A network analysis of healthcare professionals’ attitudes, affirming beliefs, and behaviors toward SGM youth: professional knowledge as a bridge

Abstract Background Sexual and gender minority (SGM) youth experience significant mental health disparities linked to barriers to accessing mental healthcare, particularly affirming care. Although healthcare professionals typically report positive attitudes and beliefs regarding caring for SGM patients, gaps in SGM-specific knowledge may hinder the translation of these positive orientations into affirmative clinical practice implementation. Objective This study employed a network analytic approach to model associations among professionals’ attitudes, affirmative practice beliefs, SGM-specific knowledge, and affirmative practice behaviors toward SGM youth across two groups: professionals who received training specific to SGM populations and those who had not. This approach enabled the examination of how these components are interconnected in a broader system and the identification of bridging nodes. Methods This cross-sectional survey involved 318 Israeli healthcare professionals from medical, mental health, and allied health disciplines, evenly split between those with (48.7%) and without (51.3%) SGM-specific training. Most participants identified as women (74.5%), followed by men (19.2%), nonbinary or genderqueer (3.5%), and other identities (2.8%). Participants completed measures of attitudes toward SGM youth, affirmative practice beliefs, SGM-specific knowledge, and affirmative practice behaviors. Network analysis was employed to model associations among domains and compare professionals with and without SGM-specific training. Results Professionals who received SGM training demonstrated significantly more positive attitudes, greater knowledge, and more affirmative practice beliefs and behaviors compared to those who had not received such training. Network analyses indicated that knowledge, particularly clinical and conceptual knowledge, occupied prominent bridging positions between attitudes and beliefs and affirmative practice behaviors, especially in the Training network. In contrast, knowledge was less connected to affirmative practice behavior among untrained professionals, whereas affirmative practice beliefs showed comparatively greater bridge connectivity. Conclusions Findings indicate that professional knowledge occupied a prominent bridging position between positive attitudes and beliefs and affirmative practice behaviors in the estimated networks. Clinically, SGM-specific knowledge represents a potentially important target for professional training and for future longitudinal and experimental evaluation. From a policy perspective, when considered alongside prior evidence, the present results support investing in structured, evidence-based SGM training in professional education, accreditation standards, and continuing education to strengthen affirmative care and reduce health disparities among SGM youth.