Development of an mHealth App by Experts for Queer Individuals' Sexual-Reproductive Health Care Services and Needs: Nominal Group Technique Study.

BACKGROUND: Queer individuals continue to be marginalized in South Africa; they experience various health care challenges (eg, stigma, discrimination, prejudice, harassment, and humiliation), mental health issues (eg, suicide and depression), and an increased spread of HIV or AIDS and sexually transmitted illnesses (STIs; chlamydia, gonorrhea, and syphilis). Mobile health (mHealth) apps have the potential to resolve the health care deficits experienced by health care providers when managing queer individuals and by queer individuals when accessing sexual-reproductive health care services and needs, thus ensuring inclusivity and the promotion of health and well-being. Studies have proven that the nominal group technique (NGT) could be used to solve different social and health problems and develop innovative solutions. This technique ensures that different voices are represented during decision-making processes and leads to robust results. OBJECTIVE: This study aims to identify important contents to include in the development of an mHealth app for addressing the sexual-reproductive health care services and needs of queer individuals. METHODS: We invited a group of 13 experts from different fields, such as researchers, queer activists, sexual and reproductive health experts, private practicing health care providers, innovators, and private health care stakeholders, to take part in a face-to-face NGT. The NGT was conducted in the form of a workshop with 1 moderator, 2 research assistants, and 1 principal investigator. The workshop lasted approximately 2 hours 46 minutes and 55 seconds. We followed and applied 5 NGT steps in the workshop for experts to reach consensus. The main question that experts were expected to answer was as follows: Which content should be included in the mHealth app for addressing sexual-reproductive health care services and needs for queer individuals? This question was guided by user demographics and background, health education and information, privacy and security, accessibility and inclusivity, functionality and menu options, personalization and user engagement, service integration and partnerships, feedback and improvement, cultural sensitivity and ethical considerations, legal and regulatory compliance, and connectivity and data use. RESULTS: Overall, experts voted and ranked the following main icons: menu options (66 points), privacy and security (39 points), user engagement (27 points), information hub (26 points), user demographics (20 points), connectivity (16 points), service integration and partnerships (10 points), functionalities (10 points), and accessibility and inclusivity (7 points). CONCLUSIONS: Conducting an NGT with experts from different fields, possessing vast skill sets, knowledge, and expertise, enabled us to obtain targeted data on the development of an mHealth app to address sexual-reproductive health care services and needs for queer individuals. This approach emphasized the usefulness of a multidisciplinary perspective to inform the development of our mHealth app and demonstrated the future need for continuity in using this approach for other digital health care innovations and interventions.

Beyond the Iron Throne: exploring the representation of homosexuality in the series Game of Thrones.

Introduction: This research delves into the representation of homosexuality in the television series Game of Thrones, adapted from George R.R. Martin's A Song of Ice and Fire saga. The study focuses on the navigation and portrayal of homosexual identities and relationships within a historically patriarchal and heteronormative genre. Methodology: A qualitative research approach, specifically thematic analysis, was utilized to scrutinize the portrayal of homosexuality across all eight seasons and 73 episodes of Game of Thrones. The analysis encompassed pivotal scenes, character development, and dialogues related to homosexual representation. Findings: Thematic analysis revealed several significant themes concerning the representation of homosexuality, including heteronormativity, the interplay of love and war, and the societal and personal impacts of sexual identity. The series portrays the challenges and resilience of homosexual characters, such as Renly Baratheon and Loras Tyrell, against a backdrop of political intrigue and personal ambition. However, the depiction at times veers into sensationalism, which may potentially desensitize viewers to the real-life struggles faced by LGBTQ+ individuals. Discussion: The study findings suggest that while Game of Thrones aims to depict homosexual relationships with complexity and depth, it also risks perpetuating negative stereotypes and sensationalizing trauma for dramatic effect. This dual portrayal underscores the broader challenge within popular media to balance representation with responsible storytelling. The study emphasizes the necessity for more nuanced and empathetic portrayals of marginalized groups to promote greater understanding and inclusivity in media narratives.

