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

Abstract

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.

The Impact of the Parental Support on Risk Factors in the Process of Gender Affirmation of Transgender and Gender Diverse People

“…Gender identity was assessed using the two questions method (one related to the gender designated at birth and another asking how the participants describe their gender identity), and people were considered eligible for participation if they reported a gender different from that assigned to them at birth (Bauer et al, 2017). The organized Brazilian social movement prefers the use of the terms travesti , transsexual and trans person (man or woman) to the anglophone umbrella term transgender.…”

Gender (mis)measurement: Guidelines for respecting gender diversity in psychological research

“…Of course, most nonbinary individuals cannot accurately describe themselves on binary measures at all. Thus, some transgender and nonbinary individuals may skip binary questions (see Tate et al, 2013), while others may select one of the binary options, which can result in gender misclassifications (see Bauer, Braimoh, Scheim, & Dharma, 2017).…”

Age differences in public stigma, self‐stigma, and attitudes toward seeking help: A moderated mediation model

“…We assessed gender using the question: "What best describes your current gender identity" with the following four response options: male, female, Indigenous, or other cultural gender minority identity (e.g., two-spirited), and something else (e.g., gender fluid, nonbinary; Bauer, Braimoh, Scheim, & Dharma, 2017). We assessed gender using the question: "What best describes your current gender identity" with the following four response options: male, female, Indigenous, or other cultural gender minority identity (e.g., two-spirited), and something else (e.g., gender fluid, nonbinary; Bauer, Braimoh, Scheim, & Dharma, 2017).…”

“…Participants reported their age, marital status, occupation status, estimated household income, and population group (White, Arab, Black, Chinese, Filipino, Indigenous, Japanese, Korean, Latin American, South Asian, Souteast Asian, West Asian, and other). We assessed gender using the question: "What best describes your current gender identity" with the following four response options: male, female, Indigenous, or other cultural gender minority identity (e.g., two-spirited), and something else (e.g., gender fluid, nonbinary; Bauer, Braimoh, Scheim, & Dharma, 2017). Because less than 1% of the sample endorsed the last two options, for data analytic purposes we coded gender as missing, 0 = female, and 1 = male.…”