Development and Usability Testing of Digital Knowledge Translation Tools for Parents on Sexual Orientation and Gender Identity

Development and Usability Testing of Digital Knowledge Translation Tools for Parents on Sexual Orientation and Gender Identity | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development and Usability Testing of Digital Knowledge Translation Tools for Parents on Sexual Orientation and Gender Identity Neelam Punjani, Amber Hussain, Shannon D Scott This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8408000/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 11 You are reading this latest preprint version Abstract Background Parents play a critical role in supporting children’s understanding of sexual orientation and gender identity (SOGI), yet many report lacking the confidence, language, or resources to initiate these conversations. Arts-based digital knowledge translation (KT) tools have demonstrated promise in promoting inclusive, emotionally resonant learning, particularly for sensitive or stigmatized topics. This study aimed to develop and evaluate the usability of two animated KT videos designed to help parents discuss SOGI with their children. Methods We conducted a sequential explanatory mixed-methods study. Two short, animated, story-based videos were developed based on prior qualitative research with Canadian parents. Development was guided by the ARCHE-ECHO KT Tool Development Cycle to ensure user-centred and iterative refinement. Twenty-four parents completed quantitative usability testing using the System Usability Scale (SUS), KT evaluation subscales, and four pre–post visual analogue scale (VAS) items assessing changes in understanding, comfort, confidence, and likelihood of initiating SOGI conversations. Eight participants subsequently joined focus groups to explore user experience in depth. Quantitative data were analyzed descriptively and with paired t-tests, while qualitative data underwent thematic analysis. Results Both videos demonstrated high usability, with mean SUS scores of 82.4 and 79.8. Pre–post VAS ratings showed significant improvements across all outcomes, including understanding of gender diversity, comfort discussing SOGI topics, and confidence responding to children’s questions (all p < .001). Participants perceived the videos as accessible, visually engaging, and culturally inclusive. Thematic analysis identified four major themes: increased parental confidence and knowledge; enhanced emotional and cognitive engagement due to arts-based design; desire for ongoing support and community resources; and value of inclusive representation. Participants recommended additional enhancements such as multilingual captions and age-specific adaptations. Conclusion Arts-based KT tools provide an effective, user-centered approach to supporting parents in engaging children in inclusive, developmentally appropriate SOGI discussions. Integrating visual storytelling with inclusive design can build parental confidence, promote open communication, and reduce stigma. These tools may complement existing sexuality education efforts and strengthen culturally responsive public health communication. Future work should examine long-term effects and develop multilingual, culturally responsive versions to broaden accessibility. Sexual orientation gender identity parents sexuality education knowledge translation arts-based methods usability testing animated videos communication Figures Figure 1 1. INTRODUCTION Comprehensive sexuality education (CSE) is a key component of child and adolescent development, extending beyond reproductive biology to encompass emotional, social, and identity-related dimensions. The World Health Organization (WHO) and other global health bodies stress that CSE must be inclusive, age-appropriate, and responsive to cultural contexts, including topics of sexual orientation and gender identity (SOGI), in order to foster healthy psychosocial outcomes for youth [ 1 ]. Despite these guidelines, many parents feel unequipped to engage their children in conversations about SOGI. This can be attributed to limited knowledge, cultural or religious constraints, and the absence of clear or supportive educational resources [ 2 , 3 ]. These challenges often result in avoidance, which leaves children without critical guidance during formative years of identity development. The role of parents in sexuality education is crucial. Studies show that when parents actively participate in discussions around sexuality including gender and orientation, their children experience healthier developmental outcomes, such as delayed initiation of sexual activity, greater use of protection, and improved mental health [ 4 – 7 ]. Specifically, children who feel supported in exploring their identities report stronger family relationships and fewer mental health risks, such as depression and anxiety [ 8 ]. However, traditional educational materials often fail to address the full spectrum of identities and family structures. These materials are frequently outdated, culturally narrow, or overly clinical, which can further alienate families from engaging with SOGI topics meaningfully [ 9 , 10 ]. Arts-based knowledge translation (KT) strategies have emerged as promising tools for bridging this gap. These strategies use narrative, imagery, and animation to engage viewers emotionally and cognitively, particularly around stigmatized or sensitive topics [ 11 ]. Evidence suggests that arts-based KT can increase understanding, enhance recall, and improve user engagement in health communication contexts [ 12 , 13 ]. This method offers a novel approach to presenting complex SOGI topics in a way that fosters inclusive, affirming communication between parents and children. Building on previous qualitative research that identified Canadian parents’ needs for accessible, inclusive, and emotionally resonant materials related to sexuality education [ 7 , 14 ], this study developed and tested two animated videos, Sexual Orientation and Gender Identity, as arts-based KT tools. These videos were designed to address gaps in parent knowledge, reduce stigma, build parental confidence, and promote open communication in diverse family settings. 2. METHODS 2.1 | Process of Arts-Based KT Tool Development: Animated Videos on SOGI Communication In response to a recognized gap in accessible and inclusive educational materials to support parents in discussing sexual orientation and gender identity (SOGI) with their children, we developed two short, animated, story-based videos as arts-based knowledge translation (KT) tools. These resources were designed to foster open, stigma-free dialogue, support emotional safety, and encourage age-appropriate and affirming communication across diverse family contexts [ 15 , 16 ]. The development process was grounded in prior qualitative research with Canadian parents, including focus groups with 30 participants from diverse social and cultural backgrounds [ 14 ]. Themes emerging from this work included the need for clear, non-judgmental language, inclusive representation, emotional sensitivity, and real-life examples of parenting conversations about SOGI [ 14 ]. The first video focused on sexual orientation, providing parents with foundational knowledge and offering strategies for discussing such concepts in appropriate ways. The second video addressed gender identity and expression, emphasizing support for children who may be questioning or exploring their gender identity [ 17 ]. Each video was designed to be 2.5–3.3 minutes long, informed by research suggesting that brief, visually rich content enhances viewer engagement and retention [ 18 ]. The videos used multiple modalities animation, voiceover, text overlays, and narrative examples to accommodate various learning styles. Content development began with a review of literature related to SOGI communication with children, inclusive education strategies, and family-based support models [ 19 – 21 ]. We also conducted a gap analysis of existing resources. To identify existing gaps in resources, we conducted a scoping review guided by the Joanna Briggs Institute framework and PRISMA-ScR guidelines. This review included 59 peer-reviewed studies on parent–child communication about sexuality, with attention to barriers faced by parents globally [ 7 ]. The analysis revealed consistent challenges such as limited parental knowledge, discomfort, lack of inclusive language, cultural and religious constraints, and underrepresentation of 2SLGBTQIA + youth. These findings directly informed our identification of critical topic areas needing attention, including developmental guidance, inclusive terminology, culturally safe parenting practices, and strategies for addressing children’s questions. Scriptwriting followed an iterative process, with drafts reviewed by total six individuals, including content experts, community advocates, and members of the original parent focus groups. The final scripts featured diverse characters and storytelling elements that fostered relatability and empathy [ 22 ]. The animation phase followed principles of educational media design, emphasizing visual clarity, pacing, and approachability while maintaining credibility [ 23 ]. Narration was delivered by professional voice actors, ensuring tone and delivery were accessible to diverse audiences [ 24 ]. Both videos are publicly accessible online: 1. Sexual Orientation: How to Talk with Your Kids. https://www.youtube.com/watch?v=9dxmIREHRHk [ 25 ]; 2. Gender Identity: How to Talk with Your Kids. https://www.youtube.com/watch?v=egvHsBTczEo [ 26 ]. In this study, we followed the ARCHE-ECHO KT Tool Development Cycle developed by Scott and Hartling (2016) [ 27 ] (see Fig. 1). 2.2 | Usability Testing Approach Given the need to ensure that the animated KT videos were not only informative but also easy for parents to use and understand, we adopted a usability testing approach rooted in human-centred design. Usability testing is a common practice in health informatics, integrating technology with human-centered design to evaluate digital health tools [ 28 ]. It plays a critical role in determining whether a developed product is effective, efficient, and satisfactory for intended users [ 29 ]. The usability evaluation of arts-based knowledge translation (KT) tools, particularly those delivered in digital formats remains an emerging area of research [ 30 ]. Key usability principles include effectiveness (does the tool accomplish its goals?), efficiency (resource use), user satisfaction, and identification of potential errors [ 28 , 29 ]. Although many usability studies in health focus on websites or clinical tools [ 31 , 32 ], growing attention is being paid to arts-based KT interventions that aim to enhance patient and caregiver engagement through narrative, visual storytelling, and interactive media [ 13 , 33 ]. For example, Archibald and Scott (2019) applied iterative usability testing, including semi-structured interviews and think-aloud protocols to assess an arts-based eBook designed for parents of children with asthma [ 30 ]. Their findings emphasized the importance of clarity, accessibility, and emotional resonance in arts-based formats. Similarly, Hartling et al. (2010) developed and tested a series of arts-based tools for pediatric conditions like croup and gastroenteritis. They used feedback from end-users to revise design features, improve information presentation, and enhance usability [ 34 ]. These approaches, informed by Department of Health and Human Services guidelines and ISO usability standards, offer valuable strategies for evaluating digital, arts-based KT resources [ 28 , 35 ]. 