The role of health professionals in providing patient-centered and equitable care to LGBTIQ+ patients: translation, cultural adaptation and validation of the Greek version of Lesbian, Gay, Bisexual and Transgender Development of Clinical Skills Scale

Ilias Pagkozidis, Bettina Haidich, Loukas Athanasiadis, Theodoros Dardavesis, Zoi Tsimtsiou

Keywords: quality in healthcare, patient-centeredness, equity, validation, LGBTIQ+, LGBT-DOCSS

Background:

Ensuring patient-centered and equitable care is intertwined with quality in primary care and important for minorities, such as the LGBTIQ+ community, often described as having limited access, lower satisfaction with health services, and worse health outcomes. This study aimed at providing a valid and reliable Greek version of a tool, allowing the recording of knowledge, attitudes and clinical preparedness of health professionals towards LGBTIQ+ patients.

Research questions:

Is the Greek version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) valid and reliable?

Method:

After obtaining permission by the scale’s developer, bilingual translation was performed, followed by cultural adaptation, which shaped the Greek version of LGBT-DOCSS, after interviewing 13 health professionals. A validation study was carried out among health professionals, at Hippocratio General Hospital of Athens. The validity of the Greek version was tested with structural validity (convergent and known groups validity) and face validity, while internal consistency and test-retest reliability (second completion after 2-3 weeks by same participants) were applied to test reliability.

Results:

Overall, 238 healthcare professionals participated in the study. The Greek LGBT-DOCSS demonstrated known groups validity, with groups characterized by older age, stronger religiosity, no contact with LGBTIQ+ individuals at work or personal life, no LGBTIQ+ health education, and heterosexual orientation being associated with lower scores (p<0.05). Convergent validity was demonstrated (correlation with the Greek version of Attitudes towards Lesbians and Gay men (ATLG) scale, Spearman's rho=-0.598, p<0.001), while face validity was confirmed by 81.9% (n=195) of participants (median 8/10). Regarding reliability, satisfactory internal consistency (Cronbach a=0.785) and test-retest reliability (Pearson's r=0.793 and student's t-test p=0.7) were found.

Conclusions:

The Greek version of LGBT-DOCSS is a valid and reliable scale, the only tool available in Greece for mapping health professionals' knowledge, readiness and attitudes towards LGBT patients, in efforts to ensure provision of patient-centered and equitable care.

Points for discussion:

What are the difficulties, if any, that health professionals in primary care face when catering for LGBTIQ+ patients?

Are health professionals in primary care prepared for providing patient-centered and equitable care to LGBTIQ+ patients?

How do you aid LGBTIQ+ patients in realizing their full health potential?