International healthcare professionals' competence in caring for LGBTQ+ children and young people: a combined qualitative and quantitative approach.
OBJECTIVE To evaluate healthcare professionals' attitudes, knowledge and clinical preparedness in caring for lesbian, gay, bisexual, transgender, queer/questioning; the + denoting inclusion of all identities (LGBTQ+) children and young people across international healthcare settings. DESIGN Mixed-methods study incorporating quantitative self-assessment of clinical competency using the LGBT-Development of Clinical Skills Scale (LGBT-DOCSS) and qualitative free-text responses exploring educational needs and perceived barriers to providing inclusive care, hosted on the Don't Forget The Bubbles platform. PARTICIPANTS 771 healthcare professionals; 770 included after removal of one duplicate. MAIN OUTCOME MEASURES Self-reported attitudes, knowledge and clinical preparedness using LGBT-DOCSS composite scores and qualitative coding of free-text responses examining contextual drivers of clinicians' confidence and practice. RESULTS Respondents were largely experienced clinicians (66% with ≥10 years in healthcare). Mean total LGBT-DOCSS Score was 5.42/7 (SD 0.80). Attitudinal scores were high (mean 6.54, SD 0.88), while basic knowledge (5.40, SD 1.26) and clinical preparedness in particular (4.31, SD 1.29) were lower. Education-related preparedness items scored the lowest, particularly regarding transgender and gender-diverse care (2.92, SD 1.69). Qualitative analysis identified two themes: barriers to inclusive care, which encompassed structural constraints, cultural norms and emotional or psychological barriers; and desire for competence, which encompassed recognition of knowledge gaps, need for transgender-specific training and desire for practical, lived-experience-informed education. CONCLUSIONS Healthcare professionals report positive attitudes but limited knowledge and preparedness. Clinicians are motivated to provide inclusive care but system-level support, structured education and skills-based training are required to translate intent into competent, inclusive clinical practice.