Table of Contents
Abstract
The Transgender Health Care humanization Scale (THcH scale) is a specialized psychometric instrument designed to evaluate the attitudes, beliefs, and clinical approaches of medical providers and Students toward gender-diverse patients. It quantifies the degree of 'humanization' in care, which encompasses empathy, respect, and the absence of stigmatizing behaviors. The tool was developed in response to the well-documented disparities and systemic discrimination that transgender individuals frequently encounter in medical settings, which often lead to healthcare avoidance and worsened health outcomes.
By providing a standardized metric for provider attitudes, the scale serves a dual purpose in both clinical and educational environments. It allows hospital administrators to assess the cultural competence of their staff and identify areas where institutional climate may be hostile or unwelcoming to transgender patients. Furthermore, it acts as a vital educational benchmark, enabling academic programs to measure the baseline readiness of future doctors and nurses, and to track the efficacy of diversity and inclusion training interventions over time.
Ultimately, the instrument represents a significant advancement in health psychology and medical education. By shifting the focus from patient pathology to provider competence, it aligns with modern, affirming models of care. The scale provides researchers with a robust, validated method to study the mechanisms of healthcare Stigma and to empirically validate interventions aimed at fostering a more equitable and compassionate healthcare system.
📊 Psychometric Scorecard
12
Multidimensional
0.92
0.972
📍 Brazil
Authors
Purpose
The primary objective of this instrument is to address a critical gap in medical education and clinical practice regarding the treatment of gender-diverse populations. Historically, healthcare curricula have lacked comprehensive training on gender-affirming care, leaving many practitioners underprepared and inadvertently fostering environments where Stigma and discrimination can thrive. This lack of preparation directly contributes to the severe health disparities observed in the transgender community.
This scale matters profoundly for researchers and clinicians because it provides a quantifiable measure of provider readiness and bias. Instead of relying on anecdotal evidence of discrimination, institutions can use this tool to systematically evaluate their workforce's capacity for empathetic care. It is particularly valuable for identifying specific educational deficits, allowing for the design of targeted cultural competency programs that can ultimately dismantle barriers to healthcare access for transgender individuals.
Construct
The core psychological construct captured by this tool is 'healthcare humanization' within the specific context of transgender patient care. This construct goes beyond mere clinical competence; it encompasses the active provision of empathetic, affirming, and respectful care, as well as the conscious avoidance of stigmatizing, pathologizing, or discriminatory behaviors. It is rooted in the broader theoretical framework of health equity and minority stress theory, which posits that systemic prejudice directly harms the well-being of marginalized groups.
The construct is operationalized through a two-dimensional structure. The first dimension focuses on proactive, positive clinical engagement, such as the provider's willingness to actively listen and offer tailored health guidance. The second dimension captures a complex mix of interpersonal attitudes, including the provider's internal comfort levels, potential fears, adherence to negative stereotypes, and their awareness of the systemic prejudice faced by transgender individuals. Together, these facets provide a holistic view of a practitioner's ability to deliver truly humanized care.
Validity
To ensure the instrument measures its intended construct without undue influence from unrelated variables, researchers rigorously evaluated its divergent validity. This was achieved by comparing the scale's scores against the Duke University Religion Index (DUREL), a measure of personal religiosity. The theoretical rationale is that while personal religious beliefs might shape a provider's general worldview, professional healthcare humanization should operate independently of these private practices.
The empirical findings strongly supported this distinction. The first factor of the scale showed virtually no correlation with any of the religiosity subscales, while the second factor exhibited only weak to moderate correlations with organizational and non-organizational religious activities. These results are highly encouraging, as they demonstrate that the scale successfully isolates professional clinical attitudes from personal religious adherence, aligning perfectly with established psychometric standards for divergent validity.
Reliability
Internal consistency is a foundational metric for any assessment tool, indicating how reliably the individual items work together to measure the overarching concept. The scale demonstrated exceptional reliability, with overall internal consistency metrics comfortably exceeding the standard acceptable threshold of 0.70.
Specifically, the overall scale yielded a Cronbach's alpha of 0.915 during the confirmatory phase, with its two underlying factors scoring 0.908 and 0.893, respectively. This high level of cohesion means that the items are highly inter-correlated and consistently capture the construct of healthcare humanization. For researchers and educators, these robust reliability values guarantee that the instrument will provide stable, dependable, and reproducible assessments of provider attitudes across different samples and administrative contexts.
