Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol.

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Bhat" }, { "@type": "Person", "name": "Nirmal Krishnan M." }, { "@type": "Person", "name": "Deeksha Shetty" }, { "@type": "Person", "name": "Bontha V. Babu" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": "Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) people struggle to identify a healthcare service that understands their problems and needs. Additionally, healthcare professionals also find it difficult to care for LGBTQIA+ as very little is studied or heard about management. The article presents a protocol for a pilot study aimed at the development of an LGBTQIA+ care curriculum for health science professionals. The study includes Phase I: The development of a curriculum based on a literature review and focus group discussion among LGBTQIA+ individuals, and Phase II: Pilot testing of LGBTQIA+ care curriculum. The study outcome will reflect the improvement in the knowledge of healthcare professionals on LGBTQIA+ care." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/12-1437/v2", "name": "Developing a module on the care of LGBTQIA+ individuals for health..." } } ] } Home Browse Developing a module on the care of LGBTQIA+ individuals for health... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Pai MS, Yesodharan R, Palimar V et al. Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.12688/f1000research.140518.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Revised Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] Mamatha Shivananda Pai 1 , Renjulal Yesodharan https://orcid.org/0000-0002-7207-1129 2 , Vikram Palimar https://orcid.org/0000-0001-5258-1992 3 , [...] Latha Thimmappa 4 , Bhavana B. Bhat 5 , Nirmal Krishnan M. 3 , Deeksha Shetty 6 , Bontha V. Babu 7 Mamatha Shivananda Pai 1 , Renjulal Yesodharan https://orcid.org/0000-0002-7207-1129 2 , [...] Vikram Palimar https://orcid.org/0000-0001-5258-1992 3 , Latha Thimmappa 4 , Bhavana B. Bhat 5 , Nirmal Krishnan M. 3 , Deeksha Shetty 6 , Bontha V. Babu 7 PUBLISHED 23 Jul 2024 Author details Author details 1 Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 2 Department of Psychiatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 3 Department of Forensic Medicine and Toxicology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 4 College of Nursing, All India Institute of Medical Sciences, Kalyani, West Bengal, 741245, India 5 Department of Pharmaceutical Regulatory Affairs and Management, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 6 Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 7 Division of Socio-behavioural, Health Systems & Implementation Research (SHI), Indian Council of Medical Research, New Delhi, Delhi, 110029, India Mamatha Shivananda Pai Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Renjulal Yesodharan Roles: Conceptualization, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Vikram Palimar Roles: Conceptualization, Investigation, Methodology, Resources, Supervision, Writing – Review & Editing Latha Thimmappa Roles: Conceptualization, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation Bhavana B. Bhat Roles: Conceptualization, Investigation, Methodology, Resources, Writing – Original Draft Preparation Nirmal Krishnan M. Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation Deeksha Shetty Roles: Investigation, Methodology, Project Administration, Resources, Writing – Original Draft Preparation Bontha V. Babu Roles: Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Manipal Academy of Higher Education gateway. Abstract Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) people struggle to identify a healthcare service that understands their problems and needs. Additionally, healthcare professionals also find it difficult to care for LGBTQIA+ as very little is studied or heard about management. The article presents a protocol for a pilot study aimed at the development of an LGBTQIA+ care curriculum for health science professionals. The study includes Phase I: The development of a curriculum based on a literature review and focus group discussion among LGBTQIA+ individuals, and Phase II: Pilot testing of LGBTQIA+ care curriculum. The study outcome will reflect the improvement in the knowledge of healthcare professionals on LGBTQIA+ care. READ ALL READ LESS Keywords Curriculum, Faculty, Health Sciences, Health professional, India, LGBTQIA+, Research Protocol, Students, SDG 3, SDG 10 Corresponding Author(s) Renjulal Yesodharan ( [email protected] ) Close Corresponding author: Renjulal Yesodharan Competing interests: No competing interests were disclosed. Grant information: The project is funded by the Indian Council of Medical Research (ICMR), New Delhi (grant number: Adhoc/207/2022/SBHSR). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2024 Pai MS et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Pai MS, Yesodharan R, Palimar V et al. Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.12688/f1000research.140518.2 ) First published: 06 Nov 2023, 12 :1437 ( https://doi.org/10.12688/f1000research.140518.1 ) Latest published: 23 Jul 2024, 12 :1437 ( https://doi.org/10.12688/f1000research.140518.2 ) Revised Amendments from Version 1 The major difference from version 1 is the rectification of certain terminologies used. For example, the curriculum has been changed to a module based on suggestions from experts. Also the authors include more details about the project. The major difference from version 1 is the rectification of certain terminologies used. For example, the curriculum has been changed to a module based on suggestions from experts. Also the authors include more details about the project. See the authors' detailed response to the review by Vimala Ramoo See the authors' detailed response to the review by Dr shubha Jayaram READ REVIEWER RESPONSES Background The Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual (LGBTQIA+) are a varied group of people with different gender identities, sexual orientations, and reproductive development. All members of the LGBTQIA+ community have different healthcare-related problems and requirements, even though they are sometimes grouped as a coalition. However, they share the stigma and discrimination that have hindered them from accessing quality healthcare in several ways ( Agarwal & Thiyam, 2022 ; MacKenzie et al. , 2020 ). Human health and social systems are interrelated. According to a Yang (2021) study, LGBTQIA+ individuals confront social challenges such as stigma, homophobia, discrimination, coming out, insufficient social support systems, and a lack of LGBTQIA+-friendly medical resources that not only put them in danger of physical and mental harm but also put their health at risk. LGBTQIA+ individuals face discrimination, violence, and bullying as they come to terms with their identity. LGBTQIA+ individuals are more vulnerable to mental health problems including anxiety and depression as a result of this type of minority stress ( Yang, 2021 ). According to the original model of Meyers (2003) , stressors are generated from having a minority status, which is overrun by the circumstances of their environment, leading to mental and physical ill-effects that have a negative impact on the lives of the socially stigmatized LGBTQIA community. Individuals can self-identify in different ways, including gender identity and sexual orientation. For the remainder of the text, we will refer to this spectrum collectively as the LGBTQIA+ community. The terms “L” for lesbian and “G” for gay refer to people who are attracted to people of the same gender; “B” for bisexual means they are attracted to people of both genders; and “T” for transgender means they identify as a gender other than the one they were given at birth; Q for Queer a sexual orientation that isn't only straight or heterosexual. It's a general word that covers those with gender-fluid or non-binary identities. It may also imply ‘Questioning’- A person who seeks answers about their gender identity or sexual orientation is said to be "questioning”; "I" stands for intersex, a term used to characterize individuals who do not conform to traditional classifications of female or male due to differences in their reproductive anatomy or sex features. Differences may exist in terms of internal sex organs, hormones, chromosomes, genitalia, and/or secondary sex traits; "A" stands for "asexual," a term used to characterize someone who is not attracted to or desirous of other people sexually. It's not the same as celibacy when individuals choose not to engage in sexual behaviours. The ‘+’ recognizes and includes additional identities and orientations not covered by the initials and refers to the community’s dynamic nature ( Agarwal & Thiyam, 2022 ). A person’s sexual and emotional attraction to another person, any resulting behaviour, and/or social connection are all considered to be part of their sexual orientation. The strongly held, innate notion that a person has of being a boy, a man, or another member of the male, female, or alternate gender is considered their gender identity. The way society views homosexuality varies widely between countries and historical eras. Heterosexuality is now accepted as the standard across the globe. LGBTQIA+ individuals face stigma and stereotypes in many countries. Despite the Delhi High Court's 2009 decriminalization of homosexuality, on December 11, 2013, the Indian Supreme Court upheld section 377 of the Indian Penal Code, which criminalizes adult consensual same-sex intercourse ( Kar et al. , 2018 ; Sathyanarayana Rao & Jacob, 2012 ; Somasundaram & Murthy, 2016 ). The