2.3 | Study Design We conducted a sequential explanatory mixed methods usability pilot to examine the usability of two digital, arts-based KT videos related to SOGI for parents. This design followed the principle of complementarity [ 36 ], wherein qualitative data were collected to elaborate on and clarify quantitative results. A sequential explanatory approach was chosen because usability studies often benefit from initial quantitative assessments to measure usability metrics, followed by qualitative exploration to understand the emotional, cultural, and contextual factors influencing user experience. Drawing on a complementary strength’s stance [ 37 ], we integrated methodologies from technology development focusing on structured usability assessment using standardized tools [ 38 ] and qualitative method used in health education to explore contextual dimensions of engagement with KT tools [ 30 ]. In usability research, conceptual saturation is not the primary aim; instead, the goal is to identify key usability barriers and facilitators. Therefore, the emphasis is on user diversity and interface exposure rather than achieving thematic saturation. The sample size was guided by existing usability literature. Bastien (2010) suggests that four to five users may uncover 85% of interface usability issues [ 29 ]. Others argue that sample size should relate to the number and complexity of tasks being evaluated [ 39 ]. Given the limited interactive tasks associated with the videos (e.g., viewing, reflecting, responding), we anticipated that a quantitative sample of 24 and a qualitative sample of 8 would be sufficient to identify usability themes and user experience challenges. This aligns with usability norms, where relatively small samples can generate high-value insights due to the focused nature of tasks. 2.3.1 | Quantitative A total of 24 Participants were recruited through purposive sampling from online parenting forums, digital community boards, and targeted social media outreach (Facebook and Twitter). To minimize the risk of fraudulent participation, we used screening questions to verify parenting status and interest in SOGI topics, and we reviewed responses for duplicate emails and inconsistencies. Eligibility criteria included: (a) being a parent or caregiver of at least one child aged 0–18, (b) fluency in English, and (c) openness to engaging with parenting resources related to SOGI topics. Participants received a secure link to view two arts-based KT videos (sexual orientation and gender identity) and then completed a 22-item self-administered questionnaire. Usability was assessed with the System Usability Scale (SUS) and five 1–5 Likert subscales covering clarity of information, visual appeal, cultural appropriateness, ease of access, and perceived usefulness, plus an item asking whether they would recommend each video. Four outcome items used 10-point visual analogue scales (VAS) anchored 0 = not at all to 10 = very much to capture pre–post change in understanding of gender diversity, comfort discussing SOGI topics, confidence responding to children’s questions, and likelihood of initiating future conversations. Open-ended prompts asked what participants found helpful, confusing, emotionally impactful, or concerning; these qualitative responses informed the interview guide for the qualitative strand. 2.3.2 | Qualitative Eight participants from the quantitative group consented to join the qualitative phase. Participants were selected using maximum variation sampling to ensure representation across gender identity, cultural background, education level, and previous experience with SOGI-related content. Two virtual focus group discussions (FGDs), each with four participants and lasting 60–90 minutes, were conducted using Zoom. Participants received secure links to re-watch the videos prior to attending. The semi-structured FGD guide was developed based on usability testing literature and emerging questionnaire data [ 30 ]. Key questions addressed emotional tone, cultural sensitivity, content clarity, and likelihood of future use in parenting contexts. All FGDs were audio-recorded and transcribed verbatim. Quotes were anonymized during analysis. 2.4 | Analysis Quantitative data from the 24 returned questionnaires were analyzed using IBM SPSS Statistics (Version 31). Descriptive statistics (means ± SD) summarized SUS and subscale ratings and recommendation proportions. Pre–post changes on the four VAS outcomes were evaluated using paired two-tailed t-tests with α = .05; t statistics and p-values were reported and within-sample effect sizes (Cohen’s d for paired samples, estimated as d = t/√N) were calculated to gauge magnitude. Transcripts from the focus group discussions were analyzed using Braun and Clarke’s (2006) six-phase thematic analysis approach [ 40 ]. The process began with familiarization, where researchers engaged in repeated reading of transcripts and listening to audio recordings to immerse themselves in the data. Initial coding was then conducted independently by two researchers using NVivo 14 software, allowing for inductive identification of meaningful features in the data. Codes were grouped into interpretive categories to search for potential themes. These emerging themes were subsequently reviewed for coherence and consistency across the dataset, ensuring they were sufficiently supported by participant narratives. Once refined, themes were clearly defined and accompanied by descriptive narratives that captured the essence of each. 2.5 | Ethical Consideration The study was approved by the University of Alberta Research Ethics Board (Pro00124683). All participants provided informed consent prior to participation and were informed of their right to withdraw at any time. Given the sensitivity of the topic, participants were also provided with mental health and community support resources. Confidentiality was ensured through anonymized transcripts, secure data storage, and the use of participant codes. 3. RESULTS 3.1 Participants Demographics A total of 24 parents participated in the study. The sample was diverse in terms of country of birth, years lived in Canada, age, gender, and, education (refer to Table 1 for consolidated summary of participant demographics). This diversity supports the usability aim of evaluating whether the tools function effectively across varied parent profiles, family contexts, and cultural backgrounds. Table 1 Demographic Characteristics of Participants (N = 24) Characteristic n (%) Gender Female 16 (66.7%) Male 6 (25.0%) Non-binary / Prefer not to say 2 (8.3%) Age Group (years) 25–34 8 (33.3%) 35–44 9 (37.5%) 45–54 5 (20.8%) 55+ 2 (8.4%) Education Level Bachelor’s degree 10 (41.7%) Graduate / Professional degree 8 (33.3%) College diploma 5 (20.8%) High school or less 1 (4.2%) Ethno-cultural Background White / European 12 (50.0%) South Asian 4 (16.7%) East Asian 3 (12.5%) Black / African 2 (8.3%) Indigenous 1 (4.2%) Other / Mixed 2 (8.3%) Province of Residence Alberta 13 (54.2%) British Columbia 7 (29.2%) Ontario 4 (16.6%) Children’s Age Range 0–5 years 5 (20.8%) 6–12 years 11 (45.8%) 13–18 years 8 (33.4%) 3.2 | Quantitative Overall usability was rated highly for both arts-based KT videos. The Sexual Orientation video achieved an excellent mean System Usability Scale (SUS) score of 82.4 (SD = 8.7), and the Gender Identity video scored 79.8 (SD = 9.2), both well above the > 68 benchmark for above-average usability [ 38 ] (Table 2 ). Subscale ratings were uniformly positive: clarity of information averaged 4.3 (SD = 0.6) and 4.1 (SD = 0.7), visual appeal 4.1 (SD = 0.8) and 4.0 (SD = 0.7), cultural appropriateness 4.2 (SD = 0.7) and 4.2 (SD = 0.6), ease of access 4.4 (SD = 0.5) and 4.3 (SD = 0.5), and perceived usefulness 4.5 (SD = 0.5) and 4.3 (SD = 0.6) for the sexual orientation and gender identity videos respectively (Table 2 ). More than 90% of participants indicated they would recommend the videos to others (92% and 90%), indicating strong acceptability and likelihood of dissemination (Table 2 ). Table 2 Usability Scores of Arts-Based KT Tools (N = 24) Usability Domain Sexual Orientation Video (M ± SD) Gender Identity Video (M ± SD) System Usability Scale (SUS) 82.4 ± 8.7 79.8 ± 9.2 Clarity of Information (1–5) 4.3 ± 0.6 4.1 ± 0.7 Visual Appeal (1–5) 4.1 ± 0.8 4.0 ± 0.7 Cultural Appropriateness (1–5) 4.2 ± 0.7 4.2 ± 0.6 Ease of Access (1–5) 4.4 ± 0.5 4.3 ± 0.5 Perceived Usefulness (1–5) 4.5 ± 0.5 4.3 ± 0.6 Will Recommend to Others (%) 92% 90% Note : SUS scores > 68 are considered above average; scores > 80 indicate excellent usability [ 38 ]. Exposure to the videos produced significant, substantive improvements in parental knowledge, confidence, and comfort. Paired t-tests comparing pre- and post-test 10-point VAS scores showed statistically significant increases across all four outcomes (all p < .001) (Table 3 ). Understanding of gender diversity rose from a pre-test mean of 6.2 (SD = 1.9) to 8.4 (SD = 1.3), t(23) = 5.62, p < .001. Comfort discussing SOGI topics increased from 5.9 (SD = 2.0) to 8.1 (SD = 1.6), t(23) = 5.04, p < .001. Confidence in responding to children’s questions improved from 6.1 (SD = 1.8) to 8.3 (SD = 1.4), t(23) = 5.49, p < .001. Likelihood of initiating conversations showed the largest change, rising from 6.7 (SD = 1.5) to 8.7 (SD = 1.1), t(23) = 6.10, p < .001 (Table 3 ). These results indicate meaningful within-sample gains in parents’ readiness and self-efficacy to engage in SOGI conversations following the intervention. Table 3 Pre–Post Changes in Parental Knowledge, Confidence, and Comfort (N = 24) Outcome Variable Pre-Test Mean (SD) Post-Test Mean (SD) t p-value Understanding of gender diversity 6.2 (1.9) 8.4 (1.3) 5.62 < .001 Comfort discussing SOGI topics 5.9 (2.0) 8.1 (1.6) 5.04 < .001 Confidence responding to children’s questions 6.1 (1.8) 8.3 (1.4) 5.49 < .001 Likelihood of initiating conversations 6.7 (1.5) 8.7 (1.1) 6.10 < .001 Note : Scores measured using 10-point Visual Analog Scale (VAS), where higher scores indicate greater confidence or comfort. Paired t-tests show statistically significant improvements (p < .05). 3.2 | Qualitative Participants took part in follow-up focus groups to further explore their experience with the tools. Thematic analysis identified four major themes that reflect parent responses to the videos. All participants reported overall satisfaction with the tools, including content, delivery, and design. Qualitative data reinforced quantitative findings and are presented narratively below. 3.2.1 | The tools enhanced parental confidence and knowledge Participants consistently reported that both videos increased their confidence and knowledge related to SOGI discussions. Many described feeling anxious or uncertain before using the tools, citing fears of using the wrong language or causing harm. The videos were described as “demystifying” and helped parents feel more prepared and emotionally reassured. A 34-year-old mother stated, “I've been worried about these conversations for months... After watching the videos, I feel like I actually have a roadmap now.” Similarly, a 41-year-old father noted, “The videos gave me actual scripts I could adapt... It's like having a coach walking me through it.” Participants appreciated the inclusion of practical strategies and realistic conversation examples. Parents also recognized that SOGI conversations could be ongoing, rather than single, formal discussions. This understanding reduced anxiety and made the topic feel more manageable. In addition to terminology and concepts, participants reported gaining a deeper understanding of child development, family dynamics, and the lived experiences of LGBTQ + individuals. 