Cultural Adaptation and Evaluation of Evidence for Validity of a Gender Minority Stress Measure among Transgender Women and Transfeminine People in China

Purpose: Gender minority stress is a culturally situated, complex construct. Despite high levels of gender minority stress reported by transgender and gender-diverse (TGD) people in mainland China, measurement of this construct in this setting is not well understood. We conducted cultural adaptation of a gender minority stress measure (discrimination, rejection, victimization, nonaffirmation of gender identity, internalized transphobia, negative expectations for the future, and nondisclosure of gender identity subscales) and evaluated evidence of validity and reliability in a sample of Chinese transgender women, transfeminine people, and other gender-diverse people assigned male at birth ( n = 277). Methods: Community-engaged cultural adaptation included needs assessment, cognitive interviewing, translation, and community and academic expert consultation. Participants ( n = 277) completed an online questionnaire assessing seven stress subscales adapted from the Gender Minority Stress and Resilience (GMSR) measure (November 2019–June 2020). We conducted confirmatory factor analyses to confirm the underlying structure and examined divergent and criterion validity. Results: A confirmatory factor analysis found that a first-order seven-factor model had adequate fit and was more appropriate than a second-order model. The seven subscales had positive correlations with each other of under 0.60, which supported the divergent validity hypothesis. However, while all subscales were positively correlated with depressive symptoms, only nonaffirmation was correlated with cigarette use, suggesting partial support for the criterion validity hypothesis. Conclusion: Results suggest good evidence for validity of the GMSR stress subscales and support its future use among other Chinese TGD populations. Community-engaged methods may be beneficial for adapting complex measures across settings.