Supreme Court of India recognized LGBTQIA+ people as the third gender in April 2014, and any discrimination against them was viewed as a violation of their constitutional rights ( Kar et al. , 2018 ; Khatri Babbar, 2016 ). Despite recent developments in the acceptance of LGBTQIA+ individuals, education on LGBTQIA+ health requirements for health professionals still lags far behind despite evidence showing a tremendous rise in LGBTQIA+ acceptance and the achievement of equality in many sectors. Multiple studies and reviews of health issues have shown a persistent gap in healthcare education, with no standard texts that include information concerning care for LGBTQIA+ individuals ( Keuroghlian et al. , 2017 ). LGBTQIA+ community members encounter several difficulties regarding sexual orientation and gender identity in a heteronormative culture. Additionally, they frequently experience prejudice and sexual assault. Further, their medical requirements are more likely to be overlooked or socially rejected due to their sexual orientation and gender identity, which can affect their medical rights and the medical care they receive. LGBTQIA+ individuals frequently struggle with coming out when dealing with medical professionals. Two things worry them; First, medical professionals’ ignorance, bias, and discrimination may impair their right to get medical care. Second, incomplete information disclosure may influence a disease’s diagnosis or possibly lead to a misdiagnosis. LGBTQIA+ individuals must carefully balance the risks of coming out with the benefit of having the right medical attention and support. These factors frequently lead to psychological pressure, which is harmful to both physical and mental health ( Yang, 2021 ). The stigmatized and discriminated populations must be addressed by healthcare practitioners. Understanding how medical students feel about homosexuality is crucial for improving the healthcare system. Patients who identify as LGBTQIA+ have encountered stigmatization, discrimination, and even refusal of care within the healthcare system ( Kar et al. , 2018 ). In 2017, the Joint United Nations Programme on HIV/AIDS UNAIDS report stated that LGBTQIA+ individuals made up 4.3% of the population in India who were at high risk of contracting AIDS ( Kar et al. , 2018 ). Due to the underrepresentation of such information in medical school curricula, clinicians may not be aware of or sensitive to the needs and issues faced by LGBTQIA+ patients when they encounter them ( Sequeira et al. , 2012 ; Magnus & Lundin, 2016 ). Healthcare professionals are frequently not trained in or sensitive to the requirements of LGBTQIA+ individuals’ health. Additionally, it might be challenging for professionals to talk about identity in general, especially when it comes to sexual orientation and gender identity. Medical education institutions can sometimes become the breeding ground for a heteronormative ideology that supports heterosexualism ( Lundin, 2011 ; Magnus & Lundin, 2016 ). Heteronormativity refers to the belief that only two opposite and mutually complementary genders exist – or that gender and sexual variation simply do not exist in social institutions ( Kannisto, 2019 ). Healthcare professionals frequently lack the necessary training and awareness regarding the health needs of LGBTQIA+ individuals. Moreover, they often find it challenging to have a conversation regarding sexuality, especially when it comes to gender identity and sexual orientation. LGBTQIA+ individuals have obstacles in receiving adequate healthcare because of inadequate training, heterosexist attitudes, or both. Inaccurate risk estimates for pregnancy, STIs, and the ineffective or improper use of screening tools can all be caused by heterosexist attitudes. These challenges could have a detrimental impact on the management of these patients' treatments and, eventually, their health ( Wahlen et al. , 2020 ). The LGBTQIA+ community is substantially more likely to experience various risk factors for poor health than heterosexual people, such as being less likely to have health insurance, being more likely to be obese, smoking more regularly, and engaging in binge and heavy drinking, the population’s age warrants additional attention. In addition, compared to heterosexual women, lesbian and bisexual women may undergo fewer preventative screenings for colon, breast, and cervical cancer. This is partly due to fear of not receiving respectful healthcare. Healthcare professionals are at the forefront of this effort and have the chance to treat everyone with respect, regardless of their sexual orientation and gender identity. Lack of time, finances, education, and clinical experience are a few obstacles that can prohibit physicians from providing respectful medical care ( Walker et al. , 2016 ). Doctor-patient interaction is essential for enhancing people’s health ( Parker & Bhugra, 2000 ). Patients may opt to keep their sexual orientation and gender identity private. In such situations, healthcare professionals must be vigilant and compassionate to deliver the best care ( Grabovac et al. , 2014 ). There are no such policies or curricula for treating LGBTQIA+ patients in India’s healthcare sector. LGBTQIA+ people have common social tendencies and decisions that impact their behavior while seeking healthcare, preventative health measures, and illness risk ( Kaufman et al. , 2014 ). It is vital to make accessible, responsive, appropriate, and well-resourced healthcare services provided by knowledgeable and trained healthcare professionals to support a better patient experience. Higher education institutions and healthcare organizations have a significant role in developing curricula ( Cui, 2023 ) that can be accessed by all groups, including those who identify as LGBTQIA+ ( McCann & Brown, 2018 ). Healthcare institutions must create a welcoming environment and make allowances for people with diverse gender identities and sexual orientations ( Hafford-Letchfield et al. , 2017 ). Medical school teachers play a vital role in helping medical students become better prepared to treat these underserved communities and reduce healthcare disparities ( Alhanachi et al. , 2021 ; Chinchilla & Arcaya, 2017 ). Training healthcare professionals during their studies can help them feel more at ease when caring for these patients and give better treatment, an essential technique for improving understanding and attitudes about LGBTQIA+ persons among healthcare professionals ( Wahlen et al. , 2020 ). Inculcating positive LGBTQIA+ attitudes among healthcare providers plays a great role in reducing homophobia and transphobia ( Gegenfurtner, 2021 ). The scope of the proposed research is to develop a module on the care of LGBTQIA+ individuals for health professionals and pilot test on faculty and students of health sciences, including faculties and students from MSc nursing, MPhil psychology, Head nurses, Medicine, and Nurse educators in the form of workshops. For this purpose, a need assessment through a review of the literature and focus group discussion with LGBTQIA+ individuals will be done. The project contributes to enhancing the UN's sustainable goals, such as SDG 3- Good health and well-being, and SDG 10- Reduced inequality. Research plan Research questions How is a module on the care of LGBTQIA+ individuals on health professionals effective in increasing their knowledge? Primary research question What are the healthcare needs of LGBTQIA+ people? To answer the primary research question, lead questions will be used to assess LGBTQIA+ individuals’ care needs, barriers to accessing care, and expectations from healthcare professionals. Secondary research question How effective is a module on the care of LGBTQIA+ individuals in increasing the knowledge of health professionals? To achieve this question, a structured knowledge-based questionnaire on LGBTQIA+ care will be administered to the health science students and faculty to assess their knowledge about LGBTQIA+ care. Hypothesis/Assumptions It is hypothesized that a module on the care of LGBTQIA+ individuals will significantly increase the knowledge of health professionals. Based on the previously published literature related to the needs of LGBTQIA+, it is assumed that a. LGBTQIA+ individuals experience stigma and discrimination. b. The present health science curriculum does not have a specific unit that deals with the management of LGBTQIA+ health problems. c. There is a lack of structured guidelines for managing the health conditions of LGBTQIA+ people. Design The study includes two phases: Phase I - development of a module on the care of LGBTQIA+ individuals for health professionals based on the literature and the need assessment through the focus group discussion among LGBTQIA+ individuals; and Phase II - A pilot testing of the module for health science faculty and students with pre- and post-test assessment design. A conceptual framework of the research design is shown in Figure 1 . Figure 1. A conceptual framework of the research design. Phase I: Developing the module a. Literature review A module on the care of LGBTQIA+ individuals for health professionals will be developed based on the detailed literature review and analysis of focus group discussion (FGD). The literature will be reviewed in detail through different sources to understand the needs of the LGBTQIA+ community. This includes academic research databases such as SCOPUS, Web of Science, PubMed, Science Direct, and CINAHL Complete. The grey literature search will also be initiated. The literature search is primarily conducted to find out the existing healthcare needs of the LGBTQIA+ community, and