LGBTQ + cultural competency training for health professionals: a systematic review
Background
Health disparities experienced by LGBTQ + individuals have been partially attributed to health professionals’ lack of cultural competence to work with them. Cultural competence, the intricate integration of knowledge, skills, attitudes, and behaviors that improve cross-cultural communication and interpersonal relationships, has been used as a training framework to enhance interactions between LGBTQ + patients and health professionals. Despite multiple published LGBTQ + cultural competency trainings, there has been no quantitative appraisal and synthesis of them. This systematic review assessed articles evaluating the design and effectiveness of these trainings and examined the magnitude of their effect on cultural competence outcomes.
Methods
Included studies quantitatively examined the effectiveness of LGBTQ + cultural competency trainings for health professionals across all disciplines in various healthcare settings. 2,069 citations were retrieved from five electronic databases with 44 articles meeting inclusion criteria. The risk of bias in the included studies was assessed by two authors utilizing the Joanna Briggs Institute critical appraisal checklists. Data extracted included study design, country/region, sample characteristic, training setting, theoretical framework, training topic, modality, duration, trainer, training target, measurement instrument, effect size and key findings. This review followed the PRISMA statement and checklist to ensure proper reporting.
Results
75% of the studies were published between 2017 and 2023. Four study designs were used: randomized controlled trial (n = 1), quasi-experimental pretest–posttest without control (n = 39), posttest only with control (n = 1) and posttest only without control (n = 3). Training modalities were multiple modalities with (n = 9) and without simulation (n = 25); single modality with simulation (n = 1); and with didactic lectures (n = 9). Trainings averaged 3.2 h. Ten studies employed LGBTQ + trainers. The training sessions resulted in statistically significant improvements in the following cultural competence constructs: (1) knowledge of LGBTQ + culture and health (n = 28, effect size range = 0.28 – 1.49), (2) skills to work with LGBTQ + clients (n = 8, effect size range = 0.12 – 1.12), (3) attitudes toward LGBTQ + individuals (n = 14, effect size range = 0.19 – 1.03), and (4) behaviors toward LGBTQ + affirming practices (n = 7, effect size range = 0.51 – 1.11).
Conclusions
The findings of this review highlight the potential of LGBTQ + cultural competency training to enhance cultural competence constructs, including (1) knowledge of LGBTQ + culture and health, (2) skills to work with LGBTQ + clients, (3) attitudes toward LGBTQ + individuals, and (4) behaviors toward LGBTQ + affirming practices, through an interdisciplinary and multi-modal approach. Despite the promising results of LGBTQ + cultural competency training in improving health professionals’ cultural competence, there are limitations in study designs, sample sizes, theoretical framing, and the absence of longitudinal assessments and patient-reported outcomes, which call for more rigorous research. Moreover, the increasing number of state and federal policies that restrict LGBTQ + health services highlight the urgency of equipping health professionals with culturally responsive training. Organizations and health systems must prioritize organizational-level changes that support LGBTQ + inclusive practices to provide access to safe and affirming healthcare services for LGBTQ + individuals.
Top-30
Journals
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6
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Journal of Homosexuality
6 publications, 6.67%
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Sexuality Research and Social Policy
4 publications, 4.44%
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Healthcare
3 publications, 3.33%
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BMC Medical Education
2 publications, 2.22%
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Frontiers in Public Health
2 publications, 2.22%
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JMIR Formative Research
2 publications, 2.22%
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Health Promotion Practice
2 publications, 2.22%
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BMJ Open
2 publications, 2.22%
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American Journal of Pharmaceutical Education
2 publications, 2.22%
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Journal of Sexual Medicine
2 publications, 2.22%
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Sexual and Gender Diversity in Social Services
2 publications, 2.22%
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American Journal of Health-System Pharmacy
1 publication, 1.11%
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Journal of Adolescent Health
1 publication, 1.11%
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Journal of the American Pharmacists Association : JAPhA
1 publication, 1.11%
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Journal of Pediatric Health Care
1 publication, 1.11%
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Nurse Educator
1 publication, 1.11%
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Archives of Sexual Behavior
1 publication, 1.11%
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Frontiers in Sociology
1 publication, 1.11%
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Supportive Care in Cancer
1 publication, 1.11%
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Academic Radiology
1 publication, 1.11%
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Evidence-based nursing
1 publication, 1.11%
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Archives of Psychiatric Nursing
1 publication, 1.11%
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International Journal of Systemic Therapy
1 publication, 1.11%
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Journal of Dental Education
1 publication, 1.11%
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Current Treatment Options in Psychiatry
1 publication, 1.11%
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Sex Education
1 publication, 1.11%
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Pastoral Psychology
1 publication, 1.11%
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International Journal of Nursing Studies Advances
1 publication, 1.11%
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Obstetrics and Gynecology Clinics of North America
1 publication, 1.11%
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6
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Publishers
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2
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20
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Springer Nature
19 publications, 21.11%
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Elsevier
19 publications, 21.11%
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Taylor & Francis
15 publications, 16.67%
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MDPI
5 publications, 5.56%
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BMJ
5 publications, 5.56%
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Oxford University Press
4 publications, 4.44%
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Frontiers Media S.A.
4 publications, 4.44%
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Wiley
4 publications, 4.44%
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SAGE
4 publications, 4.44%
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Ovid Technologies (Wolters Kluwer Health)
2 publications, 2.22%
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JMIR Publications
2 publications, 2.22%
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Research Square Platform LLC
1 publication, 1.11%
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American Medical Association (AMA)
1 publication, 1.11%
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Public Library of Science (PLoS)
1 publication, 1.11%
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Mary Ann Liebert
1 publication, 1.11%
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IntechOpen
1 publication, 1.11%
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Cold Spring Harbor Laboratory
1 publication, 1.11%
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SLACK
1 publication, 1.11%
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20
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- We do not take into account publications without a DOI.
- Statistics recalculated weekly.