Transgender Attitudes and Beliefs Scale-Greek (TABS-Gr) version: translation and initial evaluation of psychometric properties among medical students

(2023) 23:704 Voultsos et al. BMC Medical Education https://doi.org/10.1186/s12909-023-04666-7 BMC Medical Education Open Access RESEARCH Transgender Attitudes and Beliefs Scale‑Greek (TABS‑Gr) version: translation and initial evaluation of psychometric properties among medical students Polychronis Voultsos1*, Angeliki Papana2, Stella Alexandri1 and Christina‑Erato Zymvragou1 Abstract Background Transgender people face significantly greater discrimination and health disparities in health care set‑ tings than cisgender people. The role of education in eliminating this phenomenon has been increasingly recognized by many medical schools. However, transgender health content is sparse or lacking in the medical curricula of many countries. Method This study was designed to validate the Greek version of the Transgender Attitudes and Beliefs Scale (TABS-Gr). The study adopted a cross-sectional, comparative-descriptive research design. Participants (N = 203) were contacted through online recruitment and invited to complete an anonymous web-based survey. The data were col‑ lected between December 2022 and February 2023. Results The overall reliability of the TABS-Gr questionnaire was high (Cronbach’s α = 0.961, p. from Hotelling’s T-squared test < 0.000). High Cronbach’s alpha values were estimated for the three subscales, with α = 0.958 for Inter‑ personal Comfort, α = 0.906 for Gender Beliefs, and α = 0.952 for Human Values. Hotelling’s T-squared test confirmed that all items on the scale had the same mean (p < 0.001 for all subgroups). Explanatory factor analysis (EFA) dem‑ onstrated adequate fit. Convergent and discriminant validity were validated based on the estimated correlations. The three-factor structure of the Greek TABS version was confirmed. The mean total score was 155.95 (SD = 30.63), indicating that medical students had a moderately positive attitude towards transgender people. Participants showed significantly less biased (more tolerant, positive) attitudes towards transgender people on the Interpersonal Comfort (IC) and Human Value (HV) subscales than on the Sex/Gender Beliefs (SGB) subscale. A demographic comparison was conducted and demonstrated a correlation between scores and sociodemographics, except for place of origin. A statistically significant increase in the total mean score was estimated for women compared to men. Conclusion The overall psychometric findings provide some evidence to support the validity of the Greek version of the TABS. However, we call for further validation research in Greek medical schools. Since our claims for validity are based in part on an exploratory factor analysis, a future confirmatory factor analysis (CFA) is part of our call for fur‑ ther validation research. While the results of this study are mostly in line with the results of previous research, some nuances were identified. These results may inform educators, medical school curricula and education policy-makers. *Correspondence: Polychronis Voultsos Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecom‑ mons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Voultsos et al. BMC Medical Education (2023) 23:704 Page 2 of 18 Keywords Transgender health, Discrimination, Health inequities, Transgender Attitudes and Beliefs Scale (TABS), Medical education, Medical curriculum Background Transgender and gender-diverse individuals are people whose preferred gender identity or gender roles do not align with their sex assigned at birth, or “those whose gender identity does not conform to conventional binary gender categories known as gender nonbinary or gender nonconforming” ([1, 2], p: 377). Transgender individuals do not fit perfectly into binary gender. Importantly, gender incongruence is no longer classified as a mental health disorder in the ICD-11 (International Classification of Diseases). There may be a fluid continuum between strictly male and strictly female. It is reported that 1.4 million individuals in the United States identify as transgender (0.5–0.6% of the population) [1, 3, 4]. In Canada, according to the Institute of Medicine (2011), transgender people represent 0.3–0.5% of the adult population [5]. In the UK, approximately 1% of the population identifies as transgender [6]. Transgender people therefore represent a proportion of the population to be reckoned with. Future doctors are likely to be asked to provide services to transgender individuals during their career, regardless of their specialty [5]. Future physicians should be able to provide high-quality medical treatment to a wide range of patient populations, including visible and invisible gender and sexual minorities [7]. Transgender individuals deal with explicit and implicit bias in everyday life. It is argued that while explicit bias against transgender people has become unacceptable in medical education, implicit bias (i.e., without intention) remains widespread and difficult to address [7]. A survey of 4,441 heterosexual first-year medical students conducted by Burke et al. found that nearly half (45.79%) of the respondents exhibited explicit bias, with most (81.51%) expressing at least some implicit bias against LGBT individuals [8]. The role of “implicit bias” in contributing to health care disparities among transgender individuals has been highlighted by many authors [9]. In this regard, a growing body of literature has been published on transgender health over the last 15 years that suggests that transgender people are medically underserved and experience significantly greater health inequities and challenges in accessing health care services than cisgender people [1–3, 5, 6, 10–19]. This phenomenon is even more disquieting in developing countries [13]. Even in countries such as Canada where there have been major legal advances that aim to provide better treatment for transgender people, they continue to be medically underserved [5]. In Greece, there h (...truncated)