it does not involve systematic reviews. The literature on the needs, problems, and expectations of LGBTQIA+ will be studied and used to develop module. b. Focus group discussion The FGD will be conducted in a district government office in coordination with the local government health department. The Principal Investigator will moderate the FGD by following the standard methodology ( Kitzinger, 1995 ). The data will be collected from the participants after obtaining administrative permission from the authorities. The participant information will be explained in the local language, and a signed informed consent form will be obtained from the participants to collect the data and for audio recording. The participants' sociodemographic data will be taken, and the participants will self-report their sexual orientation and gender identity. The lead questions prepared for the FGD will be used to conduct the discussion ( Box 1 ). After receiving consent from the participants, a discussion will be initiated using the lead questions. Participants are encouraged to communicate and discuss their healthcare needs and expectations from the healthcare facility. Based on the participant’s response, probe questions will be asked till all the questions are answered. The FGD will be recorded using an audio recorder with the consent of the participants and nonverbal communication during the discussion. It will be used as an adjunct while transcribing the discussion. A sociogram also will be drawn to record the interactions among the participants. The FGD session will be closed by the moderator after the important points have been summarized to the participants. The team will thank the participants and compensate them for the quality time spent by the participants. The data gathered will be thematically analyzed ( Braun & Clarke, 2021 ; Kyngäs et al. , 2019 ), and will be used to develop the module for health professionals. Box 1. FGD lead questions. a. Describe your experience of visiting a hospital/clinic. (Probe-interaction with health professionals) b. What are your health needs that require medical attention? c. Explain the changes you expect to address your health needs. d. What are your expectations for addressing yourself? e. What are your expectations from the health care provider when you visit the hospital/clinic? f. How can a healthcare provider best assess your health needs? g. How can healthcare providers help you treat any illness? h. What are the challenges you face in seeking treatment for your health needs? i. Explain any other information you would like to bring to our attention. c. Development of a module on the care of LGBTQIA+ individuals Based on the literature review and FGD analysis, the authors will draft the module on the care of LGBTQIA+ individuals for health professionals. The content of the module is divided among the authors to have six chapters. Following the development of the module based on the literature review and the outcomes of the focus group discussions, the draft will be referred to the experts for content validation. Two experts will conduct this validation: one will be a transgender person with expertise in medical science, and the other will be an expert in health sciences education. The final module will be developed based on the expert’s suggestions. The developed module on the care of LGBTQIA+ individuals for health professionals will be used for Phase II. Phase II: Pilot testing of the module The module will be pilot-tested in the form of workshops for faculty and students of health sciences in the workplace. The faculty and students will be from nursing, medicine, psychology, and nurse educators. The workshop will be for one day. Knowledge will be assessed before and after the workshop using a questionnaire. The tentative topics covered in the workshop are an introduction to LGBTQIA+ care, inclusive communication, LGBTQIA+ community and health care- treatment management, mental health services for LGBTQIA+, research and evidence-based practice, interpersonal communication, and ethical and legal issues in LGBTQIA+ health care. Feedback from the participants will also be taken for the modification of the module. The module will be finalized after the pilot study, and recommendations will be submitted to health sciences institutions, their regulatory bodies, and funding agencies. Participants Phase I Phase I includes an FGD to assess the healthcare needs among self-identified LGBTQIA+ individuals. The result of the FGD and the literature review will help in preparing the module. One face-to-face FGD of 10-15 individuals who are a representative number of the self-reported LGBTQIA+ community will be recruited using purposive sampling. The details of the participants will be collected from the district authorities. They will be contacted to schedule the FGD. The sample size is kept under 10-15 to support the depth of FGD and subsequent analysis. Inclusion criteria • The participants who self-report as LGBTQIA+ community and can speak in Kannada or English. • Individuals who are above the age of 18 years. • Individuals who are willing to participate in the focus group discussion. Exclusion criteria • Any individuals who are crossdressers. • Any member of the LGBTQIA+ community who has a diagnosed mental disorder listed under chapter F of ICD 10, except gender identity disorder. Drop-out criteria and withdrawal Data collection from participants will cease when they withdraw their consent to participate, and the data that is in question will be excluded during the analysis. Phase II The participants for phase II will be selected from the health sciences institutions offering medical, nursing, and other health science programs through their heads of the institution. Faculty and students will be recruited face-to-face for the study, and the module will be pilot-tested both among the faculty and students through workshops. No dropouts are expected as the workshop is for one day. The number of participants for this group will be based on the formula: N = Zα + Zβ 2 / E / S Δ 2 where; α (two-tailed) = % Threshold probability for rejecting the null hypothesis. Type I error rate. β = % Probability of failing to reject the null hypothesis under the alternative hypothesis. Type II error rate. E = Effect size S Δ = Standard Deviation of the change in the outcome Zα = Standard normal deviate for α = 1.9600 Zβ = Standard normal deviate for β = 0.8416 B = ( Zα + Zβ )2 = 7.8489 C = ( E / S Δ)2 = 0.2844 N = B / C =27.5937 The N thus calculated is rounded up to 30 participants from students and faculty groups. Students from medical (n = 10), nursing (n = 10), clinical psychology (n = 5), and senior nurses from the teaching hospital (n = 5) will be trained in the ‘student workshop’ whereas faculty from medicine (n = 10), nursing (n = 10) and psychology (n = 5) and middle-level nurse managers or educators (n = 5) will be trained in the ‘faculty workshop’. Undergraduate students and faculty are excluded from the ‘student workshop’, and similarly, students are excluded from the ‘faculty workshop’. Outcome measures The outcome variables will be: Phase I: • Needs of the LGBTQIA+ individuals (analyzed) from FGD • A module on the care of LGBTQIA+ individuals for health professionals Phase II: • Knowledge of health professionals on the care of LGBTQIA+ individuals is measured using a structured knowledge questionnaire. Primary outcome The healthcare needs of LGBTQIA+ individuals will be assessed, and the data gathered will be used to develop the module for health professionals. Secondary outcome The module developed using the data gathered by FGD, literature review, and experts’ inputs will positively influence how LGBTQIA+ individuals are getting cared for by healthcare providers. Plan for data analysis Phase I The FGD will be analysed by thematic analysis ( Braun & Clarke, 2021 ; Renjith et al. , 2021 ). The focus of the FGD analysis is not to identify the individual contributions to the discussion but to present the spectrum of opinions of the entire group ( Van Eeuwijk & Angehrn, 2017 ). The data will be divided into simpler text units for coding, and the coding will be done manually. Units of meaningful text corresponding to similar codes will be grouped and categorized systematically by the authors. Any differences in the process of coding and categorizing will be resolved by discussion among the authors. Consensus will be achieved during these face-to-face discussions. The codes will be categorized into inductive and deductive. Inductive codes will be content-driven and raised by participants, whereas deductive codes will originate from the discussion guide and will then be verified with data ( Hennink et al. , 2019 ). Phase II: Descriptive statistics like frequency and percentage will be used for the data analysis of the workshop participants. The knowledge data will be analysed using a paired t-test. Dissemination Results will be disseminated via presentations at appropriate scientific conferences and meetings of professional bodies. The study will also be published in peer-reviewed journals, professional and institutional repositories, etc. The results will be discussed with governmental bodies and other stakeholders for broader implementation. Status of the study The study team completed the draft module and is currently in the process of pilot-testing the module on the care of LGBTQIA+ individuals for health professionals (phase II). The study is expected to be completed by December 2024, and the results will be published by 2024 and 2025. This protocol will help in reducing unnecessary duplication of effort and the costs of future studies. Discussion