Methods for enhancing midwifery students’ knowledge & attitudes on LGTBQ+ health-rights; ATHENA study

Angeliki Antonakou, Vikentia Harizopoulou, Eleni Theodoridou, Kalliope Gkougkousidou

Department of Midwifery, School of Health Sciences, International Hellenic University, Thessaloniki, Greece

Contributions to ATHENA study: Principal Investigator (PI): AA, Research team members VH, ET, KG. Funding Information: This study is part of the ATHENA project, a research initiative supported by the Hellenic Foundation for Research and Innovation (H.F.R.I.) under the "Basic Research Financing” call, which is part of the National Recovery and Resilience Plan “Greece 2.0,” funded by the European Union NextGenerationEU.

Objective: LGBTQ+ individuals face higher health disparities, often influenced by healthcare providers' attitudes. However, little research has focused on how healthcare students are trained to recognize and address their own biases towards LGBTQ+ individuals.

This study is the first to examine the impact of a structured educational intervention on final-year midwifery students' knowledge and attitudes regarding LGBTQ+ health rights.

Design: Our study design includes an initial assessment of student midwives' knowledge and attitudes, followed by a 3-hour small-group training session with a lecture, case-based discussions, and group conversation on gender equality, reproductive rights, and perinatal care for LGBTQ+ individuals. A final assessment was carried out at the workshop's completion.

Method: Calls for participation were made to student midwives via the study's webpage https://www.athenastudy.gr/ from July to November 2024. A total of 70 volunteers attended training sessions in November and December 2024, held at three different venues in Greece. After the intervention, 61 participants completed the post-training surveys, yielding an 87.2% response rate. We used the Wahlen’s et al.(2020)1 questionnaire after validating to Greek population and an ad-hoc knowledge assessment tool to evaluate the understanding of LGBTQ+ intrapartum health needs.

Results: The participants’ mean age was 21.8±2 years. Most participants (80.3%, n=49) identified as heterosexual, and 98.4% (n=60) as female. Prior to the intervention, most students held favorable attitudes towards LGBTQ+ individuals, which strengthened afterward.

Religious students showed significantly less positive attitudes (p=0.01) and worse judgment (p=0.001) towards the LGBTQ+ population compared to their non-religious peers. More positive attitudes were significantly linked to greater knowledge (r=0.30; p=0.002). The ad-hoc assessment tool showed a significant increase in participants’ knowledge of intrapartum care after the intervention (5.59±1.96 vs 7.80±1.43, p<0.01).

Conclusions: Midwifery students generally exhibited a positive attitude toward LGBTQ+ health rights. However, despite being in their final year of undergraduate training, they demonstrated limited knowledge regarding the specific health needs of LGBTQ+ individuals—a finding consistent with previous research involving other healthcare students2,3. Notably, our study showed that targeted educational interventions significantly improved both the knowledge and attitudes of midwifery students toward LGBTQ+ health, aligning with outcomes reported in similar studies4.

References:

1. Wahlen R, Bize R, Wang J, Merglen A, Ambresin AE. Medical students' knowledge of and attitudes towards LGBT people and their health care needs: Impact of a lecture on LGBT health. PLoS One. 2020 Jul 1;15(7):e0234743. doi: 10.1371/journal.pone.0234743.

2. Brown M, McCann E, McLoughlin G, Martin CH, McCormick F. The views and experiences of midwifery academics regarding LGBTQ+ health education in pre-registration programmes in the United Kingdom and Ireland: Qualitative findings from a mixed-methods study. Nurse Educ Pract. 2023 Feb;67:103554. doi: 10.1016/j.nepr.2023.103554.

3. Antonakou A. Is there a role for midwifery education to improve the knowledge and attitudes of Greek midwives on gender equality and reproductive health rights of members of the LGBTQ community?. European Journal of Midwifery. 2023;7(S1). doi:10.18332/ejm/172313.

4. Macedo A, Aurindo M, Febra C. Effectiveness of undergraduate medical students training on LGBTQIA + people health: a systematic review and meta-analysis. BMC Med Educ. 2024 Jan 16;24(1):63. doi: 10.1186/s12909-024-05041-w.