Transgender-inclusive measures of sex/gender for population surveys: Mixed-methods evaluation and recommendations

• Published in: PloS one Vol. 12; no. 5; p. e0178043
• Main Authors: Bauer, Greta R, Braimoh, Jessica, Scheim, Ayden I, Dharma, Christoffer
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.05.2017; Public Library of Science (PLoS)
• Subjects: Adolescent; Adolescents; Adult; Adults; Aged; Aggression; Analysis; Arches; Biology and Life Sciences; Birth; Canada; Cancer; Childbirth & labor; Cognitive ability; Color; Communities; Computer programs; Consortia; Data acquisition; Data analysis; Data collection; Data processing; Decision analysis; Dentistry; Disaggregation; Documentation; Documents; Editors; Epidemiology; Evaluation; Federal jurisdiction; Female; Gender; Gender Identity; Health aspects; Health care; Health care disparities; Human behavior; Human rights; Humans; Internet; Inventories; Male; Mapping; Medicine; Methods; Middle Aged; Minority & ethnic groups; Mixed methods research; People and Places; pH effects; Politics; Polls & surveys; Population; Populations; Public health; Qualitative analysis; Questionnaires; Research and Analysis Methods; Rivers; Sex; Sexual behavior; Sexual Behavior - psychology; Sexuality; Social policy; Social Sciences; Software; Speech; Statistical analysis; Surveys and Questionnaires; Time measurement; Transgender people; Transgender persons; Transgender Persons - statistics & numerical data; Transsexualism - psychology; United States; Violence; Young Adult; Young adults; United States; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0178043

Given that an estimated 0.6% of the U.S. population is transgender (trans) and that large health disparities for this population have been documented, government and research organizations are increasingly expanding measures of sex/gender to be trans inclusive. Options suggested for trans community surveys, such as expansive check-all-that-apply gender identity lists and write-in options that offer maximum flexibility, are generally not appropriate for broad population surveys. These require limited questions and a small number of categories for analysis. Limited evaluation has been undertaken of trans-inclusive population survey measures for sex/gender, including those currently in use. Using an internet survey and follow-up of 311 participants, and cognitive interviews from a maximum-diversity sub-sample (n = 79), we conducted a mixed-methods evaluation of two existing measures: a two-step question developed in the United States and a multidimensional measure developed in Canada. We found very low levels of item missingness, and no indicators of confusion on the part of cisgender (non-trans) participants for both measures. However, a majority of interview participants indicated problems with each question item set. Agreement between the two measures in assessment of gender identity was very high (K = 0.9081), but gender identity was a poor proxy for other dimensions of sex or gender among trans participants. Issues to inform measure development or adaptation that emerged from analysis included dimensions of sex/gender measured, whether non-binary identities were trans, Indigenous and cultural identities, proxy reporting, temporality concerns, and the inability of a single item to provide a valid measure of sex/gender. Based on this evaluation, we recommend that population surveys meant for multi-purpose analysis consider a new Multidimensional Sex/Gender Measure for testing that includes three simple items (one asked only of a small sub-group) to assess gender identity and lived gender, with optional additions. We provide considerations for adaptation of this measure to different contexts.