The previous study findings show that LGBTQIA+ individuals face more difficulties accessing care because of their sexual orientation and gender identities. The study found that young adult lesbians had a harder time getting access to care than young adult homosexual males. This finding is consistent with earlier research that identified differences in the healthcare experiences of sexual minority individuals. Additionally, due to negative experiences associated with their sexual orientation and identity, gay males were more prone than lesbians to delay care. Young men may be more forthcoming about their sexual orientation and identity in healthcare, which may increase the potential for negative experiences, whereas young women may be more reticent to disclose their sexual orientation and identity to providers and, as a result, feel limited in their ability to access affirming care ( Macapagal et al. , 2016 ). Contrary to earlier findings, few individuals claimed to have encountered LGBTQIA+-related discrimination in medical settings. Furthermore, the majority stated that telling their provider about their gender identity and sexual orientation had a neutral to positive impact on their care ( Mosack et al. , 2013 ). The findings from previous studies suggested that changes in the healthcare system will promote inclusive care. Studies have shown that reluctance to talk about sexual orientation and gender identity was brought on by ignorance of the medical requirements for LGBTQIA+ patients ( LaVaccare et al. , 2018 ). According to a previous research study, students who had more contact with LGBTQIA+ patients were more likely to ask about a patient’s sexual orientation and gender identity and check for children in the patient’s family. The disclosure of this information during patient interactions may be improved by early intervention by educators who teach students appropriate questions to ask during the history-taking process ( Sanchez et al. , 2006 ). The current study will explore the healthcare needs of LGBTQIA+ individuals and will result in education programs and initiatives that can improve knowledge about LGBTQIA+ individuals. It will also provide practical techniques that can easily be included in the health science curriculum, which will help reduce disparities. The module will improve the healthcare professionals’ knowledge about sexual orientation, gender identity, sexual behaviour, and sex anatomy comfort of LGBTQIA+ patients. It will also enhance the self-confidence and comfort of healthcare professionals who treat LGBTQIA+ people. Previous studies have found health professionals who are trained in inclusive LGBTQIA+ care were able to address sexual health without shame, hesitation, or ignorance and help the members of the LGBTQIA+ community ( Agarwal & Thiyam, 2022 ). The module will summarize the healthcare needs, barriers, and expectations based on FGD and primary care recommendations for LGBTQIA+ patients. This study will support the necessity for a curricular framework to reduce unconscious bias among students of healthcare professions toward LGBTQIA+ patients. Conclusion The study will address the critical gap in the healthcare professional curriculum in terms of LGBTQIA+ care. The module will enhance the skills and knowledge of healthcare providers in caring for LGBTQIA+ individuals and help them understand their needs and expectations. It will promote healthcare professionals’ positive attitudes toward LGBTQIA+ patients and improve comfort working with LGBTQIA+ patients. The module will guide researchers and educators looking to reduce prejudice against LGBTQIA+ patients in healthcare professionals, as well as a framework for teaching students to recognize and overcome their own biases. Educational Strategies that reduce bias in healthcare providers are essential steps to improving LGBTQIA+ communities' access to treatment and reducing health inequalities. Project Plan Table 1 depicts the activities and publications that will be carried out throughout the project. The project will endure for two years. Table 1. Activity plan. 2023 2024 Activity Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Phase 1- Module Development PT Literature review MSP, RY, BB, LT, VP, NK Preparing questionnaire for FGD MSP, RY, BB, LT, VP, NK Conducting FGD MSP, RY, BB, DS Data transcribing DS Data Analysis MSP, RY, DS Phase 2- Pilot testing Literature Review MSP, RY, BB, LT, VP, NK, DS Chapter preparation MSP, RY, BB, LT, VP, NK Chapter validation Experts Preparing questionnaire MSP, DS Performa validation Experts Workshop 1 MSP, RY, BB, LT, VP, NK, DS, Experts Workshop 2 MSP, RY, BB, LT, VP, NK, DS, Experts Analysis MSP, RY, BB, LT, VP, NK, DS Manuscripts MSP, RY, BB, LT, VP, NK, DS PT: Project Team Completed activity Planned activity Ethical aspects The Institutional Ethics Committee of Kasturba Medical College and Kasturba Hospital reviewed and approved the proposal on 11 th May 2022 (IEC1-138/2022). The protocol has been registered to the Clinical Trial Registry-India. Permission has been obtained from the local government authorities concerned, and written informed consent has been taken from the participants in the study. The data relating to the participants will be kept confidential and used anonymously for this study only. Codes will be used for each participant. Potential impact of the proposed research The module developed using the data given by the participants will positively influence how LGBTQIA+ individuals are being cared for by healthcare providers. This project makes a timely contribution to discussions concerning the function of professional educational interventions, which evaluates the impact of educational curricula and training for healthcare students and professionals on LGBTQIA+ healthcare issues. A policy document will be made at the end of the study by highlighting the study’s implications and will be disseminated among the ministries and other regulatory bodies of health and education. 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PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 06 Nov 2023 ADD YOUR COMMENT Comment Author details Author details 1 Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 2 Department of Psychiatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 3 Department of Forensic Medicine and Toxicology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 4 College of Nursing, All India Institute of Medical Sciences, Kalyani, West Bengal, 741245, India 5 Department of Pharmaceutical Regulatory Affairs and Management, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 6 Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 7 Division of Socio-behavioural, Health Systems & Implementation Research (SHI), Indian Council of Medical Research, New Delhi, Delhi, 110029, India Mamatha Shivananda Pai Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Renjulal Yesodharan Roles: Conceptualization, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Vikram Palimar Roles: Conceptualization, Investigation, Methodology, Resources, Supervision, Writing – Review & Editing Latha Thimmappa Roles: Conceptualization, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation Bhavana B. Bhat Roles: Conceptualization, Investigation, Methodology, Resources, Writing – Original Draft Preparation Nirmal Krishnan M. Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation Deeksha Shetty Roles: Investigation, Methodology, Project Administration, Resources, Writing – Original Draft Preparation Bontha V. Babu Roles: Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The project is funded by the Indian Council of Medical Research (ICMR), New Delhi (grant number: Adhoc/207/2022/SBHSR). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) version 2 Revised Published: 23 Jul 2024, 12:1437 https://doi.org/10.12688/f1000research.140518.2 version 1 Published: 06 Nov 2023, 12:1437 https://doi.org/10.12688/f1000research.140518.1 Copyright © 2024 Pai MS et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Pai MS, Yesodharan R, Palimar V et al. Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . 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Reviewer Report For: Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.5256/f1000research.168961.r306059 ) The direct URL for this report is: https://f1000research.com/articles/12-1437/v2#referee-response-306059 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 27 Jul 2024 Dr shubha Jayaram , Mysore Medical College and Research Institute, Mysore-570001, Karnataka, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.168961.r306059 The authors have incorporated the changes suggested , ... Continue reading READ ALL The authors have incorporated the changes suggested , which has improvised the previous version of the article. Competing Interests: No competing interests were disclosed. Reviewer Expertise: My areas of research are Medical Education, Diabetes Mellitus , Thanatochemistry, Global Burden of diseases, I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Jayaram Ds. Reviewer Report For: Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.5256/f1000research.168961.r306059 ) The direct URL for this report is: https://f1000research.com/articles/12-1437/v2#referee-response-306059 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Ramoo V. Reviewer Report For: Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.5256/f1000research.168961.r306060 ) The direct URL for this report is: https://f1000research.com/articles/12-1437/v2#referee-response-306060 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 23 Jul 2024 Vimala Ramoo , Universiti Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia Approved VIEWS 0 https://doi.org/10.5256/f1000research.168961.r306060 I have ... Continue reading READ ALL I have no further comments. