Psychometric evaluation of the questionnaire assessing primary health care providers’ knowledge and attitudes toward gender dysphoria

Introduction: Gender dysphoria is one of the significant challenges in healthcare systems, and primary healthcare providers play a key role in caring for and referring these individuals. However, their insufficient knowledge and attitudes may lead to inadequate care. Given the lack of a standard Persian tool for measuring these variables, this study aimed to psychometrically evaluate a questionnaire assessing the knowledge and attitudes of primary healthcare providers regarding gender dysphoria. Methods: This descriptive cross-sectional study was conducted in 2024 in Tabriz, involving three phases: translation, back-translation, validity, and reliability. The study sample for content validity included 15 experts, 30 healthcare providers for reliability, and 205 primary healthcare providers for construct validity. The research tool consisted of questionnaires assessing attitudes and knowledge about transgender individuals, which were translated into Persian and culturally adapted. Content validity was evaluated using content validity ratio (CVR) and content validity index (CVI), and construct validity was assessed through confirmatory factor analysis (CFA). The reliability was calculated using Cronbach’s alpha coefficient and the intra-class correlation coefficient (ICC). Results: The results of this study indicated that the overall CVI was 0.81 and the CVR was 0.93. For the knowledge section, CVI was 0.76 and CVR was 0.94, while for the attitude section, CVI was 0.85 and CVR was 0.91. In confirmatory factor analysis, the factor loadings for the attitude section were above 0.30, but some questions in the knowledge section had factor loadings lower than 0.30. The comparative fit index (CFI), goodness of fit index (GFI), normed fit index (NFI), and root mean square error of approximation (RMSEA) were 0.96, 0.90, 0.85, and 0.057, respectively, all indicating a good model fit. Additionally, the Cronbach’s alpha coefficient for the entire questionnaire was 0.86, and for the knowledge and attitude sections, it was 0.65 and 0.88, respectively. The ICC obtained from the test-retest method was 0.76, confirming the reliability of the questionnaire. Conclusion: The results of this study showed that the tool for measuring the knowledge and attitude of primary healthcare providers regarding gender dysphoria has good validity and reliability. The confirmatory factor analysis results indicated that the two-factor structure (knowledge and attitude) fits well, although some items in the knowledge section had lower factor loadings. This questionnaire can be helpful in designing educational and research programs in this area. Practical Implications: The questionnaire could be used as a screening tool in educational programs related to gender dysphoria, assessing the impact of educational interventions, and evaluating educational needs in healthcare policy-making.