Exploring constructions of female surgeons' intersecting identities and their impacts: a qualitative interview study with clinicians and patients in Ireland and Scotland.

Introduction: While many studies have explored surgeons' personal and professional identities separately, our study is the first to examine intersecting female surgical identities. We explore intersecting surgical identities constructed by self and others (colleagues and patients) within two healthcare systems and their perceived impacts answering the research question: How do female surgeons' constructed identities intersect, and what influences do those intersections have on their surgical lives? Methods: We employed qualitative methodology drawing on semi-structured biographical narrative interviews underpinned by social constructionism. We employed intersectionality theory as an analytical lens. We adopted maximum variation sampling to identify diverse participants, including 38 surgeons (29 female; 9 male), 9 non-surgical colleagues (8 female, 1 male), and 13 patients of female surgeons (7 female, 6 male). Our 29 female surgeons also included six who had transitioned out of surgery. We analyzed the dataset using a five-step Framework Analysis approach. We captured talk about identities, as well as identity talk (constructions of identity through participants' talk). Findings: Multiple intersecting personal (not just gender) and professional identities were constructed and reported to have multiple impacts on female surgeons' lives (including their education, training, and success). We present intersecting identities and their impacts relating to gender through four primary intersections: (a) gender + ethnic identities; (b) gender + parenthood identities; (c) gender + age identities; and (d) gender + professional identities (namely carer, competent, mentor/mentee, role model and leader). Our findings particularly highlight the challenges experienced by female surgeons of color, who are mothers, who are younger and/or who are leaders, illustrating diversity in women's experiences beyond that of gender alone. Finally, we found unexpected insights into male surgeons and fatherhood. Discussion: Intersectionality theory offered a novel analytical lens to extend existing knowledge on female surgical identities. Further research is warranted exploring intersecting identities of female surgeons of color, younger female surgeons, and male surgeons who are fathers, as well as identities unexplored in this study (e.g., diverse sexualities). We need to raise awareness of intersecting identities and their impacts in surgery, as well as providing training, allyship, and policy revision that is sensitive to intersectionality.

Conscience, Caricatures, and Catholic Identities.

Catholic health care is often viewed as antithetical to secular conceptions of autonomy. This view can engender calls to protect "choice" in Catholic facilities. However, this view is built on a fundamental misunderstanding of the Ethical and Religious Directives for Catholic Health Care Services (ERDs). This commentary, which responds to "Principled Conscientious Provision: Referral Symmetry and Its Implications for Protecting Secular Conscience," by Abram Brummett et al., seeks to demonstrate the nuance of the ERDs as well as to address some of the challenges various Catholic identities have when interpreting and living out the ERDs so that all patients receive high-quality, compassionate care. By highlighting the Church's desire to protect all people at every stage, I hope to dispel the caricatures that often result from misunderstandings by Catholics and non-Catholics alike.

Sport-based interventions and health in prisons: The impact of Twinning Project on prisoner wellbeing and attitudes.

Social isolation and lack of support networks are key factors contributing to mental health problems among incarcerated people, which, in turn, are associated with an increased risk of reoffending. Enabling prisoners to form positive group relations and social identities is one approach to address the cycle of ill health and incarceration. We examine the impact of a football-based intervention, the Twinning Project, on prisoners' wellbeing and social relations. Longitudinal and correlational analyses of data from N = 164 UK prisoners show how social bonding is linked with significant boosts to psychological need satisfaction, life satisfaction, efficacy beliefs as well as higher levels of wellbeing.

Body-Related Existential Dilemmas During Gender Transition: Research in the Italian Context.