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Nursing education, Critical care nursing and Nursing Management and Leadership I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ramoo V. Reviewer Report For: Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.5256/f1000research.168961.r306060 ) The direct URL for this report is: https://f1000research.com/articles/12-1437/v2#referee-response-306060 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 06 Nov 2023 Views 0 Cite How to cite this report: Jayaram Ds. Reviewer Report For: Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.5256/f1000research.153885.r221847 ) The direct URL for this report is: https://f1000research.com/articles/12-1437/v1#referee-response-221847 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 15 Dec 2023 Dr shubha Jayaram , Mysore Medical College and Research Institute, Mysore-570001, Karnataka, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.153885.r221847 Thank you for your interest and intent in publishing this article titled, “Development, implementation, and testing of LGBTQIA+ care curriculum for health science professionals: Research protocol”. I appreciate the sincere efforts put together for the preparation of this manuscript ... Continue reading READ ALL Thank you for your interest and intent in publishing this article titled, “Development, implementation, and testing of LGBTQIA+ care curriculum for health science professionals: Research protocol”. I appreciate the sincere efforts put together for the preparation of this manuscript .The topic is very relevant and the need of the hour. The following points should be addressed and the manuscript revised. Title: Title should be suitably modified to replace the word “Curriculum “ , Curriculum is a broad terminology which is defined as follows : “Curriculum is what is taught in a given course or subject. Curriculum refers to an interactive system of instruction and learning with specific goals, contents, strategies, measurement, and resources”. The study is a research protocol for fulfilling the identified gaps in the health science curriculum to provide adequate care for LGBTQIA + subjects .Therefore I suggest that the word curriculum be modified as “ Development, implementation, and testing of a module for LGBTQIA+ care to be integrated in the curriculum for health science professionals: Research protocol" . 2.Abstract : A. “Additionally, healthcare professionals also find it difficult to care for LGBTQIA+ as very little is studied or heard about management.” This can be rephrased as “Additionally, healthcare professionals also find it difficult to care for LGBTQIA+ as they are not adequately trained regarding the management of these subjects”. B. Study outcome should be modified: to include policy changing practices, not just improvement of knowledge. C. Keywords: Rationale for including SDG 3 and SDG -10? Sustainable Development Goal? As keywords as they nowhere appear in the manuscript and not discussed in the context, needs to be justified. 3.Page 3: Background: “Minority stress” to be detailed in the context of health care education, the term QIA + in LGBTQIA+ is not explained. 4.Page 3: Background: April 2014: Reference to be provided. 5.Page 3: Background: “Although the Delhi High court……………….”, This sentence to be modified for clarity. 6.Page 3: Background: Delhi High Court 2009: –reference needed. 7.Page 4: para -1:- “Hetero sexist attitudes may result in Inaccurate Risk Assessment” This sentence to be justified and rewritten for clarity . 8.Page 4; para 2: Health institutions should make room for individuals –Needs to be rephrased. 9.Page 5 : Research Plan :- points b and c , b. The present health science curriculum does not have a specific curriculum that deals with the management of LGBTQIA+ health problems. c. There is a lack of structured guidelines for managing the health conditions of LGBTQIA+ people. These points should be highlighted and discussed adequately as the need for the study. 10.Introduction to be rewritten, as it is not aligned with the objectives of the study. Research question is not aligned with the title of the topic and study objectives should be provided. What are ‘The gaps’ in the present curriculum / Gaps and lack of competency of medical professionals in communicating with and management of LGBTQIA+ subjects , whether it should be a part of the AETCOM modules of the present CBME (Competency Based Medical Education ) medical curriculum should be discussed in the background section. 11.Primary Research Question and Research Objectives are not clear. 12.In alignment with the research question, assessment of knowledge about LGBTQIA+ Care has to be included in the title. 13.Based on the previously published literature related to the needs of LGBTQIA+, it is assumed that……….: has to be rephrased and modified. 14.A, B, C, points in the methodology have to be described and highlighted in the background section. 15.Phase -1 Flow chart diagram should include obtaining Institutional Ethics Committee clearance and taking consent from the subjects. 16.Methodology: Study design: Type of study design should be described; whether qualitative, quantitative, or Mixed methods study? 17.Page 6: Methodology: For Focussed Group Discussions (FGD) initials of principal investigator and moderator to be mentioned. 18.Page 6: Methodology: Inclusion criteria for FGD participants to be detailed, How were they approached? Sample size determination of participants? Criteria for inclusion?, Justification for age group of the LGBTQIA +subjects participating in FGD, Who are all the participants of FGD apart from LGBTQIA+ subjects to be clarified; whether a separate FGD would be held for faculty of health care professionals or whether they were also a part of the first FGD needs to be clarified and justified. 19.Page 6: Methodology: How the recording of the non-verbal communication was done during FGD to be described. 20.It is mentioned that the participants of the FGD will be compensated? Details required. 21.Box -1: FGD questions: Development of FGD lead questions, details required as to how the questions of FGD were validated? And whether any formal FGD interview guide was used needs to be described. 22.Page 4: Methodology: It is mentioned “To achieve this secondary research question, a structured knowledge-based questionnaire on LGBTQIA+ care will be administered to the health science students and faculty to assess their knowledge about LGBTQIA+ care.” This structured questionnaire should be provided in the appendix/as annexure section. Whether Validity and Reliability of the questionnaire was tested, CVI and CVR were calculated;, whether I-CVI (Item level CVI )/ S-CVI (Scale level CVI ) were also calculated ? Validation process should be elaborated. 23.Page 7: Phase -11: Inclusion criteria for phase -2, age group of the health care students participating in the study to be given. 24.Page 8: How the Assessment of primary and secondary outcomes would be done; to be described. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: My areas of research are Medical Education, Diabetes Mellitus , Thanatochemistry, Global Burden of diseases, I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Jayaram Ds. Reviewer Report For: Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.5256/f1000research.153885.r221847 ) The direct URL for this report is: https://f1000research.com/articles/12-1437/v1#referee-response-221847 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 23 Jul 2024 RENJULAL YESODHARAN , Department of Psychiatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, 576104, India 23 Jul 2024 Author Response Thank you for reviewing the manuscript. Your expert suggestions are incorporated in version 2 of the manuscript. The title of the manuscript is changed, and the "curriculum" is changed to "module". ... Continue reading Thank you for reviewing the manuscript. Your expert suggestions are incorporated in version 2 of the manuscript. The title of the manuscript is changed, and the "curriculum" is changed to "module". The keywords of the study have been changed as per SDG3 and SDG10. As per your suggestion, 'minority stress is explained in the text. The details you asked about FGD will be published separately as an outcome paper; hence, it is not incorporated in this manuscript. The suggestion you mentioned will be considered while disseminating the findings of FGD. As per your suggestion, we have included more explanations for assessing the primary and secondary objectives. Thank you for reviewing the manuscript. Your expert suggestions are incorporated in version 2 of the manuscript. The title of the manuscript is changed, and the "curriculum" is changed to "module". The keywords of the study have been changed as per SDG3 and SDG10. As per your suggestion, 'minority stress is explained in the text. The details you asked about FGD will be published separately as an outcome paper; hence, it is not incorporated in this manuscript. The suggestion you mentioned will be considered while disseminating the findings of FGD. As per your suggestion, we have included more explanations for assessing the primary and secondary objectives. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 23 Jul 2024 RENJULAL YESODHARAN , Department of Psychiatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, 576104, India 23 Jul 2024 Author Response Thank you for reviewing the manuscript. Your expert suggestions are incorporated in version 2 of the manuscript. The title of the manuscript is changed, and the "curriculum" is changed to "module". ... Continue reading Thank you for reviewing the manuscript. Your expert suggestions are incorporated in version 2 of the manuscript. The title of the manuscript is changed, and the "curriculum" is changed to "module". The keywords of the study have been changed as per SDG3 and SDG10. As per your suggestion, 'minority stress is explained in the text. The details you asked about FGD will be published separately as an outcome paper; hence, it is not incorporated in this manuscript. The suggestion you mentioned will be considered while disseminating the findings of FGD. As per your suggestion, we have included more explanations for assessing the primary and secondary objectives. Thank you for reviewing the manuscript. Your expert suggestions are incorporated in version 2 of the manuscript. The title of the manuscript is changed, and the "curriculum" is changed to "module". The keywords of the study have been changed as per SDG3 and SDG10. As per your suggestion, 'minority stress is explained in the text. The details you asked about FGD will be published separately as an outcome paper; hence, it is not incorporated in this manuscript. The suggestion you mentioned will be considered while disseminating the findings of FGD. As per your suggestion, we have included more explanations for assessing the primary and secondary objectives. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Ramoo V. Reviewer Report For: Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.5256/f1000research.153885.r221846 ) The direct URL for this report is: https://f1000research.com/articles/12-1437/v1#referee-response-221846 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 15 Dec 2023 Vimala Ramoo , Universiti Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.153885.r221846 Feedback to authors Dear authors, thank you for the opportunity to read and review this interesting research protocol. My suggestions/comments to further enhance the paper are: Title: The ... Continue reading READ ALL Feedback to authors Dear authors, thank you for the opportunity to read and review this interesting research protocol. My suggestions/comments to further enhance the paper are: Title: The title effectively conveys the primary focus and purpose of the study. It clearly indicates that the research aims to develop, implement, and evaluate a curriculum for health science professionals regarding LGBTQIA+ care. It's specific and informative, which is essential for attracting the right audience and communicating the study's objectives. Overall, the title is well-constructed and aligns with the research's objectives. Scope of the Study: The scope of the study appears to be appropriately defined within the title and is further elaborated upon in the abstract and introduction sections of the research protocol. It includes three key phases: curriculum development, implementation, and testing, with the overarching goal of addressing healthcare disparities and enhancing LGBTQIA+ healthcare education for health science professionals. However, to further clarify the scope: In the introduction section, consider briefly mentioning the specific healthcare disciplines or professions within "health science professionals" that the curriculum is intended for (e.g., physicians, nurses, social workers) to provide a more precise context. I noted only the need for medical students and faculties is highlighted in the text. The importance for nurses and other healthcare professionals is not emphasized. Define who the healthcare providers are and use a consistent term either as healthcare providers or as healthcare professionals (healthcare science student mentioned in Figure 1). Avoid using them interchangeably, as this may confuse readers. Also, consider where students can be considered as providers or professionals. It is noted also the authors had mentioned assessing knowledge of LGBTQIA+ health needs and sometimes knowledge of LGBTQIA+ care – please be consistent. Research question The research question requires minor refinement of the sentence structure, for example: How does an LGBTQIA+ curriculum impact healthcare providers' knowledge of LGBTQIA+ care? However, in the study the authors plan to assess the "how" using a quantitative approach, I would suggest rephrasing to: "To what extent does an LGBTQIA+ curriculum quantitatively improve healthcare providers’ knowledge of LGBTQIA+ care?" Suggestion for the secondary research question as this will be assessed using a pre-post approach: To assess the effectiveness of the curriculum in improving healthcare professionals’ knowledge of LGBTQIA+ care. Phase 1 – Development of curriculum The curriculum development process should include a strong focus on cultural competence and sensitivity. This includes not only understanding healthcare needs but also addressing the unique cultural and ethical aspects of caring for LGBTQIA+ individuals. I would suggest that in addition to FGD and literature review, the authors should consider incorporating insights and expertise from healthcare professionals experienced in LGBTQIA+ healthcare. Experts can provide valuable guidance on best practices and ensure that the curriculum aligns with clinical reality. The content of the expert validation of the curriculum requires further elaboration in terms of the panel's expertise, the number of experts involved and the specific analysis process to be carried out. Future details on these aspects would be valuable to ensure transparency and accuracy in the validation process. I recommend determining: The composition of the expert panel, including the diversity of expertise among panel members (e.g., LGBTQIA+ healthcare, medical education, curriculum development). The total number of experts who will participate in the validation process. A clear description of the analysis process, indicating the criteria and guidelines against which the curriculum will be evaluated. How experts will provide feedback and recommendations and whether there will be a formalized assessment or evaluation system for assessing curriculum components. FGD participants: While the authors mention recruiting a representative number of self-identified LGBTQIA+ individuals, consider expanding efforts to ensure diversity within the sample. Mention whether they will actively seek participants from diverse backgrounds, age groups, and gender identities to capture a comprehensive range of perspectives and experiences. The rationale for selecting a sample size of 10-15 participants is well-explained. The authors highlighted the importance of depth in the Focus Group Discussion (FGD) and subsequent analysis. It would be helpful to mention whether this sample size is consistent with previous research or guidelines in the field to further support the appropriateness of the sample size. Exclusion criteria should not be the opposite of inclusion criteria, for example: “Any person who is not belonging to the LGBTQIA+ community” is not required. Phase II – Pilot study Insufficient information has been provided regarding the measurement instrument, and the questionnaire on knowledge. It is essential to include comprehensive details regarding the development or adaptation of the instrument, its content, the validation process, and reliability testing. The time interval between the pre-and post-test and its rationale. Figure 1 needs a more detailed description of the process. Figure 2 – not clear of the activity in Workshop I. Discussions The discussion touches on key points related to previous research and the potential impact of the curriculum. However, further elaboration, interpretation, and explicit connections between the current study and previous research would enhance the overall clarity and depth of the discussion. It would be advantageous to explicitly state how the present study seeks to build on or contribute to existing knowledge in this area. This will help readers understand the unique contributions of your research. All the best Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Nursing education, Critical care nursing and Nursing Management and Leadership I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ramoo V. Reviewer Report For: Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.5256/f1000research.153885.r221846 ) The direct URL for this report is: https://f1000research.com/articles/12-1437/v1#referee-response-221846 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 23 Jul 2024 RENJULAL YESODHARAN , Department of Psychiatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, 576104, India 23 Jul 2024 Author Response Thank you for reviewing the manuscript. We appreciate the suggestions given by you. As per your suggestions, the term ‘Medical students’ was changed to health care professionals. The research questions ... Continue reading Thank you for reviewing the manuscript. We appreciate the suggestions given by you. As per your suggestions, the term ‘Medical students’ was changed to health care professionals. The research questions were modified based on the suggestions. Modifications in the figures were undertaken to accommodate these changes. We consistently used terminologies throughout the text, as per your suggestion. A few terminologies are replaced with more technical ones. Regarding the validation of the m content module, the authors have already included experienced healthcare professionals for their suggestions. The experts validate the content of the curriculum. We have also modified the discussions. Thank you for reviewing the manuscript. We appreciate the suggestions given by you. As per your suggestions, the term ‘Medical students’ was changed to health care professionals. The research questions were modified based on the suggestions. Modifications in the figures were undertaken to accommodate these changes. We consistently used terminologies throughout the text, as per your suggestion. A few terminologies are replaced with more technical ones. Regarding the validation of the m content module, the authors have already included experienced healthcare professionals for their suggestions. The experts validate the content of the curriculum. We have also modified the discussions. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 23 Jul 2024 RENJULAL YESODHARAN , Department of Psychiatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, 576104, India 23 Jul 2024 Author Response Thank you for reviewing the manuscript. We appreciate the suggestions given by you. As per your suggestions, the term ‘Medical students’ was changed to health care professionals. The research questions ... Continue reading Thank you for reviewing the manuscript. We appreciate the suggestions given by you. As per your suggestions, the term ‘Medical students’ was changed to health care professionals. The research questions were modified based on the suggestions. Modifications in the figures were undertaken to accommodate these changes. We consistently used terminologies throughout the text, as per your suggestion. A few terminologies are replaced with more technical ones. Regarding the validation of the m content module, the authors have already included experienced healthcare professionals for their suggestions. The experts validate the content of the curriculum. We have also modified the discussions. Thank you for reviewing the manuscript. We appreciate the suggestions given by you. As per your suggestions, the term ‘Medical students’ was changed to health care professionals. The research questions were modified based on the suggestions. Modifications in the figures were undertaken to accommodate these changes. We consistently used terminologies throughout the text, as per your suggestion. A few terminologies are replaced with more technical ones. Regarding the validation of the m content module, the authors have already included experienced healthcare professionals for their suggestions. The experts validate the content of the curriculum. We have also modified the discussions. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 06 Nov 2023 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 23 Jul 24 read read Version 1 06 Nov 23 read read Vimala Ramoo , Universiti Malaya, Kuala Lumpur, Malaysia Dr shubha Jayaram , Mysore Medical College and Research Institute, Mysore-570001, Karnataka, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Jayaram D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 27 Jul 2024 | for Version 2 Dr shubha Jayaram , Mysore Medical College and Research Institute, Mysore-570001, Karnataka, India 0 Views copyright © 2024 Jayaram D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have incorporated the changes suggested , which has improvised the previous version of the article. Competing Interests No competing interests were disclosed. Reviewer Expertise My areas of research are Medical Education, Diabetes Mellitus , Thanatochemistry, Global Burden of diseases, I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Jayaram Ds. Peer Review Report For: Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.5256/f1000research.168961.r306059) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1437/v2#referee-response-306059 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Ramoo V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Jul 2024 | for Version 2 Vimala Ramoo , Universiti Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 0 Views copyright © 2024 Ramoo V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I have no further comments. Competing Interests No competing interests were disclosed. Reviewer Expertise Nursing education, Critical care nursing and Nursing Management and Leadership I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Ramoo V. Peer Review Report For: Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.5256/f1000research.168961.r306060) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1437/v2#referee-response-306060 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2023 Jayaram D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 15 Dec 2023 | for Version 1 Dr shubha Jayaram , Mysore Medical College and Research Institute, Mysore-570001, Karnataka, India 0 Views copyright © 2023 Jayaram D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for your interest and intent in publishing this article titled, “Development, implementation, and testing of LGBTQIA+ care curriculum for health science professionals: Research protocol”. I appreciate the sincere efforts put together for the preparation of this manuscript .The topic is very relevant and the need of the hour. The following points should be addressed and the manuscript revised. Title: Title should be suitably modified to replace the word “Curriculum “ , Curriculum is a broad terminology which is defined as follows : “Curriculum is what is taught in a given course or subject. Curriculum refers to an interactive system of instruction and learning with specific goals, contents, strategies, measurement, and resources”. The study is a research protocol for fulfilling the identified gaps in the health science curriculum to provide adequate care for LGBTQIA + subjects .Therefore I suggest that the word curriculum be modified as “ Development, implementation, and testing of a module for LGBTQIA+ care to be integrated in the curriculum for health science professionals: Research protocol" . 2.Abstract : A. “Additionally, healthcare professionals also find it difficult to care for LGBTQIA+ as very little is studied or heard about management.” This can be rephrased as “Additionally, healthcare professionals also find it difficult to care for LGBTQIA+ as they are not adequately trained regarding the management of these subjects”. B. Study outcome should be modified: to include policy changing practices, not just improvement of knowledge. C. Keywords: Rationale for including SDG 3 and SDG -10? Sustainable Development Goal? As keywords as they nowhere appear in the manuscript and not discussed in the context, needs to be justified. 3.Page 3: Background: “Minority stress” to be detailed in the context of health care education, the term QIA + in LGBTQIA+ is not explained. 4.Page 3: Background: April 2014: Reference to be provided. 5.Page 3: Background: “Although the Delhi High court……………….”, This sentence to be modified for clarity. 6.Page 3: Background: Delhi High Court 2009: –reference needed. 7.Page 4: para -1:- “Hetero sexist attitudes may result in Inaccurate Risk Assessment” This sentence to be justified and rewritten for clarity . 8.Page 4; para 2: Health institutions should make room for individuals –Needs to be rephrased. 9.Page 5 : Research Plan :- points b and c , b. The present health science curriculum does not have a specific curriculum that deals with the management of LGBTQIA+ health problems. c. There is a lack of structured guidelines for managing the health conditions of LGBTQIA+ people. These points should be highlighted and discussed adequately as the need for the study. 10.Introduction to be rewritten, as it is not aligned with the objectives of the study. Research question is not aligned with the title of the topic and study objectives should be provided. What are ‘The gaps’ in the present curriculum / Gaps and lack of competency of medical professionals in communicating with and management of LGBTQIA+ subjects , whether it should be a part of the AETCOM modules of the present CBME (Competency Based Medical Education ) medical curriculum should be discussed in the background section. 11.Primary Research Question and Research Objectives are not clear. 12.In alignment with the research question, assessment of knowledge about LGBTQIA+ Care has to be included in the title. 13.Based on the previously published literature related to the needs of LGBTQIA+, it is assumed that……….: has to be rephrased and modified. 14.A, B, C, points in the methodology have to be described and highlighted in the background section. 15.Phase -1 Flow chart diagram should include obtaining Institutional Ethics Committee clearance and taking consent from the subjects. 16.Methodology: Study design: Type of study design should be described; whether qualitative, quantitative, or Mixed methods study? 17.Page 6: Methodology: For Focussed Group Discussions (FGD) initials of principal investigator and moderator to be mentioned. 18.Page 6: Methodology: Inclusion criteria for FGD participants to be detailed, How were they approached? Sample size determination of participants? Criteria for inclusion?, Justification for age group of the LGBTQIA +subjects participating in FGD, Who are all the participants of FGD apart from LGBTQIA+ subjects to be clarified; whether a separate FGD would be held for faculty of health care professionals or whether they were also a part of the first FGD needs to be clarified and justified. 19.Page 6: Methodology: How the recording of the non-verbal communication was done during FGD to be described. 20.It is mentioned that the participants of the FGD will be compensated? Details required. 21.Box -1: FGD questions: Development of FGD lead questions, details required as to how the questions of FGD were validated? And whether any formal FGD interview guide was used needs to be described. 