Factor Analysis
The structural architecture of the questionnaire was rigorously evaluated using a split-sample approach, employing both exploratory and confirmatory techniques. Initially, an exploratory factor analysis utilizing an oblique rotation method revealed a clear two-factor structure, indicating that the items naturally clustered into two distinct but correlated thematic dimensions.
To verify this structure, a confirmatory factor analysis was subsequently conducted using Maximum Likelihood estimation on an independent sample. The results provided excellent support for the two-factor model. The fit indices were highly favorable, with the Comparative Fit Index (0.972) and the Tucker-Lewis Index (0.964) both easily surpassing the stringent 0.95 benchmark for excellent fit. Furthermore, error metrics such as the Root Mean Square Error of Approximation (0.069) and the Standardized Root Mean Square Residual (0.043) fell well within optimal ranges. These findings conclusively demonstrate that the scale's theoretical design is empirically sound and structurally robust.
Subscales
| Subscale | Items | Description |
|---|---|---|
| Factor 1 | 1, 2, 3, 4 | Measures proactive clinical engagement, active listening, and the perceived importance of guiding transgender patients in basic healthcare. |
| Factor 2 | 5, 6, 7, 8, 9, 10, 11, 12 | Measures interpersonal attitudes, comfort levels, recognition of systemic prejudice, and the presence or absence of stigmatizing beliefs. |
Instrument
| Test Type | Self-report questionnaire |
| Format | 12 items, 5-point Likert scale (1=strongly disagree to 5=strongly agree) |
| Scoring | Scores are calculated by summing the ordinal values for the 12 items. Total scores range from 12 to 60. |
| Language | Portuguese, English |
| Population | healthcare professionals, Students |
| Administration | Self-administered |
Transgender Health Care Humanization Scale Items
Items are currently not available
The individual items of this scale are not publicly available. Researchers interested in using this instrument should contact the original authors directly to request the scale materials.
Sample
The study included 450 healthcare professionals (nursing, medicine, and dentistry) and final-semester clinical Students from a public university hospital in Brazil. The sample was randomly split into two groups for Exploratory Factor Analysis (n=240) and confirmatory factor analysis (n=203).
Cite This Paper
Liliane Lins-Kusterer, Nicolle Melo Vieira, Carlos Brites (2023). Transgender Health Care humanization Scale. International journal for equity in health. https://doi.org/10.1186/s12939-024-02351-9
References
19 references
- White Hughto JM, Reisner SL, Pachankis JE. Transgender Stigma and health: A critical review of Stigma determinants, mechanisms, and interventions. Soc Sci Med [Internet]. Elsevier Ltd; 2015;147:222–31. https://doi.org/10.1016/j.socscimed.2015.11.010 🔗 https://doi.org/10.1016/j.socscimed.2015.11.010
- Kosenko K, Rintamaki L, Raney S, Maness K. Transgender Patient Perceptions of Stigma in Health Care Contexts. Med Care [Internet]. Lippincott Williams & Wilkins; 2013;51:819–22. http://www.jstor.org/stable/42568763 🔗 https://doi.org/10.1097/MLR.0b013e31829fa90d
- Miskolci R, Signorelli MC, Canavese D, Teixeira FDB, Polidoro M, Moretti-Pires RO et al. Health challenges in the LGBTI + population in Brazil: a scenario analysis through the triangulation of methods. Cien Saude Colet [Internet]. 2022;27:3815–24. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232022001003815&tlng=en 🔗 https://doi.org/10.1590/1413-812320222710.06602022en
- Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E et al. Global health burden and needs of transgender populations: a review. Lancet [Internet]. 2016;388:412–36. https://linkinghub.elsevier.com/retrieve/pii/S014067361600684X 🔗 https://doi.org/10.1016/S0140-6736(16)00684-X
- Rocon PC, Sodré F, Rodrigues A, de Barros MEB, Pinto GSS, Roseiro MCFB. Life after sexual reassignment surgery: significance for gender and transsexuality. Cienc E Saude Coletiva. 2020;25:2347–56. 🔗 https://doi.org/10.1590/1413-81232020256.26002018
- Safer JD, Coleman E, Feldman J, Garofalo R, Hembree W, Radix A, et al. Barriers to Health Care for Transgender individuals HHS Public Access. Curr Opin Endocrinol Diabetes Obes. 2016;23:168–71. 🔗 https://doi.org/10.1097/MED.0000000000000227
- Burgwal A, Gvianishvili N, Hård V, Kata J, Nieto IG, Orre C et al. The impact of training in transgender care on healthcare providers competence and confidence: a cross-sectional survey. Healthc. 2021;9. 🔗 https://doi.org/10.3390/healthcare9080967
- da Silva ACG, Lins-Kusterer L, Luz E, Brites C. Development and Validation of a Transgender Health Care humanization Scale. Transgender Heal [Internet]. 2023;8:444–9. https://www.liebertpub.com/doi/https://doi.org/10.1089/trgh.2021.0176 🔗 https://doi.org/10.1089/trgh.2021.0176
- Joseph F, Hair WC Jr., Black, Barry J, Babin REA. Multivariate Data Analysis. Pearson Educ. Ltd.; 2014.