The scientific literature shows that gender transition is effective in improving the general well-being of transgender people. However, so far, little attention has been paid to the actual role of the body concerning the existential dilemma that holds the person hostage during transition. This study investigates the relationship between the body-here considered in its concrete, experienced, imagined, and intersubjective dimensions-and gender identity. Twenty-five transgender people who live in Italy were interviewed to identify interpretive repertoires and identity positionings. Four main repertoires and positionings emerged: 1) Interpretative repertoires on the body in transition, where an enduring influence of gender binarism and biological determinants were observed; 2) Expectations regarding medically induced modifications of the body ranging from self-confidence to uncertainty; 3) Positionings toward medically induced bodily modifications, ranging from enthusiasm to resignation; and 4) Inter- and Intrapersonal positionings, where the other than self was found to act as a self-confirming resource or as a constant unpredictable and potentially threatening source of disconfirmation. Practitioners need to develop a stronger awareness of the different dimensions, meanings, and discourses surrounding bodily experience to more effectively intervene in their clinical practice with transgender people.

Social Group Membership, Social Identities, and Mental Health Experiences in Urban Poor Communities in Ghana: A Critical Social Psychology Inquiry.

Social groups and identities significantly influence mental health outcomes, yet their impact in resource-poor communities remains understudied. We explored the role of social group memberships and identities in shaping mental health experiences in two urban poor communities in Ghana. Data from 77 participants were analyzed thematically, revealing widespread engagement in social groups that provide access to both material and symbolic resources. However, these groups also serve as sources of tension and contribute to the stigmatization and marginalization of vulnerable members. Those affected include individuals with severe mental disorders, men experiencing depression, young men involved in substance abuse, family caregivers, migrant and tenant households, and otherwise healthy individuals with recurring psychosocial challenges. The groups exacerbate mental health challenges and restrict access to care among marginalized populations. The findings underscore the need for targeted interventions aimed at enhancing mental health support and reducing stigma in resource-poor settings.

Life Satisfaction and Gender Congruence in Transgender Individuals: A Role for Occupational Therapy.

Societal restrictions impact transgender individuals' ability to engage in occupations that match their internal gender identity preventing gender affirmation. The aim was to explore transgender individuals' perceived levels of gender congruence and life satisfaction. A cross-sectional survey with a nonprobability sample of transgender adults was used to provide a preliminary exploration of transgender individuals' gender congruence and life satisfaction using the Gender Congruence and Life Satisfaction and World Health Organization Quality of Life-BREF. When comparing the means of the physical, psychological, social, and environmental domains to the population norm, the respondents demonstrated statistically lower scores in all four domains of the WHOQOL-BREF. In both the WHOQOL-BREF and GCLS, the mean score in psychological health and life satisfaction were the lowest. Transgender individuals prioritize self-care activities, such as hairstyling, and body image to affirm internal gender identity. Occupational therapy can assist with supporting gender transition in several occupational contexts.

Life satisfaction and gender congruence in transgender individuals: A role for occupational therapy.Why was the study done? Transgender persons can experience discrimination because they do not adhere to societal gender norms. Consequently, they report high levels of anxiety, depression, and suicidality. They are often unable to engage in activities that match their internal identity perpetuating feelings of isolation and loneliness. The transgender community struggles with injustices that negatively affect their life satisfaction and gender congruence, which is the feeling that one's body and life match their gender identity. What did the researchers do? The research team implemented two surveys to explore gender congruence, affirmation, and life satisfaction in transgender individuals. The surveys were used to better understand how participants feel regarding body image, psychological health, environmental safety, social health, physical health, and life satisfaction. What did the researchers find? A majority of participants reported poor psychological functioning, life satisfaction, and body image. Contributory factors included gender incongruence secondary to physical characteristics and gender perception based on physical appearance. Participants reported high levels of anxiety and depressed mood, which negatively impacted personal well-being. What do the findings mean? This study identified important areas that can be focused on to improve the overall psychological functioning, personal well-being, and life satisfaction of transgender individuals. Transgender individuals place significant importance on self-care activities, leisure and social activities, and body image through validation of gender authenticity. This information substantiates the use of occupational therapy services to facilitate gender congruence and affirmation through engagement in activities that match their internal gender identity. Occupational therapy intervention may assist with occupational transition thereby improving life satisfaction and personal well-being.

Social media use and vaccination among Democrats and Republicans: Informational and normative influences.