3.2.2 | Arts-based design improved accessibility and engagement The videos’ animated format was widely praised for making sensitive content feel more approachable and emotionally resonant. Participants noted that the visual storytelling allowed them to engage with challenging material in a non-threatening way. A 29-year-old mother explained, “There's something about the animation that makes it feel safer to explore these topics... It's not as intense as watching real people.” Diverse visual representation was highlighted as a major strength, allowing parents to see themselves and others reflected in the content. This enhanced both relevance and learning. Emotional engagement appeared to contribute to increased empathy and motivation for inclusive parenting. 3.2.3 | Ongoing support and community connection is needed While participants found the videos informative and empowering, many expressed interests in continued support and community-based learning. Parents indicated that the tools sparked additional questions and highlighted the complexity of ongoing SOGI education. A 38-year-old mother shared, “The tools gave me a great starting point... but they also made me realize how much more there is to learn.” Participants suggested follow-up resources, discussion groups, and expanded learning materials to support long-term engagement. This was especially emphasized by parents who felt socially isolated or lacked community resources. 3.2.4 | Inclusive representation fostered relevance and relatability Parents responded positively to the inclusive representation of ethnicity, family structures, and gender expression. The use of diverse characters helped normalize conversations around SOGI and ensured that the videos were relevant to a wide range of families. This representation contributed to the high perceived usefulness and relatability of the content. One participant noted that the videos made the topic “feel like it belongs to everyone, not just families with LGBTQ + kids,” suggesting the tools effectively framed SOGI discussions as universal rather than niche. 3.3 | Areas for improvement Participants identified a few areas for enhancement. Some requested closed captioning options in multiple languages to support broader accessibility. Others suggested supplementary materials such as downloadable conversation guides and frequently asked questions. Technical feedback included requests for improved mobile compatibility and offline viewing options. A few participants also recommended tailoring future videos for specific child age groups, reflecting differences in developmental stages and communication strategies. These suggestions provide concrete direction for iterative refinement and future tool development. Overall, participant feedback emphasized the value of the tools while highlighting the potential for further development to support continued learning and accessibility. 4. DISCUSSION The development and evaluation of two animated KT tools addressing SOGI for Canadian parents demonstrate the value of combining arts-based approaches with user-centred design to enhance understanding, emotional engagement, and accessibility. The consistently high usability scores and rich qualitative feedback underscore that such tools not only educate but also empower parents to have inclusive, developmentally appropriate conversations with their children. Our findings align with a growing body of literature highlighting how arts-based, especially when paired with narrative structures can foster emotional resonance and relatability [ 30 , 41 ]. Participants frequently referred to the animated format and diverse character representation as reducing intimidation and making complex content more digestible. This supports existing research suggesting that multimodal strategies using visual and inclusive imagery can increase motivation to engage with sensitive topics [ 34 , 42 – 44 ]. Another evidence from Hartling et al. (2010) further reinforces this, showing that a web-based animated KT tool improved parental knowledge and confidence regarding pediatric illness management [ 34 ]. While no significant difference in decisional regret was observed, participants rated the tool highly in usability and satisfaction, echoing our own findings and highlighting the broader effectiveness of visually engaging, narrative-based formats in supporting informed and confident decision-making. The emotional and cognitive accessibility of these tools appears to support vicarious learning and perspective-taking. Storytelling is not only a method of information delivery but a way to simulate social experiences and enhance empathy [ 45 ]. Participants described feeling better equipped to support their children, not just because they understood the terminology but because they could emotionally visualize how conversations might unfold. This matches prior work where participants reported that story-based KT tools helped put themselves in the story [ 30 ]. This illustrates how the arts-based medium strengthened both informational and emotional readiness an important mechanism underlying the quantitative outcomes. Participant feedback strongly reinforced the value of engaging users throughout the development cycle. Consistent with KT design literature [ 46 , 47 ], iterative review by content experts, community members, and parents contributed to culturally sensitive and developmentally appropriate content. This collaborative approach appears central to the high usability scores and the perception that the videos were respectful, non-judgmental, and relatable. Moreover, participants’ call for additional resources such as downloadable guides, multilingual captioning, and age-specific versions underscores that effective KT tools function best as components of a broader ecosystem of support, rather than standalone products. This supports recent research advocating for multi-format, layered KT strategies that sustain learning over time [ 44 ]. The positive response to visual inclusivity representation across ethnicity, gender expression, and family types also aligns with research indicating that diversity in KT tools enhances both engagement and transferability of knowledge [ 48 ]. This is especially pertinent in SOGI education, where cultural safety and representation are essential to fostering openness and reducing stigma. Given that SOGI topics are often marginalized or seen as peripheral, inclusive imagery is particularly critical for reducing stigma and increasing accessibility. Usability testing remains critical for ensuring tools meet real-world needs. As noted by Bastien (2010), usability is multidimensional encompassing efficiency, satisfaction, clarity, and cultural fit [ 29 ]. Our findings affirm that testing not only validates function but reveals emotional and social dimensions of KT effectiveness. 4.1 | Limitations There were certain limitations to this study that should be considered when interpreting the findings. First, although the usability testing sample size met standards for qualitative and formative research, it remained small and therefore limits the generalizability of the quantitative findings. Larger, more diverse samples would allow for a more robust examination of effectiveness, usability, and acceptability across varied parent populations. Second, participants were primarily recruited through community organizations and social media channels, which may have introduced selection bias toward parents who were already motivated or comfortable engaging with SOGI-related content. More hesitant, ambivalent, or disengaged parents may not be fully represented, and future research should intentionally include these groups. Third, usability testing was conducted virtually rather than in person. Although this enabled geographic diversity and flexibility, it may have restricted observation of non-verbal cues and naturalistic user interaction, which can be valuable for identifying subtle usability issues. Fourth, the study used only English-language materials. This limits cultural and linguistic inclusivity and may exclude parents who would benefit from SOGI communication tools but require additional language supports. Multilingual adaptations are recommended to improve reach and cultural relevance. Lastly, the study did not include long-term follow-up. Although parents reported immediate improvements in confidence, comfort, and understanding, it remains unclear whether these gains translate into sustained behaviour change or improved parent–child communication over time. Future research should evaluate longitudinal effects and explore how repeated exposure or supplementary KT tools influence outcomes. 5. CONCLUSION In conclusion, this study provides meaningful evidence that arts-based, user-centred KT tools can effectively support parents in navigating sensitive conversations about sexual orientation and gender identity with their children. The two animated videos demonstrated high usability, strong acceptability, and significant improvements in parental knowledge, comfort, and confidence, key components of readiness for SOGI-related communication. By integrating visual storytelling, inclusive representation, and developmentally appropriate messaging, these tools addressed recognized gaps in existing sexuality education resources and offered an accessible, emotionally safe entry point for parents. The positive qualitative feedback further illustrates how arts-based formats can foster empathy, reduce anxiety, and make complex content more approachable. This approach may serve as a model for future KT interventions targeting topics that are socially complex, emotionally charged, or frequently avoided in traditional health education materials. Continued refinement such as multilingual captioning, age-specific adaptations, and supplementary conversation guides will enhance the scalability and inclusivity of these tools. Declarations Ethics approval and consent to participate: University of Alberta Research Ethics Board (Pro00124683) Clinical trial number: Not applicable. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests Funding: No Funding Authors' contributions: Neelam Punjani - conceptualization, data collection, analysis, writing; Amber Hussain - writing, analysis, reviewing; Shannon D Scott - analysis, reviewing, supervision. 