Want to make your research and clinical practice more LGBTQ+ inclusive? Here’s how!
by Stéphanie Gauvin and Kat Merwin, SSTAR Student Members
Why do we care about LGBTQ+ inclusive research and clinical practices?
We know that components of sexual well-being (e.g., sexual satisfaction, sexual functioning, sexual distress) are important to study because of their associations with factors of global well-being, including general life happiness (Laumann et al., 2006), general health (Gallicchio et al., 2007), and relationship satisfaction (Lawrance et al., 1995; Santtila et al., 2008; Sprecher, 2002). Unfortunately, this information is based largely on research conducted with cisgender and heterosexual individuals. Despite the increasing number of research studies focusing on sexual and relational well-being in gender and sexually diverse individuals, there still remains a general tendency to exclude gender and sexually diverse individuals in the literature (e.g., Lehmiller), resulting in a disparate amount of knowledge compared to what is available on cisgender and heterosexual individuals. This lack of sexually and gender diverse voices in sex and relationship research has serious implications for providing culturally competent and evidence-based care to gender and sexually diverse individuals.
Providing clinical care that is culturally competent and evidence-based is important as historically, individuals in same-gender relationships have faced discrimination from healthcare institutions based on misconceptions about sexual orientation (e.g.,‘homosexuality’ as an illness in the Diagnostic and Statistical Manual (DSM) until 1973). Indeed, bridging this knowledge gap is especially important given that 45.2% of same-gender oriented individuals in one study reported that they had terminated a therapeutic relationship as a result of culturally incompetent care (Israel, Gorcheva, Burnes, & Walther, 2008).
By making our research practices more inclusive we can both avoid experiences of discrimination in research participation and help inform evidence-based, culturally competent care for gender and sexual diverse clients.
We hope that this blog post will help to start conversations and actions to making our field of research more inclusive!
Tips and Tricks when Designing Studies
Recruitment
Create a Positive Space
In clinical practice we often make explicit efforts to demonstrate that we are inclusive and accepting of all individuals, for example, we might have rainbow stickers or flags in our office, use inclusive language on paperwork and during our intake interviews, have gender neutral washrooms, and/or include information about gender and sexual diversity on our clinic websites (you can find recommendations for inclusive clinical practices here (https://www.rainbowhealthontario.ca/), here (https://www.apadivisions.org/division-44/resources), here (https://www.umhn.ca/), and here (https://www.apa.org/practice/guidelines/transgender.pdf).
We can also apply those skills from clinical practice to our research practices! For example, when we are selecting images for our recruitment posters we can use images that show we are a safe space, such as including gender and sexually diverse couples or including rainbow flags (for a free resource of inclusive stock photos see The Gender Spectrum Collection here). We can also make our language on recruitment materials more inclusive* by adding lines like ‘All sexual orientations and gender identities welcome!’ or ‘all couples’ and by avoiding cisnormative language (e.g., individuals with vulvar pain rather than women with vulvar pain) or heteronormative/offensive language (e.g., penetration rather than intercourse; partner rather than boyfriend/girlfriend; LGBTQ or sexually diverse instead of homosexual*). Including pronouns in screening and intake forms can also be a great way to make our gender diverse participants more comfortable! In addition to asking our participants about their pronouns, we can include our own pronouns in our email signatures and on our Letters of Information/Informed consent.
*note: For more detailed explanation on the use of the term ‘homosexual’ and for information on other terms to avoid see https://www.glaad.org/reference/offensive
Reach Out!
To recruit a diverse sample we need to recruit in diverse spaces! There are many queer spaces both on and offline that are welcoming of researchers. When recruiting in online spaces it is important to be respectful of the communities that we are posting within. For example, if we are posting on a Reddit forum or in a Facebook group we should thoroughly read the rules to see if research posts are allowed, if it is unclear we should message the moderators/group leaders to obtain permission first. We should also be mindful of making sure that our recruitment materials are inclusive (see section above) and be open, encouraging, and responsive to feedback from community members. For local recruitment we should make an effort to also post recruitment materials in queer spaces (with permission, of course). We can also establish connections with community members/advocates to receive feedback on our study materials and get help with recruitment. When working with community members in an advisory relationship it is important to appropriately compensate them for their involvement (e.g., authorship, financial compensation, and/or inclusion in the acknowledgment section).
Measures
Demographics
One of the most important (and yet most easily dismissed) parts of research is the demographic information we collect. Without this key information we aren’t able to know who our research is about and, more importantly, who the results of the study may be applicable to. The demographics section of our studies also provides us with an opportunity to increase the inclusivity of our research—if we want to make our research inclusive we have to make sure we use language and include options that are applicable to people beyond those that identify as straight and cis-gender! Otherwise you may lose participants once they start to fill out the demographics section and see that they can’t accurately tell you who they are.