Our objective was to determine whether social media influences vaccination through informational and normative influences among Democrats and Republicans. We use a probability-based longitudinal study of Americans (N = 1768) collected between December 2022 and September 2023 to examine the prospective associations between social media use and vaccination as well as informational and normative influence as mediating processes. Greater social media use correlates with more frequent vaccination (cross-lagged coefficients: COVID-19 = 0.113, p < 0.001; influenza = 0.123, p < 0.001). The underlying processes, however, vary between Democrats and Republicans. Democrats who use social media more are more likely to vaccinate because they encounter information about new pathogens. In contrast, Republicans who use social media more are more likely to vaccinate because they think that people who are important to them receive the recommended vaccines. Our findings underscore the potential for social media campaigns to promote vaccination, among both Democrats and Republicans by paying attention to the specific processes in each audience.

Integrating Cultural Humility into Medical Education Using a Structured and Interactive Workshop.

Background: Cultural humility is a lifelong commitment to self-evaluation, redressing power imbalances in patient-physician relationships and developing mutually trusting beneficial partnerships. Objective: The objective of this study was to determine the feasibility and efficacy of cultural humility training. Methods: From July 2020-March 2021, 90-minute educational workshops attended by 133 medical students, resident physicians and medical education faculty included 1) pre- and post- intervention surveys; 2) interactive presentation on equity and cultural humility principles; 3) participants explored sociocultural identities and power; and 4) reflective group discussions. Results: There were significant increases from pre to post intervention assessments for perception scores (3.89 [SEM= 0.04] versus 4.22 [0.08], p<0.001) and knowledge scores (0.52 [0.02] versus 0.67 [0.02], p<0.001). Commonest identities participants recognized as changing over time were personality = 40%, appearance = 36%, and age =35%. Commonest identities experienced as oppressed/subjugated were race/ethnicity = 54%, gender = 40% and religion = 28%; whilst commonest identities experienced as privileged were gender= 49%, race/ethnicity = 42% and appearance= 25%. Male participants assigned mean power score of 73% to gender identity compared to mean power score of -8% by female participants (P<0.001). Non-Hispanic Whites had mean power score for race identity of 62% compared to 13% for non-white participants (p<0.001). English as a second language was only acknowledged as an oppressed/subjugated identity by those born outside the United States (p<0.001). Conclusion: An interactive educational workshop can increase participants' knowledge and perceptions regarding cultural humility. Participants can self-reflect to recognize sociocultural identities that are oppressed/subjugated or privileged.

Are surveys blind to sexual and gender diversity? Reflections and an open proposal.

This article presents an open proposal on how to include questions that capture different gender identities and sexual orientations in quantitative research. Our theoretical framework is feminist theory and the evolution of feminist debates on identity categories, where the introduction of an intersectional gender perspective has been an important paradigm shift. We have compiled different previous categorization proposals and consider the consequences of not including categories that reflect identity diversity in surveys in order to finally offer our proposal for operationalizing identities. The proposal aims to ensure comparability in longitudinal studies and, at the same time, to incorporate new identity frameworks and an intersectional perspective in quantitative methodology research.

Innovative governance for transformative energy policy in sub-Saharan Africa after COVID-19: Green pathways in Egypt, Nigeria, and South Africa.