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International standards for HCI and usability. Int J Hum-Comput Stud 2001; 55: 533–552. Bastien JMC. Usability testing: a review of some methodological and technical aspects of the method. Int J Med Inf 2010; 79: e18–e23. Archibald MM, Scott SD. Learning from usability testing of an arts-based knowledge translation tool for parents of a child with asthma. Nurs Open 2019; 6: 1615–1625. Kastner M, Lottridge D, Marquez C, et al. Usability evaluation of a clinical decision support tool for osteoporosis disease management. Implement Sci 2010; 5: 96. Stinson J, McGrath P, Hodnett E, et al. Usability Testing of an Online Self-management Program for Adolescents With Juvenile Idiopathic Arthritis. J Med Internet Res 2010; 12: e30. Phillips EK, Chudyk AM, Monnin C, et al. The Use of Arts‐Based Methods to Enhance Patient Engagement in Health Research. Health Expect 2024; 27: e70127. Hartling L, Scott S, Pandya R, et al. Storytelling as a communication tool for health consumers: development of an intervention for parents of children with croup. Stories to communicate health information. BMC Pediatr 2010; 10: 64. Department of Health and Human Services. Usability, https://www.usability.gov/guidelines/index.html (n.d.). Greene JC, Caracelli VJ, Graham WF. Toward a Conceptual Framework for Mixed-Method Evaluation Designs. Educ Eval Policy Anal 1989; 11: 255–274. Morse J. Procedures and Practice of Mixed Method Design: Maintaining Control, Rigor, and Complexity. In: SAGE Handbook of Mixed Methods in Social & Behavioral Research . 2455 Teller Road, Thousand Oaks California 91320 United States: SAGE Publications, Inc., pp. 339–352. Bangor A, Kortum PT, Miller JT. An Empirical Evaluation of the System Usability Scale. Int J Hum-Comput Interact 2008; 24: 574–594. Straub ET. Understanding Technology Adoption: Theory and Future Directions for Informal Learning. Rev Educ Res 2009; 79: 625–649. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77–101. Barone T, Eisner EW. Arts Based Research . SAGE Publications, 2011. Le A, Hartling L, Scott SD. The development and usability testing of digital knowledge translation tools for parents of children with acute otitis media. Epub ahead of print 3 July 2021. DOI: 10.1101/2021.06.29.21259431. Le A, Hartling L, Scott SD. The development and usability testing of digital knowledge translation tools for parents of children with bronchiolitis. Epub ahead of print 28 June 2021. DOI: 10.1101/2021.06.21.21259266. Scott SD, Elliott SA, Reid K, et al. The development and usability testing of six arts-based knowledge translation tools for parents about COVID-19. Epub ahead of print 1 April 2025. DOI: 10.1101/2025.03.31.25324968. Kirkpatrick MK, Ford S, Castelloe BP. Storytelling: An Approach to Client-Centered Care. Nurse Educ 1997; 22: 38–40. Taddio A, Ilersich AL, Ipp M, et al. Physical interventions and injection techniques for reducing injection pain during routine childhood immunizations: Systematic review of randomized controlled trials and quasi-randomized controlled trials. Clin Ther 2009; 31: S48–S76. Shoup JA, Wagner NM, Kraus CR, et al. Development of an Interactive Social Media Tool for Parents With Concerns About Vaccines. Health Educ Behav 2015; 42: 302–312. Giles ML. The Sexual Subjectivity of Youth with Physical Disabilities: An Arts-Based Study in Toronto, Canada . University of Toronto, 2024. Additional Declarations No competing interests reported. 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Hussain","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIie3OMQrCMBTG8SeBurRkfVLQK0QKweMECrp0KAjiIFoQdBHngqcQLxAI6NIDvEFEcXXQRTqJguCiBN0c8hsCgfz5AuA4/wifJ+MAFfNTUq1lAOZ1/yIBLvS3CV/Moks5aIURxXuT9ndDnrHD2TqyLWTorzGS1BYmL7qI2ovsU5RIBh7GkpQwwUQhaN/+uwYlj4/dcLTKO2cT3BQ2tM9KWyIoERhMkAlMHiuZQqF9z7rSpHYvDObIsDilJl+r2tJ4smVL6hSvLuV1yPi0szymA8Xrm/GRbMkH7Mf3juM4zrs733RHgMOb+HAAAAAASUVORK5CYII=","orcid":"","institution":"University of Alberta","correspondingAuthor":true,"prefix":"","firstName":"Amber","middleName":"","lastName":"Hussain","suffix":""},{"id":570236305,"identity":"0f5062e9-e473-4368-a094-8b1b6241a7a3","order_by":2,"name":"Shannon D Scott","email":"","orcid":"","institution":"University of Alberta","correspondingAuthor":false,"prefix":"","firstName":"Shannon","middleName":"D","lastName":"Scott","suffix":""}],"badges":[],"createdAt":"2025-12-19 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16:16:06","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":105492,"visible":true,"origin":"","legend":"","description":"","filename":"8ea40e5967dd4f44964c3cc16dc4fac91structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8408000/v1/6c4a2285b4802fed6f7d6329.xml"},{"id":100070010,"identity":"845cca19-ff20-415b-9d46-cbc2093c7ee3","added_by":"auto","created_at":"2026-01-12 16:15:52","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":117547,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8408000/v1/544685aacf2f457ccf4786ae.html"},{"id":100069961,"identity":"493c7532-d9f0-4464-9565-2901fc102d9d","added_by":"auto","created_at":"2026-01-12 16:15:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":480234,"visible":true,"origin":"","legend":"\u003cp\u003e\u0026nbsp;See image above for figure legend.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8408000/v1/f5b231ad7f5bdc66c35b5a89.png"},{"id":100070925,"identity":"e10ab22f-4816-4f68-b6da-8950d1e3a388","added_by":"auto","created_at":"2026-01-12 16:18:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1339397,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8408000/v1/ec8ed1d9-952e-446f-8d56-ca363b2d7b3a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and Usability Testing of Digital Knowledge Translation Tools for Parents on Sexual Orientation and Gender Identity","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eComprehensive sexuality education (CSE) is a key component of child and adolescent development, extending beyond reproductive biology to encompass emotional, social, and identity-related dimensions. The World Health Organization (WHO) and other global health bodies stress that CSE must be inclusive, age-appropriate, and responsive to cultural contexts, including topics of sexual orientation and gender identity (SOGI), in order to foster healthy psychosocial outcomes for youth [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Despite these guidelines, many parents feel unequipped to engage their children in conversations about SOGI. This can be attributed to limited knowledge, cultural or religious constraints, and the absence of clear or supportive educational resources [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These challenges often result in avoidance, which leaves children without critical guidance during formative years of identity development.\u003c/p\u003e \u003cp\u003eThe role of parents in sexuality education is crucial. Studies show that when parents actively participate in discussions around sexuality including gender and orientation, their children experience healthier developmental outcomes, such as delayed initiation of sexual activity, greater use of protection, and improved mental health [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Specifically, children who feel supported in exploring their identities report stronger family relationships and fewer mental health risks, such as depression and anxiety [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, traditional educational materials often fail to address the full spectrum of identities and family structures. These materials are frequently outdated, culturally narrow, or overly clinical, which can further alienate families from engaging with SOGI topics meaningfully [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eArts-based knowledge translation (KT) strategies have emerged as promising tools for bridging this gap. These strategies use narrative, imagery, and animation to engage viewers emotionally and cognitively, particularly around stigmatized or sensitive topics [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Evidence suggests that arts-based KT can increase understanding, enhance recall, and improve user engagement in health communication contexts [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This method offers a novel approach to presenting complex SOGI topics in a way that fosters inclusive, affirming communication between parents and children.\u003c/p\u003e \u003cp\u003eBuilding on previous qualitative research that identified Canadian parents\u0026rsquo; needs for accessible, inclusive, and emotionally resonant materials related to sexuality education [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], this study developed and tested two animated videos, Sexual Orientation and Gender Identity, as arts-based KT tools. These videos were designed to address gaps in parent knowledge, reduce stigma, build parental confidence, and promote open communication in diverse family settings.\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 | Process of Arts-Based KT Tool Development: Animated Videos on SOGI Communication\u003c/h2\u003e \u003cp\u003eIn response to a recognized gap in accessible and inclusive educational materials to support parents in discussing sexual orientation and gender identity (SOGI) with their children, we developed two short, animated, story-based videos as arts-based knowledge translation (KT) tools. These resources were designed to foster open, stigma-free dialogue, support emotional safety, and encourage age-appropriate and affirming communication across diverse family contexts [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe development process was grounded in prior qualitative research with Canadian parents, including focus groups with 30 participants from diverse social and cultural backgrounds [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Themes emerging from this work included the need for clear, non-judgmental language, inclusive representation, emotional sensitivity, and real-life examples of parenting conversations about SOGI [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe first video focused on sexual orientation, providing parents with foundational knowledge and offering strategies for discussing such concepts in appropriate ways. The second video addressed gender identity and expression, emphasizing support for children who may be questioning or exploring their gender identity [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEach video was designed to be 2.5\u0026ndash;3.3 minutes long, informed by research suggesting that brief, visually rich content enhances viewer engagement and retention [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The videos used multiple modalities animation, voiceover, text overlays, and narrative examples to accommodate various learning styles.\u003c/p\u003e \u003cp\u003eContent development began with a review of literature related to SOGI communication with children, inclusive education strategies, and family-based support models [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. We also conducted a gap analysis of existing resources. To identify existing gaps in resources, we conducted a scoping review guided by the Joanna Briggs Institute framework and PRISMA-ScR guidelines. This review included 59 peer-reviewed studies on parent\u0026ndash;child communication about sexuality, with attention to barriers faced by parents globally [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The analysis revealed consistent challenges such as limited parental knowledge, discomfort, lack of inclusive language, cultural and religious constraints, and underrepresentation of 2SLGBTQIA\u0026thinsp;+\u0026thinsp;youth. These findings directly informed our identification of critical topic areas needing attention, including developmental guidance, inclusive terminology, culturally safe parenting practices, and strategies for addressing children\u0026rsquo;s questions.