Nurses’ Implicit and Explicit Attitudes Towards Transgender People and the Need for Trans-Affirming Care

Abstract

Background: The primary objective of this study is to investigate the implicit and explicit attitudes of healthcare professionals – in particular nurses – towards transgender people. This is especially important in light of recent calls for improved trans-affirming care provision by healthcare professionals to generate quality healthcare access and outcomes for transgender people.

Methods: We use publicly available data from the transgender version of the Implicit Association Test from 2020 to 2021. We focus on differences between three subsets of participant: (1) non-healthcare professionals (N=120,077), (2) non-nursing healthcare professionals (N=14,572) and (3) nursing healthcare professionals (N=6,945). We present the results of parametric statistical tests (t-tests) and an ordinary least squares regression, to analyse the robustness of our results when controlling for a host of sociodemographic characteristics.

Results: We find that non-healthcare professionals have significantly lower implicit bias towards transgender people compared to healthcare professionals. Further, within healthcare professionals, we find nurses have significantly higher implicit bias towards transgender people compared to non-nurses. We show how implicit bias and explicit attitudes are highly correlated. Further, we provide evidence that healthcare professionals – but in particular nurses – have more medicalised conceptions of gender when compared to non-healthcare professionals.

Conclusion: Whilst nurses continue to have higher levels of implicit and explicit bias towards transgender people, due to an overly medicalised understanding of gender, there remains a need to globally establish additional enhanced trans-affirming care training provision for nursing and medical students.

Funding Statement: No funding was granted for this research.

Declaration of Interests: The authors report no declarations of interest.

Keywords: Transgender, nursing education, implicit bias, trans-affirmative education, Diversity, nurse attitudes