The impact of an educational program based on the reproductive health of LGBT individuals developed for nursing students to improve the knowledge, skills and attitudes of students: A quasi-experimental study

Reproductive health deals with the reproductive abilities of people. It concerns the ability of a person to have a satisfying and safe sex life and the freedom to decide whether and when to use this ability and how often (United Nations, 1994). Sexual health is an essential part of reproductive health and situations concerning the sexual health of the individual directly affect their reproductive health. Hence, it is necessary to address all groups, especially minority groups, to protect and promote a society's health (WHO, 2010). LGBT individuals are one of the minority groups. Across the lifespan, this community struggles with various disparities in health outcomes and healthcare access related to sexual and reproductive health (SRH) due to discrimination and stigma (Walker et al., 2016). LGBT individuals have different requirements for SRH. They have unique health needs and present higher rates of HIV and other sexually transmitted infections (STIs), unprotected sexual intercourse and unwanted pregnancies, sexual violence, and spouse/partner violence (Agénor et al., 2016, Blosnich et al., 2014, Herbst et al., 2008, Ward et al., 2014). The belief that heterosexism is the norm and should be adopted by everyone, or the homophobic attitudes of health personnel and false or insufficient information about the LGBT community causes them to hide their sexual orientation or sexual identity from healthcare personnel. Hence, they benefit less from reproductive health services such as family planning, assisted reproductive techniques, pregnancy, childbirth, and postpartum care. In addition, due to insufficient information and discriminatory experiences, they undergo fewer health screening tests (Blosnich et al., 2014, Walker et al., 2016, Ward et al., 2014) and vaccination against STIs and higher rates of reproductive system cancers. These disparities are essential obstacles to receiving adequate and quality reproductive health care (O’Brien and Ellis, 2016).

Nurses with an advocacy role are essential in eliminating disparities against LGBT individuals. The American Nurses Association emphasized that nurses should provide adequate care and defend LGBT individuals. Educators should include LGBT health in their undergraduate nursing programs (American Nurses Association, 2018). A recent study reported that increasing LGBT-specific content in nursing curricula, practice guidelines, faculty development, and research is essential to improving LGBT health (Hughes et al., 2022). However, nursing students do not receive adequate training to address the specific needs of LGBT individuals because their curriculum contains very little information on LGBT health issues. The studies on the needs of the LGBT community are limited in nursing science (Carabez et al., 2015, Echezona-Johnson, 2017, Sekoni et al., 2017). The poor knowledge of nursing students on LGBT issues may cause them to have negative attitudes (Carabez et al., 2015, Nama et al., 2017) and provide insufficient health care for LGBT individuals (Hand and Gedzyk-Nieman, 2022, Koch et al., 2021).

Gaps in education and practice must be well understood to guide the curriculum in undergraduate nursing education programs. Educational programs that help students become aware of the health needs of LGBT individuals should be developed and integrated into nursing undergraduate programs (Bilgic et al., 2018). LGBT individuals should be included in nursing undergraduate programs. Courses should be enriched with different active learning methods to effectively develop the cognitive, affective, and psychomotor areas of nursing students. Active learning methods such as using standardized patients (SPs) (Hickerson et al., 2018, Koch et al., 2021, Mert Karadas and Terzioglu, 2019), role-play, case discussions, film and video analysis are recommended in nursing education (Koch et al., 2021, Ma and Zhou, 2022, McEwing, 2020, Smith et al., 2021). Active learning strategies enable the students to take responsibility, develop their thinking skills, and motivate them, thus positively affecting the quality of learning (Chan et al., 2021, Ghezzi et al., 2021). A flipped classroom is a student-centered teaching method guided by the educator. It uses active learning methods and responds to the characteristics and educational needs of the current nursing students (Dong et al., 2021, Özbay and Çınar, 2021). Integrating active learning methods into the flipped classroom significantly increases the achievement and problem-solving skills of the students (Entezari and Javdan, 2016). Nurse educators can benefit from the development of an innovative curriculum that integrates theoretical and clinical practice, considering the specific SRH needs and risks of the LGBT community. Although studies on the health of LGBT individuals exist in the literature (Koch et al., 2021, McEwing, 2020, Muckler et al., 2019, Smith et al., 2021), no study involving flipped classrooms coupled with active learning methods for LGBT reproductive health is found in nursing literature. The nursing education programs in Turkey do not include a specific course on the reproductive health of LGBT individuals. These individuals are often discussed in classes dealing with infectious or mental health diseases (Beycan Ekitli and Çam, 2017, Bilgic et al., 2018). In conservative countries such as Turkey, with a predominantly Muslim population, LGBT reproductive health cannot be adequately addressed due to religious and cultural values, Islamic political structure, and insufficient education. Moreover, the health personnel may even be reluctant to provide health services to LGBT individuals (Bilgic et al., 2018).

This study aimed to evaluate the impact of an educational program designed to understand the reproductive health of LGBT individuals. The course was developed for nursing students to help them better understand and record the reproductive health and history of the LGBT community. It aimed to enable practical communication skills and improve the attitude of the nursing students toward LGBT individuals.

The following hypotheses were tested in this study: there will be significant differences between before and after the educational program in changes of: (1) the knowledge of nursing students about LGBT individuals and their reproductive health, (2) the attitude of the nursing students toward LGBT individuals, (3) the ability of nursing students to obtain the reproductive health history from LGBT individuals and (4) the ability of the nursing students to communicate effectively with LGBT individuals.

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