\u003c/p\u003e \u003cp\u003eScriptwriting followed an iterative process, with drafts reviewed by total six individuals, including content experts, community advocates, and members of the original parent focus groups. The final scripts featured diverse characters and storytelling elements that fostered relatability and empathy [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe animation phase followed principles of educational media design, emphasizing visual clarity, pacing, and approachability while maintaining credibility [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Narration was delivered by professional voice actors, ensuring tone and delivery were accessible to diverse audiences [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBoth videos are publicly accessible online: 1. Sexual Orientation: How to Talk with Your Kids. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.youtube.com/watch?v=9dxmIREHRHk\u003c/span\u003e\u003cspan address=\"https://www.youtube.com/watch?v=9dxmIREHRHk\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]; 2. Gender Identity: How to Talk with Your Kids. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.youtube.com/watch?v=egvHsBTczEo\u003c/span\u003e\u003cspan address=\"https://www.youtube.com/watch?v=egvHsBTczEo\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In this study, we followed the ARCHE-ECHO KT Tool Development Cycle developed by Scott and Hartling (2016) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] (see Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 | Usability Testing Approach\u003c/h2\u003e \u003cp\u003eGiven the need to ensure that the animated KT videos were not only informative but also easy for parents to use and understand, we adopted a usability testing approach rooted in human-centred design. Usability testing is a common practice in health informatics, integrating technology with human-centered design to evaluate digital health tools [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. It plays a critical role in determining whether a developed product is effective, efficient, and satisfactory for intended users [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The usability evaluation of arts-based knowledge translation (KT) tools, particularly those delivered in digital formats remains an emerging area of research [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Key usability principles include effectiveness (does the tool accomplish its goals?), efficiency (resource use), user satisfaction, and identification of potential errors [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough many usability studies in health focus on websites or clinical tools [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], growing attention is being paid to arts-based KT interventions that aim to enhance patient and caregiver engagement through narrative, visual storytelling, and interactive media [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. For example, Archibald and Scott (2019) applied iterative usability testing, including semi-structured interviews and think-aloud protocols to assess an arts-based eBook designed for parents of children with asthma [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Their findings emphasized the importance of clarity, accessibility, and emotional resonance in arts-based formats. Similarly, Hartling et al. (2010) developed and tested a series of arts-based tools for pediatric conditions like croup and gastroenteritis. They used feedback from end-users to revise design features, improve information presentation, and enhance usability [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. These approaches, informed by Department of Health and Human Services guidelines and ISO usability standards, offer valuable strategies for evaluating digital, arts-based KT resources [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 | Study Design\u003c/h2\u003e \u003cp\u003eWe conducted a sequential explanatory mixed methods usability pilot to examine the usability of two digital, arts-based KT videos related to SOGI for parents. This design followed the principle of complementarity [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], wherein qualitative data were collected to elaborate on and clarify quantitative results. A sequential explanatory approach was chosen because usability studies often benefit from initial quantitative assessments to measure usability metrics, followed by qualitative exploration to understand the emotional, cultural, and contextual factors influencing user experience. Drawing on a complementary strength\u0026rsquo;s stance [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], we integrated methodologies from technology development focusing on structured usability assessment using standardized tools [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] and qualitative method used in health education to explore contextual dimensions of engagement with KT tools [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn usability research, conceptual saturation is not the primary aim; instead, the goal is to identify key usability barriers and facilitators. Therefore, the emphasis is on user diversity and interface exposure rather than achieving thematic saturation. The sample size was guided by existing usability literature. Bastien (2010) suggests that four to five users may uncover 85% of interface usability issues [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Others argue that sample size should relate to the number and complexity of tasks being evaluated [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Given the limited interactive tasks associated with the videos (e.g., viewing, reflecting, responding), we anticipated that a quantitative sample of 24 and a qualitative sample of 8 would be sufficient to identify usability themes and user experience challenges. This aligns with usability norms, where relatively small samples can generate high-value insights due to the focused nature of tasks.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 | Quantitative\u003c/h2\u003e \u003cp\u003eA total of 24 Participants were recruited through purposive sampling from online parenting forums, digital community boards, and targeted social media outreach (Facebook and Twitter). To minimize the risk of fraudulent participation, we used screening questions to verify parenting status and interest in SOGI topics, and we reviewed responses for duplicate emails and inconsistencies. Eligibility criteria included: (a) being a parent or caregiver of at least one child aged 0\u0026ndash;18, (b) fluency in English, and (c) openness to engaging with parenting resources related to SOGI topics.\u003c/p\u003e \u003cp\u003eParticipants received a secure link to view two arts-based KT videos (sexual orientation and gender identity) and then completed a 22-item self-administered questionnaire. Usability was assessed with the System Usability Scale (SUS) and five 1\u0026ndash;5 Likert subscales covering clarity of information, visual appeal, cultural appropriateness, ease of access, and perceived usefulness, plus an item asking whether they would recommend each video. Four outcome items used 10-point visual analogue scales (VAS) anchored 0\u0026thinsp;=\u0026thinsp;not at all to 10\u0026thinsp;=\u0026thinsp;very much to capture pre\u0026ndash;post change in understanding of gender diversity, comfort discussing SOGI topics, confidence responding to children\u0026rsquo;s questions, and likelihood of initiating future conversations. Open-ended prompts asked what participants found helpful, confusing, emotionally impactful, or concerning; these qualitative responses informed the interview guide for the qualitative strand.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 | Qualitative\u003c/h2\u003e \u003cp\u003eEight participants from the quantitative group consented to join the qualitative phase. Participants were selected using maximum variation sampling to ensure representation across gender identity, cultural background, education level, and previous experience with SOGI-related content.\u003c/p\u003e \u003cp\u003e Two virtual focus group discussions (FGDs), each with four participants and lasting 60\u0026ndash;90 minutes, were conducted using Zoom. Participants received secure links to re-watch the videos prior to attending. The semi-structured FGD guide was developed based on usability testing literature and emerging questionnaire data [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Key questions addressed emotional tone, cultural sensitivity, content clarity, and likelihood of future use in parenting contexts. All FGDs were audio-recorded and transcribed verbatim. Quotes were anonymized during analysis.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 | Analysis\u003c/h2\u003e \u003cp\u003eQuantitative data from the 24 returned questionnaires were analyzed using IBM SPSS Statistics (Version 31). Descriptive statistics (means\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) summarized SUS and subscale ratings and recommendation proportions. Pre\u0026ndash;post changes on the four VAS outcomes were evaluated using paired two-tailed t-tests with α\u0026thinsp;=\u0026thinsp;.05; t statistics and p-values were reported and within-sample effect sizes (Cohen\u0026rsquo;s d for paired samples, estimated as d\u0026thinsp;=\u0026thinsp;t/\u0026radic;N) were calculated to gauge magnitude.\u003c/p\u003e \u003cp\u003eTranscripts from the focus group discussions were analyzed using Braun and Clarke\u0026rsquo;s (2006) six-phase thematic analysis approach [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The process began with familiarization, where researchers engaged in repeated reading of transcripts and listening to audio recordings to immerse themselves in the data. Initial coding was then conducted independently by two researchers using NVivo 14 software, allowing for inductive identification of meaningful features in the data. Codes were grouped into interpretive categories to search for potential themes. These emerging themes were subsequently reviewed for coherence and consistency across the dataset, ensuring they were sufficiently supported by participant narratives. Once refined, themes were clearly defined and accompanied by descriptive narratives that captured the essence of each.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.5 | Ethical Consideration\u003c/h2\u003e \u003cp\u003e The study was approved by the University of Alberta Research Ethics Board (Pro00124683). All participants provided informed consent prior to participation and were informed of their right to withdraw at any time. Given the sensitivity of the topic, participants were also provided with mental health and community support resources. Confidentiality was ensured through anonymized transcripts, secure data storage, and the use of participant codes.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Participants Demographics\u003c/h2\u003e \u003cp\u003eA total of 24 parents participated in the study. The sample was diverse in terms of country of birth, years lived in Canada, age, gender, and, education (refer to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for consolidated summary of participant demographics). This diversity supports the usability aim of evaluating whether the tools function effectively across varied parent profiles, family contexts, and cultural backgrounds.