While there are no exact standards regarding language to use that will work for every participant (or client if you’re in a clinical setting), there are some general recommendations:
- When possible use an open text box (you can easily recode this using statistical software (i.e., syntax).
- Make sure to not just have ‘woman’ and ‘man’ but also include trans and gender diverse options. See this document for some examples.
- When asking about sexual orientation or gender/sex, especially in a clinical setting, provide people with an option to ‘Prefer to self-describe’ (followed by an open textbox) and ‘Prefer not to say’
Standardized Clinical and Research Measures
It is important to consider inclusivity of language when selecting measures to include in your research study or to use in your clinical practice. Use measures validated in diverse populations and ensure that the language used is appropriate (e.g., replace ‘intercourse’ with ‘vaginal penetration’, check pronouns, check for out of date sexual orientation language, see if it would be applicable to non-monogamous relationships).
For some examples, please see: Female Sexual Function Index validated with sexual minority women https://www.liebertpub.com/doi/full/10.1089/jwh.2011.3072 International Index of Erectile Functioning for men who have sex with men https://onlinelibrary.wiley.com/doi/full/10.1111/j.1743-6109.2009.01579.x
Knowledge Translation
Knowledge translation is becoming an increasingly important aspect of conducting research. In a time when social media allows information to reach a wider and more diverse audience, it’s getting even more accessible. However, what is critical to keep in mind is where and how we share our research findings with the general public—even more so when we are conducting inclusive research.
Where Should I Share my Findings?
Ensure that you make your knowledge translation efforts accessible to the communities you included in your research! For example, if you recruited from online sources (e.g., Facebook pages, Reddit forums) reach out to those same sources to share your findings. The same thing goes for more local recruitment— share the results of your research in the same spaces you posted recruitment materials (with permission, of course). If you connected with community members or advocates, provide them with accessible materials that summarize your findings.
How Should I Share my Findings?
The same way you should be careful with the language you use in your study and when recruiting for it, be mindful with the language you use when sharing your findings. Even if your sample of 1000 had 999 participants that identified as cis-gender and only one participant that did not, ensure you use language that accurately represents your entire sample (i.e., avoid cis-normative language when talking about your results)! If you do research with people in relationships, make sure that the terms you use to talk about those relationships are accurate (e.g., use ‘partner’ instead of wife/husband/boyfriend/girlfriend, use appropriate pronouns, etc.).
It’s not only language that matters when we consider how to share our research findings! It’s also important to be mindful of what images you include (or rather who is represented in or by those images) and if you plan on using videos to share your research think carefully about who is included in your videos. The good news is, there are several people in our field who already do this quite well! For a great example of how to share results of inclusive research in a way that accurately represents results—and does so with a sense of humour—check out this video out of Dr. Karen Blair’s lab.
You can check out some other excellent knowledge translation of inclusive research by the following individuals and/or research groups:
KLB Research has started to provide interactive online poster presentations where you can view the research, ask questions, and much more!
SSTAR member Dr. Justin Lehmiller has several different types of knowledge translation represented on his an incredibly popular website Sex & Psychology! There are blog posts, infographics, and he even has a youtube channel (check out this research-related video he put out for Pride 2019).
Meg-John Barker and Alex Iantaffi (and illustrator Julia Scheele) collaborated with Dr. Sari van Anders to create a zine about Dr. van Anders’ Sexual Configurations Theory
Stéphanie Gauvin, Phillip Joy, and Matthew Lee collaborated with 37 artists to create a comic anthology on body image for Queer men called Rainbow Reflections (Twitter: @Queer Bodies; you can also see them on Facebook)
The Kinsey Institute (Website: kinseyinstitute.org Twitter: @kinseyinstitute; Instagram: kinseyinstitute)
The Science of Sex Podcast has some excellent episodes, such as https://scienceofsexpodcast.com/50-50-shades-of-transgender/ (You can check out other episodes here: https://scienceofsexpodcast.com/)
We hope this applied blog has provided you with some ideas, tips, and tricks on how to move towards conducting more inclusive research or clinical practice. Remember that you have the SSTARGAZE community to reach out to with your questions on how to make your research/clinical practice more inclusive or want to bounce ideas about inclusive research/clinical practices off of your fellow SSTARGAZERS.
Do you have any additional tips or tricks for conducting inclusive research or making your clinical practice more LGBTQ+ inclusive? Comment below!
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Stéphanie Gauvin is a PhD candidate in Clinical Psychology at Queen's University. Her research focuses on how individuals in relationships negotiate and navigate sexual challenges, with a particular focus on how sexual script flexibility is related to sexual well-being.
Kat Merwin is a PhD student in the Clinical Psychology program at Dalhousie University, where she works under the supervision of Dr. Natalie O. Rosen in the Couples and Sexual Health Lab. Kat’s research focuses on communication that occurs during sexual activity and how it is associated with the sexual and relationship well-being of same- and mixed-sex couples in long-term relationships.