Trans-Inclusive Provider Scale

Background

Transgender and gender diverse (TGD) individuals experience barriers to accessing culturally responsive care across different types of health services. Although there have been scales to assess allyship and trans-inclusive behavior regarding this population, there is no scale to assess and support health providers in offering affirming care to these individuals. This study develops and validates a scale to assess for trans-inclusive healthcare practices, which may be used in a variety of ways.

Methods

The authors and community partners, along with focus groups of transgender and nonbinary individuals, developed 34 initial practices indicating provider inclusivity of transgender and gender diverse patients. Data were collected in 2018, using an online survey of transgender and gender diverse adults in Michigan (n=626) as part of the Michigan Trans Health Survey, analyzed in 2019. To create the final scale, a self-response 5-point rating scale asked participants their opinion about how important each item would be for making their provider transgender-inclusive. On this scale, 1 represented not important and 5, very important. Ten cognitive interviews were conducted to assess how participants would understand the items and directions.

Results

An exploratory factor analysis was conducted. In this exploratory factor analysis, the Kaiser–Meyer–Olkin Measure of Sampling Adequacy was 0.907, exceeding the recommended value of 0.6, and the Bartlett's test of sphericity reached significance (χ²=14,052.719, df=435, p<0.001), supporting the factorability of the correlation matrix. A 6-factor scale emerged. The following 6 components were retained with 27 items: trans-inclusive messaging, name/pronoun usage, outreach, gender-affirming practice, referral comfort, and inclusive intake forms. Full sample analysis showed Cronbach's α to be 0.91. The sample was split in half to run 2 sets of cases in a principal components analysis, Sample A (n=323) and Sample B (n=303). Percentage of variance explained and Cronbach's α were consistent across samples, giving evidence to reliability and validity.

Conclusions and Implications

Findings suggest that the Trans Inclusive Provider Scale may be useful in identifying providers’ behaviors regarding inclusivity of transgender and gender diverse patients and provide growth opportunities at both individual and practice levels. he validated TIPS can be used in multiple ways and in various settings, including healthcare settings, public health research, and medical schools. It was originally designed for use as a pretest/post-test mechanism for healthcare professionals to assess the efficacy of transgender health training in changing practice behaviors. However, throughout the development process, members of both the healthcare profession and of the TGD population have noted a variety of uses for this scale beyond measuring training efficacy. It could also guide improvements after trainings or be used as a micro-intervention, allowing providers to assess behaviors and identify opportunities to improve.