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics of Participants (N\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-binary / Prefer not to say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Group (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e55+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (8.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduate / Professional degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthno-cultural Background\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite / European\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth Asian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEast Asian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack / African\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndigenous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther / Mixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProvince of Residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlberta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (54.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBritish Columbia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (29.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOntario\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (16.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChildren\u0026rsquo;s Age Range\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;12 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (45.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026ndash;18 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (33.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2 | Quantitative\u003c/h2\u003e \u003cp\u003eOverall usability was rated highly for both arts-based KT videos. The Sexual Orientation video achieved an excellent mean System Usability Scale (SUS) score of 82.4 (SD\u0026thinsp;=\u0026thinsp;8.7), and the Gender Identity video scored 79.8 (SD\u0026thinsp;=\u0026thinsp;9.2), both well above the \u0026gt;\u0026thinsp;68 benchmark for above-average usability [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Subscale ratings were uniformly positive: clarity of information averaged 4.3 (SD\u0026thinsp;=\u0026thinsp;0.6) and 4.1 (SD\u0026thinsp;=\u0026thinsp;0.7), visual appeal 4.1 (SD\u0026thinsp;=\u0026thinsp;0.8) and 4.0 (SD\u0026thinsp;=\u0026thinsp;0.7), cultural appropriateness 4.2 (SD\u0026thinsp;=\u0026thinsp;0.7) and 4.2 (SD\u0026thinsp;=\u0026thinsp;0.6), ease of access 4.4 (SD\u0026thinsp;=\u0026thinsp;0.5) and 4.3 (SD\u0026thinsp;=\u0026thinsp;0.5), and perceived usefulness 4.5 (SD\u0026thinsp;=\u0026thinsp;0.5) and 4.3 (SD\u0026thinsp;=\u0026thinsp;0.6) for the sexual orientation and gender identity videos respectively (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). More than 90% of participants indicated they would recommend the videos to others (92% and 90%), indicating strong acceptability and likelihood of dissemination (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUsability Scores of Arts-Based KT Tools (N\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsability Domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSexual Orientation Video (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGender Identity Video (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystem Usability Scale (SUS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClarity of Information (1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisual Appeal (1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCultural Appropriateness (1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEase of Access (1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceived Usefulness (1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWill Recommend to Others (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eNote\u003c/em\u003e: SUS scores\u0026thinsp;\u0026gt;\u0026thinsp;68 are considered above average; scores\u0026thinsp;\u0026gt;\u0026thinsp;80 indicate excellent usability [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eExposure to the videos produced significant, substantive improvements in parental knowledge, confidence, and comfort. Paired t-tests comparing pre- and post-test 10-point VAS scores showed statistically significant increases across all four outcomes (all p\u0026thinsp;\u0026lt;\u0026thinsp;.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Understanding of gender diversity rose from a pre-test mean of 6.2 (SD\u0026thinsp;=\u0026thinsp;1.9) to 8.4 (SD\u0026thinsp;=\u0026thinsp;1.3), t(23)\u0026thinsp;=\u0026thinsp;5.62, p\u0026thinsp;\u0026lt;\u0026thinsp;.001. Comfort discussing SOGI topics increased from 5.9 (SD\u0026thinsp;=\u0026thinsp;2.0) to 8.1 (SD\u0026thinsp;=\u0026thinsp;1.6), t(23)\u0026thinsp;=\u0026thinsp;5.04, p\u0026thinsp;\u0026lt;\u0026thinsp;.001. Confidence in responding to children\u0026rsquo;s questions improved from 6.1 (SD\u0026thinsp;=\u0026thinsp;1.8) to 8.3 (SD\u0026thinsp;=\u0026thinsp;1.4), t(23)\u0026thinsp;=\u0026thinsp;5.49, p\u0026thinsp;\u0026lt;\u0026thinsp;.001. Likelihood of initiating conversations showed the largest change, rising from 6.7 (SD\u0026thinsp;=\u0026thinsp;1.5) to 8.7 (SD\u0026thinsp;=\u0026thinsp;1.1), t(23)\u0026thinsp;=\u0026thinsp;6.10, p\u0026thinsp;\u0026lt;\u0026thinsp;.001 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). These results indicate meaningful within-sample gains in parents\u0026rsquo; readiness and self-efficacy to engage in SOGI conversations following the intervention.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre\u0026ndash;Post Changes in Parental Knowledge, Confidence, and Comfort (N\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-Test Mean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-Test Mean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderstanding of gender diversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.4 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComfort discussing SOGI topics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.9 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.1 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfidence responding to children\u0026rsquo;s questions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.3 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLikelihood of initiating conversations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.7 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.7 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eNote\u003c/em\u003e: Scores measured using 10-point Visual Analog Scale (VAS), where higher scores indicate greater confidence or comfort. Paired t-tests show statistically significant improvements (p\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.2 | Qualitative\u003c/h2\u003e \u003cp\u003eParticipants took part in follow-up focus groups to further explore their experience with the tools. Thematic analysis identified four major themes that reflect parent responses to the videos. All participants reported overall satisfaction with the tools, including content, delivery, and design. Qualitative data reinforced quantitative findings and are presented narratively below.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 | The tools enhanced parental confidence and knowledge\u003c/h2\u003e \u003cp\u003eParticipants consistently reported that both videos increased their confidence and knowledge related to SOGI discussions. Many described feeling anxious or uncertain before using the tools, citing fears of using the wrong language or causing harm. The videos were described as \u0026ldquo;demystifying\u0026rdquo; and helped parents feel more prepared and emotionally reassured.\u003c/p\u003e \u003cp\u003eA 34-year-old mother stated, \u003cem\u003e\u0026ldquo;I've been worried about these conversations for months... After watching the videos, I feel like I actually have a roadmap now.\u0026rdquo;\u003c/em\u003e Similarly, a 41-year-old father noted, \u003cem\u003e\u0026ldquo;The videos gave me actual scripts I could adapt... It's like having a coach walking me through it.\u0026rdquo;\u003c/em\u003e Participants appreciated the inclusion of practical strategies and realistic conversation examples.\u003c/p\u003e \u003cp\u003e Parents also recognized that SOGI conversations could be ongoing, rather than single, formal discussions. This understanding reduced anxiety and made the topic feel more manageable. In addition to terminology and concepts, participants reported gaining a deeper understanding of child development, family dynamics, and the lived experiences of LGBTQ\u0026thinsp;+\u0026thinsp;individuals.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 | Arts-based design improved accessibility and engagement\u003c/h2\u003e \u003cp\u003eThe videos\u0026rsquo; animated format was widely praised for making sensitive content feel more approachable and emotionally resonant. Participants noted that the visual storytelling allowed them to engage with challenging material in a non-threatening way.\u003c/p\u003e \u003cp\u003eA 29-year-old mother explained, \u003cem\u003e\u0026ldquo;There's something about the animation that makes it feel safer to explore these topics... It's not as intense as watching real people.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eDiverse visual representation was highlighted as a major strength, allowing parents to see themselves and others reflected in the content. This enhanced both relevance and learning. Emotional engagement appeared to contribute to increased empathy and motivation for inclusive parenting.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.2.3 | Ongoing support and community connection is needed\u003c/h2\u003e \u003cp\u003eWhile participants found the videos informative and empowering, many expressed interests in continued support and community-based learning. Parents indicated that the tools sparked additional questions and highlighted the complexity of ongoing SOGI education.\u003c/p\u003e \u003cp\u003eA 38-year-old mother shared, \u003cem\u003e\u0026ldquo;The tools gave me a great starting point... but they also made me realize how much more there is to learn.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipants suggested follow-up resources, discussion groups, and expanded learning materials to support long-term engagement. This was especially emphasized by parents who felt socially isolated or lacked community resources.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.2.4 | Inclusive representation fostered relevance and relatability\u003c/h2\u003e \u003cp\u003eParents responded positively to the inclusive representation of ethnicity, family structures, and gender expression. The use of diverse characters helped normalize conversations around SOGI and ensured that the videos were relevant to a wide range of families. This representation contributed to the high perceived usefulness and relatability of the content.\u003c/p\u003e \u003cp\u003eOne participant noted that the videos made the topic \u0026ldquo;feel like it belongs to everyone, not just families with LGBTQ\u0026thinsp;+\u0026thinsp;kids,\u0026rdquo; suggesting the tools effectively framed SOGI discussions as universal rather than niche.