Learning from innovations that fail is imperative for innovations that succeed. The theoretical underpinnings for this innovative framing are reflexivity, transformative unlearning, and intelligent failure. This framework proposes a definition of "transformative governance" as governance that creates structural equities. Governments rebuilding their economies after the COVID-19 pandemic seek equitable green transformations; that are gendered, structural, and sustainable, learning from the implemented gender-sensitive responses (hereafter referred to as policy innovations). This paper argues that transformative practices, beliefs, values, assumptions, policies, and systematic learnings are complementary to post-crisis transformations. The aim is to promote systematic learnings from innovation governance failure regarding energy policy through the analysis of COVID-19 practices and the unlearning of policy innovation beliefs, values, and assumptions that are not transformative. I ask: how gender-equitable, structurally equitable, and green-transformative were the COVID-19 policy innovations? The study's approach is qualitative and situated within the constructivist research paradigm. It uses reflexive thematic analysis combined with innovative coded policy narrative and a transformative index-matching technique, to identify the gap within transformative interventions. The study included 58 policy innovations (n = 58) collected from the UNDP, KPMG, government reports, and news flashes from the three most populous nations in sub-Sahara Africa: Egypt, Nigeria, and South Africa. The study found that policy innovations were inequitable in terms of gender, structure, and sustainability whereas the derived transformative pathways are equitable and gender-transformative, structurally transformative, and green-transformative. The rationales behind a transformative approach to policy reflect the systemic failures across key areas: market dynamics, research and development, and green transformation. Policy innovators can align transformative pathways for innovative governance that implements transformative energy policy. To address the needs of multiple fragile and vulnerable identities, the derived post-pandemic framework is an intersectional plan with 10 policy learning pillars. The plan includes local energy transformation and reinforcement of energy justice components, such as the localization of the energy industry, community power, and social norms, including Ubuntu, which translates to "I am because we are." Reengagement in global supply chains requires South-South trade relations to be restrategized.

An Intersectional Exploration of Outness, Encountered Discrimination and Violence, and Non-Suicidal Self-Injury among Asexual Youth across Gender Identities.

Current research on asexual youth is limited, especially in understanding the impact of their outness and the intersection of sexual orientation with gender minority identities. This study investigates the influence of outness on experiences of harassment, discrimination, violence, and the risk of non-suicidal self-injury (NSSI) among asexual youth, with a focus on those with transgender and non-binary identities. Data for this study were obtained from the 2021 Ace Community Survey, an international online survey designed to assess the needs and health status of the Ace community, targeting respondents aged 13 and older. The analysis involved a subsample of 5574 respondents aged 13 to 24 (mean age = 19.28), including 2361 cisgender (mean age = 19.65), 1,195 transgender (mean age = 18.80), and 2,018 non-binary individuals (mean age = 19.13). The results revealed that experienceds of sexual violence, verbal aggression, and physical harassment and bullying not only correlated with but also completely mediated the relationship between outness and NSSI. Asexual transgender youth experienced heightened levels of discrimination and NSSI but demonstrated notable resilience against the negative effects of identity disclosure, highlighting complex dynamics of vulnerability and protection within these communities.

Virtuous Collective Attention.

How can a collective pay attention virtuously? Imagine a group of scientists. It matters what topics they pay attention to, that is, which topics they draw to the foreground and take to be relevant, and which they leave in the background. It also matters which aspects of an investigated phenomenon they foreground, and which aspects they leave unnoticed in the background. If we want to understand not only how individuals pay attention of this kind virtuously, but also collectives, we first need a framework to understand virtuous collective agency. A result of this article will be that virtuous collective action depends on the collective being institutionalized. At the same time, we have to think of the constituents of the collective in terms of practical identities (as opposed to individuals). This is what enables us to understand how a collective can acquire the stability required for virtue, and how we don't end up with a summative account of group virtue, respectively. It will be argued that collectives only have the required stability in their actions when their commitments are habitualized in the form of institutionalized procedures. An Aristotelian understanding of virtue distinguishes between commitment, inclination, and action. Only when a subject's inclination is fully lined up with her commitment, do we arrive at the required stability (of character) for virtuous action. In the case of individuals, to build up an appropriate inclination consists in an inscribing of the commitment into the feelings and body of the subject. If a commitment is fully 'embodied' in this sense, it has formed the individual's inclination accordingly. How can one make sense of this in the case of collective subjects? This article tries to show that for collectives, the embodiment of commitment (the forming of the fitting inclinations) consists in creating policies, procedures, and rules that stabilize the acting according to the commitment, irrespective of the motivation of each individual involved in the collective. Hence, embodiment of commitment, in the case of collectives, is institutionalization. The article then explores what this requirement of institutionalization means for collective attention. The illustration will draw on a distinction between focused and open-minded attention. It will be shown that for either case - focused and open-minded - in order for a collective to pay attention virtuously, it needs to have its commitments institutionalized.

