Development and Preliminary Validation of a Scale to Measure Perceived Therapist’s Knowledge about Gender Identity Diversity among Trans and Non-Binary Individuals in Puerto Rico

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1) There are other papers by Riggs that might be useful given they have also measured knowledge

2) Given similar scales exist, it would be useful to know why this new measure is needed - the introduction says nothing about other measures

3) It seems problematic that a validation study didn't include other measures for convergent and divergent validity 

4) The context should be mentioned in the title and abstract and some background on Puerto Rico and trans people given for the international reader

 

Author Response

Attached you will find an explanation letter. 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review the manuscript entitled, “Development and Preliminary Validation of a Scale to Measure 2 Perceived Knowledge about Gender Identity Diversity in Therapy among Trans and Non-Binary Individuals” for consideration for publication at the journal, Investigation in Health, Psychology and Education. This manuscript reports on the reliability of a measure to assess patient's perceptions of mental health provider's knowledge about transgender and nonbinary people's experiences. 

I agree that there is widespread need to address and improve the knowledge of mental health professionals regarding gender identity diversity in therapy spaces.

 

Abstract

·         Please revise the first and second sentences in the abstract for clarity. Their meaning is unclear.

Introduction

·         Page 1, line 40: The term ‘transsexual’ is a pejorative and outdated term. Please either explain and justify why it is acceptable to use or remove it from the manuscript. If the authors are referring to transgender or gender diverse people who have undergone surgeries as part of their gender affirmation process, then please use more affirming and inclusive language. Unfortunately, this looks like an unintentional, but deeply problematic, microaggression that reproduces widespread prejudice against transgender and gender diverse humans.  One possible source for this type of information is: https://williamsinstitute.law.ucla.edu/publications/geniuss-trans-pop-based-survey/

·         Page 1, line 44-46: The descriptions of discrimination and bias from LGB community against TGNB community do not connect with or support the points about mental health professionals. Please revise to be clear and focused on the mental health providers or draw clear and direct connections about how these two sources of bias relate.

·         Page 3, line 58: WPATH’s standards of care title is incorrect, please correct it: https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644

·         It is not clear from the introduction that there is a gap in measures that needs to be filled by the new measure. Authors have not clarified or named the gap in measurement to justify the need for generating and testing a measure of openness and knowledge about gender identity diversity. This is a paragraph/section that is entirely missing that should be developed and added to the manuscript.

·         The introduction needs to be modified to provide rational for why patients should report on provider openness and knowledge about gender identities, rather than providers themselves.

 

Methods

·         Please clarify the meaning of “secondary data approach” with instrumental design and support the definition with a citation. If the data used for this project were embedded in a larger project, please describe that project and cite a publication that thoroughly describes the methodology.

Procedure

·         Please describe how the 12 expert judges were identified and selected. Please include in the description the qualifications that made them ‘expert’ in this area.

Participants

·         “The team extracted”, line 125: please revise; this language is unclear and inappropriate. Something like “From the larger study, 57 participants were identified as having self-reported trans and non-binary identities”

·         It is not clear WHO the participants were. Were participants mental health providers? Were they general citizens, patients, something else? Please clarify. If the participants were NOT mental health providers, please describe the process and rational for asking non-providers to answer questions about openness to and knowledge of transgender and gender diverse identities. The reviewer only became clear about who answered the survey items, when the survey items were presented on page 6.

·          

Instruments

·         Please site the source of the demographic characteristics/variables.

·         Please provide examples of stems and questions that were included in the 25 item measure about openness and knowledge.

Analyses

·         Please revise to put statistical software description at the end of the analysis plan section.

·         Please revise the first sentence to be “descriptive and summary statistics…” not examinations.
“Descriptive and summary statistics were calculated for demographic variables and the newly formed scale.  This included calculating means, standard deviations, and reliability assessments”.

Discussion

·         Page 9, line 220: “….was not statically supported”. I think the authors meant statistically supported; this should be revised to clarify.

·         Significant development is needed to support and communicate idea that there is need for reporting on patient’s perspective on providers knowledge about experiences had by gender diverse people. This is true for the introduction as well.

·         Page 10, line 252: please revise gender minorities to transgender and nonbinary people.

Comments on the Quality of English Language

Please see overall comments regarding editorial concerns with grammar, word choice, and typos.

Author Response

Attached you will find an explanation letter. 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This is an important addition to the available instruments that assess the clinical experiences of the trans population. 

Author Response

Thank you for your revision.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Authors did a good job responding to reviewer feedback and critique. no further concerns.