Exploring How U.S. High School Staff Support, Protect, and Affirm Sexual and Gender Minority Youth: Methods and Lessons Learned from a Qualitative Interview Study

Abstract

Background. Sexual and gender minority youth (SGMY) experience health inequities compared with cisgender heterosexuals, and these inequities are heightened in areas with high structural stigma. Quantitative research shows school assets (e.g., adult support) are associated with better health for SGMY. Though some qualitative studies elucidated how school staff support SGMY, none have triangulated such strategies in a geographically and sociodemographically diverse sample of school staff and SGMY. This paper describes a multi-perspective qualitative study design and offers lessons learned from conducting such a study. Methods. Using a novel stratified sampling frame, we interviewed 60 SGMY and 29 school staff who attended/worked at high schools in U.S. states with low, medium, and high structural stigma. To ensure sociodemographic diversity, we constructed sampling quotas, and recruited SGMY using social media and staff using a multi-pronged approach. Results. The stratified sampling strategy met our goal of enrolling diverse SGMY and staff participants. SGMY participants attended schools in low ( n = 20), medium ( n = 22), and high ( n = 18) structural stigma states. We enrolled 18 cisgender girls, 18 cisgender boys, and 24 gender minority youth. Fifty-three percent of SGMY were youth of color, and 45% attended schools in rural areas. School staff participants worked at schools in low ( n = 11), medium ( n = 11), and high ( n = 7) structural stigma states. School staff participants were 55% heterosexual, 91% cisgender, and had diverse roles (e.g., teacher, principal, librarian, and nurse). Conclusions. This paper describes new methods for collecting qualitative data from diverse SGMY and school staff. Some lessons learned from this study include the importance of using trauma-informed interviewing methods, having a suicidality safety protocol, establishing a priori sampling quotas, and creating tailored social media advertisements. With these data we will explore the heterogeneity of SGMY and school staff experiences across varying structural stigma levels, yielding foundational information for future school-based interventions.

Going the Extra Mile: How High School Staff Use Informal Strategies to Support, Protect, and Care for LGBTQ+ Students*

“…Any discrepancies between coders and refinements to the codebook were documented and subsequently discussed at weekly team meetings until agreement was achieved (details of the composition of the research team available elsewhere). 19 ''Informal strategies'' emerged as a key theme from this initial analysis.…”

“…Details on the methods of this parent study, including information on the positionality of the team and steps taken to ensure the validity of the findings, are presented elsewhere. 19 Briefly, we used a stratified sampling frame to purposively enroll high school staff participants across the United States within 3 categories (high, medium, and low) of sexual minority-related structural stigma, which we assessed at the state level using a validated scale (example scale items: concentration of same-sex couples based on 2010 Census; public opinion toward sexual and gender minority issues). 20 To ensure a diverse sample, our sampling frame also included additional strata for gender, race/ethnicity, urbanicity, sexual and gender minority status, and role in school; for sampling quotas, see Table 1 and Coulter et al (2018).…”

“…20 To ensure a diverse sample, our sampling frame also included additional strata for gender, race/ethnicity, urbanicity, sexual and gender minority status, and role in school; for sampling quotas, see Table 1 and Coulter et al (2018). 19 Given that the goal of the larger qualitative study was to generate formative knowledge about the experiences of students identifying as LGBTQ+ and the high school staff working with them, we expected that 30 staff interviews would generate ample data to meet the study aims. 21 We recruited participants via advertisements on social media (Facebook, Instagram, Twitter, Reddit), professional organizations, and our social networks.…”

“…22 In collecting and analyzing data, we used a phenomenological approach focused on capturing Texas (2) Tennessee (1) West Virginia (1) * For each of the 3 structural stigma strata, we sought to recruit 10 participants total, including 3 cisgender men, 3 non-white/non-Latine participants, 2 participants from rural areas, 6 cisgender heterosexual participants, 2 administrators, 1 clinical provider, 1 food service provider, and 1 librarian. For sampling rationale, please see Coulter et al (2022). 19 rich, accurate descriptions of informal strategies from participants' perspectives.…”

“…For sampling rationale, please see Coulter et al (2022). 19 rich, accurate descriptions of informal strategies from participants' perspectives. 23…”