Utilizing an Intersectional Approach to Examine Experiences of Hunger Among Adolescents During COVID-19: Considering Race/Ethnicity, Sexual Identity, and Employment Disparities in a Nationally Representative Sample.

PURPOSE: This study examines correlates of experiences of hunger among adolescents in the United States (U.S) by the intersectionality of race/ethnicity with sociodemographic characteristics (gender, sexual identity, and adolescent/parent job loss) with the aim of identifying subgroups most at risk for hunger during the COVID-19 pandemic. METHODS: This cross-sectional study uses nationally representative data from the Adolescent Behaviors and Experiences Survey (ABES) collected from January to June 2021. The analytic sample was high school students aged 14-17 with complete data (n = 6023). Descriptive statistics, bivariate, and multivariate logistic regression models were used to examine associations between sociodemographic factors and hunger (1-item measure) among adolescents during the pandemic for the analytic sample and stratified by race/ethnicity. RESULTS: The prevalence of hunger was 24.1% for the analytic sample and was highest among American Indian/Alaskan Native/Other Pacific Islander youth (37.2%), followed by non-Hispanic Black (31.8%) and Hispanic (28.4%) youth, and lowest among Non-Hispanic White youth (18.6%). In the analytic sample, there were significant differences in experiences of hunger by race/ethnicity, sexual identity, and adolescent/parent job loss during the pandemic (p < 0.05). When stratified by race/ethnicity, there were differential associations of hunger with sexual identity, and adolescent/parent job loss. CONCLUSIONS: These findings provide evidence of differential experiences of hunger during the pandemic among adolescents by sociodemographic factors. Results highlight the need for taking an intersectional approach when examining issues such as hunger. Future policies and programs should be mindful of factors associated with hunger and should prioritize using an equity-informed approach when engaging with multiply-marginalized adolescents.

Intersectionality, BRCA Genetic Testing, and Intrafamilial Communication of Risk: A Qualitative Study.

Significant health disparities exist in relation to pathogenic variants in BRCA1/2. This study aimed to better understand the barriers and facilitators to BRCA1/2 genetic testing and intrafamilial communication of risk in racially and ethnically diverse individuals. We conducted qualitative interviews with non-Hispanic White (n = 11) and Black, Indigenous, People of Color (BIPOC) individuals (n = 14) who underwent testing for pathogenic BRCA1/2 variants. We employed template analysis, case study analysis, and comparative case study analysis to examine healthcare experiences related to genetic testing as well as intrafamilial communication of risk. Applying an intersectional lens, we sought to inform more person-centered approaches to precision healthcare and help dismantle disparities in genomic healthcare. Template analysis revealed salient factors at the individual (psychosocial well-being), interpersonal/familial, and healthcare system levels. A two-part case study analysis provided insights into how race/ethnicity, cultural norms, and socioeconomic status interact with systemic and structural inequities to compound disparities. These findings underscore the need for person-centered, tailored, and culturally sensitive approaches to understanding and addressing the complexities surrounding testing and the communication of BRCA risk. Applying an intersectional lens can inform more person-centered approaches to precision healthcare and may help to surmount existing disparities.

Cumulative Police Exposures, Police Violence Stress, and Depressive Symptoms: A Focus on Black LGBQ Youth in Baltimore City, Maryland.

