Survey of 34,000 health care professionals indicates higher bias against transgender people

By analyzing data from the Harvard Implicit Association Test—a widely accepted measure of a person's attitudes toward people based on characteristics like race, gender, and sexuality—researchers find that health care professionals, and in particular nurses, are more biased against transgender people than are people who are not health care professionals.

A questionnaire administered before and after the test shows that health care professionals are less likely to know transgender people personally and that nurses are more likely to conflate sex and gender identity. These results are reported in the journal Heliyon.

The Implicit Association Test works by asking participants to categorize groups of people with "good" words like "nice" or "laughter" and "bad" words like "nasty" or "rotten." Its results are collected by a team of scientists as a part of Project Implicit since 1998 and are made available for use by the public and other researchers.

To specifically assess the attitudes of health care professionals towards transgender people, the researchers focused on a subset of the respondents from 2020 to 2022, including 11,996 nursing health care professionals and 22,443 non-nursing health care professionals. These responses were compared to 177,810 responses of non-health care professionals.

A person's bias is reported as their "D-score," which can range from -2 to 2, with higher scores indicating more anti-transgender views. The standard classification for this test lists values over 0.15 as "slightly biased," and over 0.35 and 0.65 as "moderately" and "strongly" biased, respectively.

Non-health care professionals on average reported a D-score of 0.116, which is considered to mean that they have little to no bias. However, health care professionals (non-nursing), reported an elevated score of 0.149, which is on the edge of what is considered to be "slightly biased." The average D-score for nursing health care professionals was 0.176, which falls clearly within the range of "slightly biased."

The participants' D-score assesses their implicit bias—their true beliefs which they may be too reluctant to share—but their explicit bias, or their self-reported views, were assessed by a questionnaire.

Nursing health care professionals were significantly more likely to agree with statements like "I believe a person can never change their gender" or "I think there is something wrong with a person who says they are neither a man nor a woman" compared to other health care professionals and non-health care professionals.

"Our finding that nurses have higher levels of implicit bias towards transgender people may be related to a tendency to conflate sex and gender identity, as shown by higher levels of agreement with transphobic statements that conflate these two distinct concepts," write authors Daniel W. Derbyshire of the University of Exeter and Tamsin Keay of Coventry University.

The questionnaire also asked about the participants' relationships with transgender people in their daily lives. While health care professionals—including nurses and non-nurses—were more likely to have met a transgender person than non-health care professionals, they reported that they were less likely to have a transgender friend or family member.

"This suggests that health care professionals' (both nurses and non-nurses) experience of interacting with transgender people may be largely confined to a work context," write the authors.

The authors note that the participants in this test are limited to those who visited the Project Implicit website and chose to complete the test. "As such, the sample may be subject to sample selection bias in terms of the demographics and Implicit Association Test (IAT) results of participants," write the authors.

"However, it may be anticipated that people with particularly negative attitudes towards transgender people would avoid taking the Transgender IAT and the results presented here may therefore under-represent the extent of implicit bias towards transgender people."