22.Page 4: Methodology: It is mentioned “To achieve this secondary research question, a structured knowledge-based questionnaire on LGBTQIA+ care will be administered to the health science students and faculty to assess their knowledge about LGBTQIA+ care.” This structured questionnaire should be provided in the appendix/as annexure section. Whether Validity and Reliability of the questionnaire was tested, CVI and CVR were calculated;, whether I-CVI (Item level CVI )/ S-CVI (Scale level CVI ) were also calculated ? Validation process should be elaborated. 23.Page 7: Phase -11: Inclusion criteria for phase -2, age group of the health care students participating in the study to be given. 24.Page 8: How the Assessment of primary and secondary outcomes would be done; to be described. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise My areas of research are Medical Education, Diabetes Mellitus , Thanatochemistry, Global Burden of diseases, I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 23 Jul 2024 RENJULAL YESODHARAN, Department of Psychiatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, 576104, India Thank you for reviewing the manuscript. Your expert suggestions are incorporated in version 2 of the manuscript. The title of the manuscript is changed, and the "curriculum" is changed to "module". The keywords of the study have been changed as per SDG3 and SDG10. As per your suggestion, 'minority stress is explained in the text. The details you asked about FGD will be published separately as an outcome paper; hence, it is not incorporated in this manuscript. The suggestion you mentioned will be considered while disseminating the findings of FGD. As per your suggestion, we have included more explanations for assessing the primary and secondary objectives. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Jayaram Ds. Peer Review Report For: Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.5256/f1000research.153885.r221847) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1437/v1#referee-response-221847 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2023 Ramoo V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 15 Dec 2023 | for Version 1 Vimala Ramoo , Universiti Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 0 Views copyright © 2023 Ramoo V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Feedback to authors Dear authors, thank you for the opportunity to read and review this interesting research protocol. My suggestions/comments to further enhance the paper are: Title: The title effectively conveys the primary focus and purpose of the study. It clearly indicates that the research aims to develop, implement, and evaluate a curriculum for health science professionals regarding LGBTQIA+ care. It's specific and informative, which is essential for attracting the right audience and communicating the study's objectives. Overall, the title is well-constructed and aligns with the research's objectives. Scope of the Study: The scope of the study appears to be appropriately defined within the title and is further elaborated upon in the abstract and introduction sections of the research protocol. It includes three key phases: curriculum development, implementation, and testing, with the overarching goal of addressing healthcare disparities and enhancing LGBTQIA+ healthcare education for health science professionals. However, to further clarify the scope: In the introduction section, consider briefly mentioning the specific healthcare disciplines or professions within "health science professionals" that the curriculum is intended for (e.g., physicians, nurses, social workers) to provide a more precise context. I noted only the need for medical students and faculties is highlighted in the text. The importance for nurses and other healthcare professionals is not emphasized. Define who the healthcare providers are and use a consistent term either as healthcare providers or as healthcare professionals (healthcare science student mentioned in Figure 1). Avoid using them interchangeably, as this may confuse readers. Also, consider where students can be considered as providers or professionals. It is noted also the authors had mentioned assessing knowledge of LGBTQIA+ health needs and sometimes knowledge of LGBTQIA+ care – please be consistent. Research question The research question requires minor refinement of the sentence structure, for example: How does an LGBTQIA+ curriculum impact healthcare providers' knowledge of LGBTQIA+ care? However, in the study the authors plan to assess the "how" using a quantitative approach, I would suggest rephrasing to: "To what extent does an LGBTQIA+ curriculum quantitatively improve healthcare providers’ knowledge of LGBTQIA+ care?" Suggestion for the secondary research question as this will be assessed using a pre-post approach: To assess the effectiveness of the curriculum in improving healthcare professionals’ knowledge of LGBTQIA+ care. Phase 1 – Development of curriculum The curriculum development process should include a strong focus on cultural competence and sensitivity. This includes not only understanding healthcare needs but also addressing the unique cultural and ethical aspects of caring for LGBTQIA+ individuals. I would suggest that in addition to FGD and literature review, the authors should consider incorporating insights and expertise from healthcare professionals experienced in LGBTQIA+ healthcare. Experts can provide valuable guidance on best practices and ensure that the curriculum aligns with clinical reality. The content of the expert validation of the curriculum requires further elaboration in terms of the panel's expertise, the number of experts involved and the specific analysis process to be carried out. Future details on these aspects would be valuable to ensure transparency and accuracy in the validation process. I recommend determining: The composition of the expert panel, including the diversity of expertise among panel members (e.g., LGBTQIA+ healthcare, medical education, curriculum development). The total number of experts who will participate in the validation process. A clear description of the analysis process, indicating the criteria and guidelines against which the curriculum will be evaluated. How experts will provide feedback and recommendations and whether there will be a formalized assessment or evaluation system for assessing curriculum components. FGD participants: While the authors mention recruiting a representative number of self-identified LGBTQIA+ individuals, consider expanding efforts to ensure diversity within the sample. Mention whether they will actively seek participants from diverse backgrounds, age groups, and gender identities to capture a comprehensive range of perspectives and experiences. The rationale for selecting a sample size of 10-15 participants is well-explained. The authors highlighted the importance of depth in the Focus Group Discussion (FGD) and subsequent analysis. It would be helpful to mention whether this sample size is consistent with previous research or guidelines in the field to further support the appropriateness of the sample size. Exclusion criteria should not be the opposite of inclusion criteria, for example: “Any person who is not belonging to the LGBTQIA+ community” is not required. Phase II – Pilot study Insufficient information has been provided regarding the measurement instrument, and the questionnaire on knowledge. It is essential to include comprehensive details regarding the development or adaptation of the instrument, its content, the validation process, and reliability testing. The time interval between the pre-and post-test and its rationale. Figure 1 needs a more detailed description of the process. Figure 2 – not clear of the activity in Workshop I. Discussions The discussion touches on key points related to previous research and the potential impact of the curriculum. However, further elaboration, interpretation, and explicit connections between the current study and previous research would enhance the overall clarity and depth of the discussion. It would be advantageous to explicitly state how the present study seeks to build on or contribute to existing knowledge in this area. This will help readers understand the unique contributions of your research. All the best Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Nursing education, Critical care nursing and Nursing Management and Leadership I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 23 Jul 2024 RENJULAL YESODHARAN, Department of Psychiatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, 576104, India Thank you for reviewing the manuscript. We appreciate the suggestions given by you. As per your suggestions, the term ‘Medical students’ was changed to health care professionals. The research questions were modified based on the suggestions. Modifications in the figures were undertaken to accommodate these changes. We consistently used terminologies throughout the text, as per your suggestion. A few terminologies are replaced with more technical ones. Regarding the validation of the m content module, the authors have already included experienced healthcare professionals for their suggestions. The experts validate the content of the curriculum. We have also modified the discussions. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Ramoo V. Peer Review Report For: Developing a module on the care of LGBTQIA+ individuals for health professionals: Research protocol. [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1437 ( https://doi.org/10.5256/f1000research.153885.r221846) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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