The present study investigates associations between cumulative police exposures, police violence stress, and depressive symptoms among Black youth, and whether LGBQ (lesbian, gay, bisexual, and queer) identities moderate these associations. Data come from the Survey of Police-Adolescent Contact Experiences (SPACE), a cross-sectional survey of a community-based sample of Black youth ages 12-21 in Baltimore City, Maryland (n = 345), administered from August 2022 to July 2023. We used multivariable ordinary least squares regression to estimate direct associations and product-term analysis to test for effect modification by sexual identities. We also calculate covariate-adjusted predicted depressive symptoms scores by cumulative police exposures and police violence stress across sexual identities. Findings indicate that LGBQ youth collectively reported higher levels of police violence stress than heterosexual youth. Still, LGBQ youth varied in their cumulative police exposures, which were significantly higher among bisexual and queer youth than lesbian or gay youth. Associations between cumulative police exposures, police violence stress, and depressive symptoms were significantly moderated by LGBQ identity, with the largest associations emerging for bisexual and queer youth. Police exposures and police violence stress also compounded to worsen depressive symptoms among the subsample of LGBQ youth. Collectively, our findings suggest that LGBQ youth-especially bisexual and queer youth-may be particularly vulnerable to the mental health harms of cumulative police exposures and police violence stress. Intersectional, public health approaches that combine prevention and treatment strategies are needed to mitigate LGBQ mental health inequities stemming from cumulative police exposures and police violence stress.

Smartphone-Based Virtual and Augmented Reality Implicit Association Training (VARIAT) for Reducing Implicit Biases Toward Patients Among Health Care Providers: App Development and Pilot Testing.

Background: Implicit bias is as prevalent among health care professionals as among the wider population and is significantly associated with lower health care quality. Objective: The study goal was to develop and evaluate the preliminary efficacy of an innovative mobile app, VARIAT (Virtual and Augmented Reality Implicit Association Training), to reduce implicit biases among Medicaid providers. Methods: An interdisciplinary team developed 2 interactive case-based training modules for Medicaid providers focused on implicit bias related to race and socioeconomic status (SES) and sexual orientation and gender identity (SOGI), respectively. The simulations combine experiential learning, facilitated debriefing, and game-based educational strategies. Medicaid providers (n=18) participated in this pilot study. Outcomes were measured on 3 domains: training reactions, affective knowledge, and skill-based knowledge related to implicit biases in race/SES or SOGI. Results: Participants reported high relevance of training to their job for both the race/SES module (mean score 4.75, SD 0.45) and SOGI module (mean score 4.67, SD 0.50). Significant improvement in skill-based knowledge for minimizing health disparities for lesbian, gay, bisexual, transgender, and queer patients was found after training (Cohen d=0.72; 95% CI -1.38 to -0.04). Conclusions: This study developed an innovative smartphone-based implicit bias training program for Medicaid providers and conducted a pilot evaluation on the user experience and preliminary efficacy. Preliminary evidence showed positive satisfaction and preliminary efficacy of the intervention.

Vowel alternation with final i offers an easy-to-learn morphological option for a sex-blind grammatical gender in French.

Like all modern Romance languages, French has a sex-based grammatical gender with two genders, feminine and masculine, and a lexicon that is highly sex-differentiated. These characteristics give rise to a number of issues, including the problematic generic use of the masculine grammatical gender, coupled with the challenge of sex categorization itself, and the epistemological difficulty of an adequate sociological description and analysis of what gender commonsense categories really are about. To remedy these concerns, several authors have proposed the creation of an additional, epicene grammatical gender. We have identified three such systematic proposals, or solutions, which specify various morphological options for new epicene nouns and gender markers on their satellite elements. These options include the use of non-standard or rarely used characters, the merging of feminine and masculine gender markers, as well as consonantal and vowel changes. In the simplest proposal, referred to as "solution I," new epicene forms are mostly derived from feminine forms by systematically replacing with an i the final e that generally differentiates feminines from their masculine counterparts in written French. Although these solutions are used in some communities, their learnability has not been addressed so far, even though it could be a determining factor in their popularity and their eventual integration into standard French. In the present study, we provide a first assessment of this aspect by means of an online translation test. For each solution, French-speaking participants were instructed that they would be trained to learn an "alien" language that does not mark sex/gender categories (these alien languages correspond to standard French where only gendered words referring to people are replaced by the new epicene forms recommended by each solution). After a short learning-by-example phase, participants were required to translate into the alien language a set of 16 standard French sentences. The translations were analyzed as a function of several variables including the participants' self-reported age and sex, the word categories and the solutions themselves. While all solutions proved quickly learnable, participants' responses with solution I achieved the highest accuracy score, in particular with regard to the production of non-standard epicene forms.