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.3 | Areas for improvement\u003c/h2\u003e \u003cp\u003eParticipants identified a few areas for enhancement. Some requested closed captioning options in multiple languages to support broader accessibility. Others suggested supplementary materials such as downloadable conversation guides and frequently asked questions. Technical feedback included requests for improved mobile compatibility and offline viewing options. A few participants also recommended tailoring future videos for specific child age groups, reflecting differences in developmental stages and communication strategies. These suggestions provide concrete direction for iterative refinement and future tool development.\u003c/p\u003e \u003cp\u003eOverall, participant feedback emphasized the value of the tools while highlighting the potential for further development to support continued learning and accessibility.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThe development and evaluation of two animated KT tools addressing SOGI for Canadian parents demonstrate the value of combining arts-based approaches with user-centred design to enhance understanding, emotional engagement, and accessibility. The consistently high usability scores and rich qualitative feedback underscore that such tools not only educate but also empower parents to have inclusive, developmentally appropriate conversations with their children.\u003c/p\u003e \u003cp\u003eOur findings align with a growing body of literature highlighting how arts-based, especially when paired with narrative structures can foster emotional resonance and relatability [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Participants frequently referred to the animated format and diverse character representation as reducing intimidation and making complex content more digestible. This supports existing research suggesting that multimodal strategies using visual and inclusive imagery can increase motivation to engage with sensitive topics [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan additionalcitationids=\"CR43\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Another evidence from Hartling et al. (2010) further reinforces this, showing that a web-based animated KT tool improved parental knowledge and confidence regarding pediatric illness management [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. While no significant difference in decisional regret was observed, participants rated the tool highly in usability and satisfaction, echoing our own findings and highlighting the broader effectiveness of visually engaging, narrative-based formats in supporting informed and confident decision-making.\u003c/p\u003e \u003cp\u003eThe emotional and cognitive accessibility of these tools appears to support vicarious learning and perspective-taking. Storytelling is not only a method of information delivery but a way to simulate social experiences and enhance empathy [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Participants described feeling better equipped to support their children, not just because they understood the terminology but because they could emotionally visualize how conversations might unfold. This matches prior work where participants reported that story-based KT tools helped put themselves in the story [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This illustrates how the arts-based medium strengthened both informational and emotional readiness an important mechanism underlying the quantitative outcomes.\u003c/p\u003e \u003cp\u003eParticipant feedback strongly reinforced the value of engaging users throughout the development cycle. Consistent with KT design literature [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], iterative review by content experts, community members, and parents contributed to culturally sensitive and developmentally appropriate content. This collaborative approach appears central to the high usability scores and the perception that the videos were respectful, non-judgmental, and relatable.\u003c/p\u003e \u003cp\u003eMoreover, participants\u0026rsquo; call for additional resources such as downloadable guides, multilingual captioning, and age-specific versions underscores that effective KT tools function best as components of a broader ecosystem of support, rather than standalone products. This supports recent research advocating for multi-format, layered KT strategies that sustain learning over time [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe positive response to visual inclusivity representation across ethnicity, gender expression, and family types also aligns with research indicating that diversity in KT tools enhances both engagement and transferability of knowledge [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. This is especially pertinent in SOGI education, where cultural safety and representation are essential to fostering openness and reducing stigma. Given that SOGI topics are often marginalized or seen as peripheral, inclusive imagery is particularly critical for reducing stigma and increasing accessibility.\u003c/p\u003e \u003cp\u003eUsability testing remains critical for ensuring tools meet real-world needs. As noted by Bastien (2010), usability is multidimensional encompassing efficiency, satisfaction, clarity, and cultural fit [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Our findings affirm that testing not only validates function but reveals emotional and social dimensions of KT effectiveness.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.1 | Limitations\u003c/h2\u003e \u003cp\u003eThere were certain limitations to this study that should be considered when interpreting the findings.\u003c/p\u003e \u003cp\u003eFirst, although the usability testing sample size met standards for qualitative and formative research, it remained small and therefore limits the generalizability of the quantitative findings. Larger, more diverse samples would allow for a more robust examination of effectiveness, usability, and acceptability across varied parent populations.\u003c/p\u003e \u003cp\u003eSecond, participants were primarily recruited through community organizations and social media channels, which may have introduced selection bias toward parents who were already motivated or comfortable engaging with SOGI-related content. More hesitant, ambivalent, or disengaged parents may not be fully represented, and future research should intentionally include these groups.\u003c/p\u003e \u003cp\u003eThird, usability testing was conducted virtually rather than in person. Although this enabled geographic diversity and flexibility, it may have restricted observation of non-verbal cues and naturalistic user interaction, which can be valuable for identifying subtle usability issues.\u003c/p\u003e \u003cp\u003eFourth, the study used only English-language materials. This limits cultural and linguistic inclusivity and may exclude parents who would benefit from SOGI communication tools but require additional language supports. Multilingual adaptations are recommended to improve reach and cultural relevance.\u003c/p\u003e \u003cp\u003eLastly, the study did not include long-term follow-up. Although parents reported immediate improvements in confidence, comfort, and understanding, it remains unclear whether these gains translate into sustained behaviour change or improved parent\u0026ndash;child communication over time. Future research should evaluate longitudinal effects and explore how repeated exposure or supplementary KT tools influence outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. CONCLUSION","content":"\u003cp\u003eIn conclusion, this study provides meaningful evidence that arts-based, user-centred KT tools can effectively support parents in navigating sensitive conversations about sexual orientation and gender identity with their children. The two animated videos demonstrated high usability, strong acceptability, and significant improvements in parental knowledge, comfort, and confidence, key components of readiness for SOGI-related communication.\u003c/p\u003e \u003cp\u003eBy integrating visual storytelling, inclusive representation, and developmentally appropriate messaging, these tools addressed recognized gaps in existing sexuality education resources and offered an accessible, emotionally safe entry point for parents. The positive qualitative feedback further illustrates how arts-based formats can foster empathy, reduce anxiety, and make complex content more approachable.\u003c/p\u003e \u003cp\u003eThis approach may serve as a model for future KT interventions targeting topics that are socially complex, emotionally charged, or frequently avoided in traditional health education materials. Continued refinement such as multilingual captioning, age-specific adaptations, and supplementary conversation guides will enhance the scalability and inclusivity of these tools.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: University of Alberta Research Ethics Board (Pro00124683)\u003c/p\u003e\n\u003cp\u003eClinical trial number:\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials:\u0026nbsp;The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u0026nbsp;The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003eFunding:\u0026nbsp;No Funding\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions:\u0026nbsp;Neelam Punjani - conceptualization, data collection, analysis, writing; Amber Hussain - writing, analysis, reviewing; Shannon D Scott\u0026nbsp;- analysis, reviewing, supervision. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgement:\u0026nbsp;Not Applicable\u003cbr\u003e \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Guidelines on comprehensive sexuality education., https://www.who.int/news-room/questions-and-answers/item/comprehensive-sexuality-education (2023).\u003c/li\u003e\n\u003cli\u003eFaccio E, Bordin E, Cipolletta S. Transsexual parenthood and new role assumptions. \u003cem\u003eCult Health Sex\u003c/em\u003e 2013; 15: 1055\u0026ndash;1070.\u003c/li\u003e\n\u003cli\u003eThomas K, Nash R, Patterson K, et al. Dad taught me nothing about relationships and sexuality: how contemporary Australian fathers became sex ed dads. \u003cem\u003eCult Health Sex\u003c/em\u003e 2023; 25: 287\u0026ndash;303.\u003c/li\u003e\n\u003cli\u003eRobinson RB, Frank DI. 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Parents\u0026rsquo; Perspectives About Adolescent Boys\u0026rsquo; Involvement in Biomedical HIV Prevention Research. \u003cem\u003eArch Sex Behav\u003c/em\u003e 2018; 47: 1923\u0026ndash;1935.\u003c/li\u003e\n\u003cli\u003eScott SD, Le A, Hartling L. Developing and testing an arts-based, digital knowledge translation tool for parents about childhood croup. Epub ahead of print 4 June 2021. DOI: 10.1101/2021.06.03.21257424.\u003c/li\u003e\n\u003cli\u003ePunjani N, Scott SD, Hussain A. Parents\u0026rsquo; information needs and their recommendations for effective sexuality education to children. \u003cem\u003eFront Public Health\u003c/em\u003e 2025; 13: 1653924.\u003c/li\u003e\n\u003cli\u003ePullen Sansfa\u0026ccedil;on A, Kirichenko V, Holmes C, et al. Parents\u0026rsquo; Journeys to Acceptance and Support of Gender-diverse and Trans Children and Youth. \u003cem\u003eJ Fam Issues\u003c/em\u003e 2020; 41: 1214\u0026ndash;1236.\u003c/li\u003e\n\u003cli\u003eSmallenberg J. 