Testing a Cultural Humility Based Measurement Tool for Sexually and Gender Diverse Positive Spaces in Ontario Public Health Units

Abstract

Background: Sexually and/or gender diverse persons face discrimination and marginalization within and beyond the health care system due to their sexual orientation and/or gender identity. These experiences can lead to poor health outcomes and negative coping strategies. In Ontario, public health nurses (PHNs) could reduce such health inequities by changing their practice and by influencing change within their local public health agencies. Fostering positive spaces using a cultural humility approach is a means through which PHNs could render public health unit spaces safer for sexually and/or gender diverse persons, however; there is a lack of valid and reliable tools for PHNs to assess a cultural humility approach to positive spaces. Purpose: The purpose of this thesis was to advocate for a shift in practice away from cultural competence and towards cultural humility and to test the validity and reliability of modified versions of the Ontario Public Health Association’s (OPHA) personal and workplace tools for perceptions of sexually and gender diverse positive spaces within Ontario public health units. Methods: The existing OPHA tools were modified based on literature review findings and a cultural humility approach. The tools were tested for face and content validity with a group of expert panelists (N=5) and with Registered Nurses (RNs) (N=5) providing direct services to clients and community partners in public health. To test for construct validity and internal consistency, a cross-sectional online questionnaire was delivered to 1 978 RNs working in public health through email and mailed invitations. Results: An exploratory factor analysis (EFA) of the personal tool (N=259) yielded 40-items with a 15-factor solution; 12 factors had a reliability rating of moderate to excellent. An EFA of the workplace tool yielded a 38-item tool with 10 underlying dimensions; eight of these factors had a reliability rating of moderate to excellent. Conclusion: Evidence-informed improvements have been made to the OPHA positive space tools. Study findings offer an initial reference point for the underlying structure of positive spaces in Ontario public health units. These tools, with further improvements and testing, could be used to inform positive space testing in public health units.