- Koenig HG, Büssing A. The Duke University Religion Index (DUREL): A Five-Item Measure for Use in Epidemological Studies. Religions [Internet]. 2010;1:78–85. http://www.mdpi.com/2077-1444/1/1/78 🔗 https://doi.org/10.3390/rel1010078
- Cattell RB, The Scree Test For The Number Of Factors. Multivariate Behav Res [Internet]. 1966;1:245–76. http://www.tandfonline.com/doi/abs/10.1207/s15327906mbr0102_10 🔗 https://doi.org/10.1207/s15327906mbr0102_10
- Kaiser HF. An index of factorial simplicity. Psychometrika [Internet]. 1974;39:31–6. http://link.springer.com/10.1007/BF02291575 🔗 https://doi.org/10.1007/BF02291575
- Nunnally J, Bernstein I. Psychometric Theory, 3rd edn, 1994. McGraw-Hill, New York. 1994.
- Muthen B, Kaplan D. A comparison of some methodologies for the factor analysis of non-normal Likert variables: A note on the size of the model. Br J Math Stat Psychol [Internet]. 1992;45:19–30. https://bpspsychub.onlinelibrary.wiley.com/doi/https://doi.org/10.1111/j.2044-8317.1992.tb00975.x 🔗 https://doi.org/10.1111/j.2044-8317.1992.tb00975.x
- Wang J, Wang X. Structural equation modeling: applications using mplus. Struct Equ Model Appl Using Mplus. 2019;1:512.
- Cohen J. Statistical power for the social sciences. 2nd ed. New York, United States of America: Laurence Erlbaum and Associates; 1988.
- Hurley AE, Scandura TA, Schriesheim CA, Brannick MT, Seers A, Vandenberg RJ, et al. Exploratory and confirmatory factor analysis: guidelines, issues, and alternatives. J Organ Behav. 1997;18:667–83. 🔗 https://doi.org/10.1002/(SICI)1099-1379(199711)18:6<667::AID-JOB874>3.0.CO;2-T
- Lorenzo-Seva U. SOLOMON: a method for splitting a sample into equivalent subsamples in factor analysis. Behav Res Methods [Internet]. Springer US; 2022;54:2665–77. https://doi.org/10.3758/s13428-021-01750-y 🔗 https://doi.org/10.3758/s13428-021-01750-y
- Asquith A, Sava L, Harris AB, Radix AE, Pardee DJ, Reisner SL. Patient-centered practices for engaging transgender and gender diverse patients in clinical research studies. BMC Med Res Methodol. 2021;21:1–15. 🔗 https://doi.org/10.1186/s12874-021-01328-4
Cite this article
Mohammed looti (2026). Transgender Health Care Humanization Scale. PSYCHOLOGICAL SCALES. Retrieved from https://scales.arabpsychology.com/s/transgender-health-care-humanization-scale/
Mohammed looti. "Transgender Health Care Humanization Scale." PSYCHOLOGICAL SCALES, 14 Aug. 2026, https://scales.arabpsychology.com/s/transgender-health-care-humanization-scale/.
Mohammed looti. "Transgender Health Care Humanization Scale." PSYCHOLOGICAL SCALES, 2026. https://scales.arabpsychology.com/s/transgender-health-care-humanization-scale/.
Mohammed looti (2026) 'Transgender Health Care Humanization Scale', PSYCHOLOGICAL SCALES. Available at: https://scales.arabpsychology.com/s/transgender-health-care-humanization-scale/.
[1] Mohammed looti, "Transgender Health Care Humanization Scale," PSYCHOLOGICAL SCALES, vol. X, no. Y, ص Z-Z, August, 2026.
Mohammed looti. Transgender Health Care Humanization Scale. PSYCHOLOGICAL SCALES. 2026;vol(issue):pages.