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Sexual Orientation, Gender Identity, and Adoption Law. \u003cem\u003eFam Court Rev\u003c/em\u003e 2018; 56: 374\u0026ndash;383.\u003c/li\u003e\n\u003cli\u003eMcKay EA, Fontenot HB. Parent-Adolescent Sex Communication with Sexual and Gender Minority Youth: An Integrated Review. \u003cem\u003eJ Pediatr Health Care\u003c/em\u003e 2020; 34: e37\u0026ndash;e48.\u003c/li\u003e\n\u003cli\u003eSeager Van Dyk I, Clark KA, Dougherty LR, et al. Parent responses to their sexual and gender minority children: Implications for parent-focused supportive interventions. \u003cem\u003ePsychol Sex Orientat Gend Divers\u003c/em\u003e 2024; 11: 1\u0026ndash;16.\u003c/li\u003e\n\u003cli\u003eMcCrimmon J, Widman L, Brasileiro J. Adolescent Barriers to Sexual Communication with Their Parents: Differences by Sexual and Gender Identity. \u003cem\u003eJ Sex Res\u003c/em\u003e 2025; 62: 610\u0026ndash;621.\u003c/li\u003e\n\u003cli\u003eD\u0026rsquo;Amico E, Julien D. Disclosure of Sexual Orientation and Gay, Lesbian, and Bisexual Youths\u0026rsquo; Adjustment: Associations with Past and Current Parental Acceptance and Rejection. \u003cem\u003eJ GLBT Fam Stud\u003c/em\u003e 2012; 8: 215\u0026ndash;242.\u003c/li\u003e\n\u003cli\u003eIstar Lev A. How Queer!\u0026mdash;The Development of Gender Identity and Sexual Orientation in LGBTQ‐Headed Families. \u003cem\u003eFam Process\u003c/em\u003e 2010; 49: 268\u0026ndash;290.\u003c/li\u003e\n\u003cli\u003eSexual orientation: How to talk with your kids. YouTube, https://www.youtube.com/watch?v=9dxmIREHRHk (2025).\u003c/li\u003e\n\u003cli\u003eGender Identity: How to talk with your kids. YouTube, https://www.youtube.com/watch?v=egvHsBTczEo (2025).\u003c/li\u003e\n\u003cli\u003eScott SD, Hartling L. Engaging with parents to develop innovative e-tools that merge research and story., https://colloquium2018.cochrane.org/abstracts/engaging-parents-develop-innovative-knowledge-translation-tools-merge-research-and-story (2016).\u003c/li\u003e\n\u003cli\u003eBevan N. International standards for HCI and usability. \u003cem\u003eInt J Hum-Comput Stud\u003c/em\u003e 2001; 55: 533\u0026ndash;552.\u003c/li\u003e\n\u003cli\u003eBastien JMC. Usability testing: a review of some methodological and technical aspects of the method. \u003cem\u003eInt J Med Inf\u003c/em\u003e 2010; 79: e18\u0026ndash;e23.\u003c/li\u003e\n\u003cli\u003eArchibald MM, Scott SD. Learning from usability testing of an arts-based knowledge translation tool for parents of a child with asthma. \u003cem\u003eNurs Open\u003c/em\u003e 2019; 6: 1615\u0026ndash;1625.\u003c/li\u003e\n\u003cli\u003eKastner M, Lottridge D, Marquez C, et al. Usability evaluation of a clinical decision support tool for osteoporosis disease management. \u003cem\u003eImplement Sci\u003c/em\u003e 2010; 5: 96.\u003c/li\u003e\n\u003cli\u003eStinson J, McGrath P, Hodnett E, et al. Usability Testing of an Online Self-management Program for Adolescents With Juvenile Idiopathic Arthritis. \u003cem\u003eJ Med Internet Res\u003c/em\u003e 2010; 12: e30.\u003c/li\u003e\n\u003cli\u003ePhillips EK, Chudyk AM, Monnin C, et al. The Use of Arts‐Based Methods to Enhance Patient Engagement in Health Research. \u003cem\u003eHealth Expect\u003c/em\u003e 2024; 27: e70127.\u003c/li\u003e\n\u003cli\u003eHartling L, Scott S, Pandya R, et al. Storytelling as a communication tool for health consumers: development of an intervention for parents of children with croup. Stories to communicate health information. \u003cem\u003eBMC Pediatr\u003c/em\u003e 2010; 10: 64.\u003c/li\u003e\n\u003cli\u003eDepartment of Health and Human Services. Usability, https://www.usability.gov/guidelines/index.html (n.d.).\u003c/li\u003e\n\u003cli\u003eGreene JC, Caracelli VJ, Graham WF. Toward a Conceptual Framework for Mixed-Method Evaluation Designs. \u003cem\u003eEduc Eval Policy Anal\u003c/em\u003e 1989; 11: 255\u0026ndash;274.\u003c/li\u003e\n\u003cli\u003eMorse J. Procedures and Practice of Mixed Method Design: Maintaining Control, Rigor, and Complexity. In: \u003cem\u003eSAGE Handbook of Mixed Methods in Social \u0026amp; Behavioral Research\u003c/em\u003e. 2455 Teller Road, Thousand Oaks California 91320 United States: SAGE Publications, Inc., pp. 339\u0026ndash;352.\u003c/li\u003e\n\u003cli\u003eBangor A, Kortum PT, Miller JT. An Empirical Evaluation of the System Usability Scale. \u003cem\u003eInt J Hum-Comput Interact\u003c/em\u003e 2008; 24: 574\u0026ndash;594.\u003c/li\u003e\n\u003cli\u003eStraub ET. Understanding Technology Adoption: Theory and Future Directions for Informal Learning. \u003cem\u003eRev Educ Res\u003c/em\u003e 2009; 79: 625\u0026ndash;649.\u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. \u003cem\u003eQual Res Psychol\u003c/em\u003e 2006; 3: 77\u0026ndash;101.\u003c/li\u003e\n\u003cli\u003eBarone T, Eisner EW. \u003cem\u003eArts Based Research\u003c/em\u003e. SAGE Publications, 2011.\u003c/li\u003e\n\u003cli\u003eLe A, Hartling L, Scott SD. The development and usability testing of digital knowledge translation tools for parents of children with acute otitis media. Epub ahead of print 3 July 2021. DOI: 10.1101/2021.06.29.21259431.\u003c/li\u003e\n\u003cli\u003eLe A, Hartling L, Scott SD. The development and usability testing of digital knowledge translation tools for parents of children with bronchiolitis. Epub ahead of print 28 June 2021. DOI: 10.1101/2021.06.21.21259266.\u003c/li\u003e\n\u003cli\u003eScott SD, Elliott SA, Reid K, et al. The development and usability testing of six arts-based knowledge translation tools for parents about COVID-19. Epub ahead of print 1 April 2025. DOI: 10.1101/2025.03.31.25324968.\u003c/li\u003e\n\u003cli\u003eKirkpatrick MK, Ford S, Castelloe BP. Storytelling: An Approach to Client-Centered Care. \u003cem\u003eNurse Educ\u003c/em\u003e 1997; 22: 38\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003eTaddio A, Ilersich AL, Ipp M, et al. Physical interventions and injection techniques for reducing injection pain during routine childhood immunizations: Systematic review of randomized controlled trials and quasi-randomized controlled trials. \u003cem\u003eClin Ther\u003c/em\u003e 2009; 31: S48\u0026ndash;S76.\u003c/li\u003e\n\u003cli\u003eShoup JA, Wagner NM, Kraus CR, et al. Development of an Interactive Social Media Tool for Parents With Concerns About Vaccines. \u003cem\u003eHealth Educ Behav\u003c/em\u003e 2015; 42: 302\u0026ndash;312.\u003c/li\u003e\n\u003cli\u003eGiles ML. \u003cem\u003eThe Sexual Subjectivity of Youth with Physical Disabilities: An Arts-Based Study in Toronto, Canada\u003c/em\u003e. University of Toronto, 2024.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sexual orientation, gender identity, parents, sexuality education, knowledge translation, arts-based methods, usability testing, animated videos, communication","lastPublishedDoi":"10.21203/rs.3.rs-8408000/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8408000/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eParents play a critical role in supporting children\u0026rsquo;s understanding of sexual orientation and gender identity (SOGI), yet many report lacking the confidence, language, or resources to initiate these conversations. Arts-based digital knowledge translation (KT) tools have demonstrated promise in promoting inclusive, emotionally resonant learning, particularly for sensitive or stigmatized topics. This study aimed to develop and evaluate the usability of two animated KT videos designed to help parents discuss SOGI with their children.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a sequential explanatory mixed-methods study. Two short, animated, story-based videos were developed based on prior qualitative research with Canadian parents. Development was guided by the ARCHE-ECHO KT Tool Development Cycle to ensure user-centred and iterative refinement. Twenty-four parents completed quantitative usability testing using the System Usability Scale (SUS), KT evaluation subscales, and four pre\u0026ndash;post visual analogue scale (VAS) items assessing changes in understanding, comfort, confidence, and likelihood of initiating SOGI conversations. Eight participants subsequently joined focus groups to explore user experience in depth. Quantitative data were analyzed descriptively and with paired t-tests, while qualitative data underwent thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBoth videos demonstrated high usability, with mean SUS scores of 82.4 and 79.8. Pre\u0026ndash;post VAS ratings showed significant improvements across all outcomes, including understanding of gender diversity, comfort discussing SOGI topics, and confidence responding to children\u0026rsquo;s questions (all p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Participants perceived the videos as accessible, visually engaging, and culturally inclusive. Thematic analysis identified four major themes: increased parental confidence and knowledge; enhanced emotional and cognitive engagement due to arts-based design; desire for ongoing support and community resources; and value of inclusive representation. Participants recommended additional enhancements such as multilingual captions and age-specific adaptations.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eArts-based KT tools provide an effective, user-centered approach to supporting parents in engaging children in inclusive, developmentally appropriate SOGI discussions. Integrating visual storytelling with inclusive design can build parental confidence, promote open communication, and reduce stigma. These tools may complement existing sexuality education efforts and strengthen culturally responsive public health communication. Future work should examine long-term effects and develop multilingual, culturally responsive versions to broaden accessibility.\u003c/p\u003e","manuscriptTitle":"Development and Usability Testing of Digital Knowledge Translation Tools for Parents on Sexual Orientation and Gender Identity","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 16:00:59","doi":"10.21203/rs.3.rs-8408000/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-11T10:19:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T13:49:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"92271437532066438667939400405747072038","date":"2026-04-08T14:01:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243690788596182937725791806127098677842","date":"2026-03-14T04:19:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-09T20:50:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"301385617883063387669982804923483652526","date":"2026-01-20T18:52:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-06T12:19:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-23T06:33:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-23T02:27:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-23T02:26:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-12-19T20:19:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"192e7352-7014-41c4-9487-05e978990d9c","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-11T10:19:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T13:49:27+00:00","index":149,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T10:29:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 16:00:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8408000","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8408000","identity":"rs-8408000","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}