subscale (knowledge, clinical preparedness, attitudes) to serve as a baseline for use as dependent variables in analyses. Respondent data also included age, gender identity, sexual orientation, educational degree, practice setting, years of experience, geographic region of practice, whether a family member or close friend identified as a sexual or gender minority, hours of continuing education, and religiosity. One-way ANOVA and Tukey's HSD were used to examine differences in mean subscale scores by demographic and other variables (significance established as p < .05).
RESULTS: Practitioners working in mental health practice areas, those who reported being close to an individual that identified as SGM, and those with master's degrees had significantly higher scores on all three subscales of the LGBT-DOCSS. Practitioners who had three or more hours of continuing education related to SGM had significantly higher self-reported knowledge and clinical preparedness. The percent of respondents who had continuing education on this topic was low: 67% percent reported having no continuing education related to working with SGM; 20% had 1-2 hours of training; only 12% reported 3 or more hours of continuing education. When compared to respondents who identified as heterosexual, respondents who identified as lesbian/gay had significantly higher results for knowledge and skills. Respondents who had practiced for 16 or more years scored significantly lower in the knowledge area, whereas respondents with less than 1 year of experience scored the highest. Attitude scores were significantly lower for respondents who reported religion was very important, in comparison to respondents reported that religion was somewhat, not so much or not at all important.
CONCLUSION: While the scope of the study does not cover all sexual and gender minorities, it nevertheless identified gaps in self-reported knowledge, clinical preparedness, and attitudes of occupational therapy practitioners working with the LGBT population. It demonstrated that a relatively small number of continuing education hours can impact self-perceived knowledge and clinical preparedness and underscores the need for self-assessment tools and training related to cultural differences and cultural humility, as well as practical information related to clients' occupational needs. This should be of interest to occupational therapy educators, managers, and practitioners who seek to improve the equity and inclusiveness of healthcare for sexual and gender minority clients.
References
Beck Dallaghan, G., Medder, L., Zabinski, J., Neeley, J., Roman, S., Emrich, M., Borges, N., & Bragg, N. (2018). Lesbian, gay, bisexual, and transgender health: A survey of attitudes, knowledge, preparedness, campus climate, and student recommendations for change in four Midwestern medical schools. Medical Science Educator, 28(1), 181-189. https://doi.org/10.1007/s406i70-018-0536-3
Bidell, M. P. (2017). The lesbian, gay, bisexual, and transgender development of clinical skills scale (LGBT-DOCSS): Establishing a new interdisciplinary self- assessment for health providers. Journal of Homosexuality, 64(10), 1432- 1460. https://doi.org/10.1080/00918369.2017.121389
Institute of Medicine (IOM). (2011). The health of lesbian, gay, bisexual, and transgender (LGBT) people: Building a foundation for better understanding. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK64801/
Kuzma, E. K., Pardee, M., & Darling-Fisher, C. S. (2019). Lesbian, gay, bisexual, and transgender health: Creating safe spaces and caring for patients with cultural humility. Journal of the American Association of Nurse Practitioners, 31(3), 167-174. https://doi.org/10.1097/JXX.0000000000000131
