Attitudes, Perceptions, and Knowledge of Greek Midwives Toward LGBT Individuals: Findings From the ATHENA Study and Validation of the Greek Version of the Perception and Knowledge of Sexual and Gender Minority Health (PKSGMH) Questionnaire.

INTRODUCTION: Lesbian, gay, bisexual, and transgender (LGBT) people experience worse health indicators compared to the general population and encounter notable healthcare disparities, especially in reproductive and midwifery care. However, the growing visibility of the LGBT community and the ongoing advocacy for reproductive equality have raised awareness about nontraditional families and led to an increased demand for midwifery care that is inclusive and responsive to these needs. This study aimed to investigate Greek midwives' knowledge and attitudes toward LGBT health by validating the Greek version of the Perception and Knowledge of Sexual and Gender Minority Health (PKSGMH) instrument.

METHODS: An anonymous online survey on n = 187 Greek midwives was conducted from July to August 2024. The PKSGMH questionnaire was used after obtaining the author's permission and adapting it to align with Greek standards. It consisted of 81 questions, including eight demographic questions, 66 questions related to LGBT issues, and seven questions about professional midwifery experience.

RESULTS: Participants' mean age was 41 years (standard deviation (SD) = 9.9). One hundred eighty-four were women (99.5%), n = 181 (96.8%) were heterosexual, n = 125 (66.8%) were married, and n = 131 (70.1%) had LGBT acquaintances. One hundred twelve (59.9%) provided care to LGBT patients, primarily lesbians (52.9%). The participants had an average professional experience of 15.2 years (SD = 9.9), but only eight (4.3%) had received training specifically for LGBT individuals. However, n = 140 (76.1%) came into contact with gay, lesbian, and bisexual patients. Reliability indexes of all scales were above or close to acceptable levels (≥0.70). Positive correlations were found among attitude scales toward LGBT people. Negative attitudes toward LGBT people were linked to more negative attitudes toward LGBT patients and less practice with them. Greater knowledge was associated with more positive attitudes and better practice with LGBT patients. Being married or partnered in a heterosexual relationship, not having LGBT acquaintances, and a lack of experience in providing care to LGBT patients were associated with having more negative attitudes toward LGBT people. Midwives with LGBT-specific training had less negative attitudes. Older age and longer years of professional experience were associated with more negative attitudes. At the same time, more frequent contact with LGBT people/patients in the workplace was associated with less negative attitudes.

CONCLUSION: The Greek version of the PKSGMH instrument demonstrated good reliability and validity. Greek midwives have moderate to high levels of knowledge and neutral to positive attitudes toward LGBT people and patients. Continuing professional education on LGBT-focused issues could resolve knowledge gaps, misconceptions, and perceived competency deficiencies.