## Protocol Section
### Identification Module
**NCT ID:** NCT06434805

**Brief Title:** An Education Initiative to Reduce Stigma Towards Sex Workers and Sexual Minorities Among Nursing Students

**Official Title:** An Education Initiative to Reduce Stigma Towards Sex Workers and Sexual Minorities Among Nursing Students: a Pilot Study

#### Organization Study ID Info
**ID:** HE-NHS2024/02
#### Organization
**Class:** OTHER
**Full Name:** Hong Kong Metropolitan University
### Status Module
#### Completion Date
**Date:** 2024-12-31

**Type:** ESTIMATED

#### Expanded Access Info
#### Last Update Post Date
**Date:** 2024-05-31

**Type:** ESTIMATED

**Last Update Submit Date:** 2024-05-29

**Overall Status:** NOT_YET_RECRUITING

#### Primary Completion Date
**Date:** 2024-09-30

**Type:** ESTIMATED

#### Start Date
**Date:** 2024-05-30

**Type:** ESTIMATED

**Status Verified Date:** 2024-05

#### Study First Post Date
**Date:** 2024-05-30
**Type:** ACTUAL
**Study First Submit Date:** 2024-05-18
**Study First Submit QC Date:** 2024-05-23
### Sponsor Collaborators Module

#### Lead Sponsor

**Class:** OTHER

**Name:** Hong Kong Metropolitan University

#### Responsible Party

**Investigator Affiliation:** Hong Kong Metropolitan University

**Investigator Full Name:** Dr Polly MA Haixia

**Investigator Title:** Assistant Professor

**Type:** PRINCIPAL_INVESTIGATOR

### Oversight Module

**Is FDA Regulated Device:** False

**Is FDA Regulated Drug:** False

**Oversight Has DMC:** False

### Description Module

**Brief Summary:** Background: Sex workers and sexual minorities (SWSM) often encounter barriers when accessing healthcare services due to social stigma and discrimination. In Hong Kong, stigma and prejudice exist among nurses and nursing students toward SWSM.

Aims: This education initiative aims to improve the knowledge, attitudes, and clinical competence of nursing students in caring for SWSM.

Methods: This pilot study will employ a one-group pre-and post-test design. Convenience sampling will be used to recruit 52 nursing students from the clinical phase of the Bachelor of Nursing program at the School of Nursing and Health Studies of Hong Kong Metropolitan University, as well as nursing students from other local universities. The intervention will consist of a four-session one-day workshop based on social cognitive theory and interpersonal contact theory. The workshop will cover various topics, including terminologies, human rights, stigma and discrimination in healthcare settings, contact with SWSM, and skills building. The primary outcome measure will include participants' attitudes toward SWSM. Secondary outcome measures included their knowledge and clinical competence. These outcome measurements will be assessed at baseline (T0) and after the intervention (T1) and three months follow up (T2). Additionally, focus group discussions will be carried out to explore participants' experiences of the intervention.

Discussion: Findings from this study could contribute to the existing knowledge on stigma surrounding SWSM in Hong Kong and its impact on healthcare. The intervention is expected to increase the knowledge, attitudes, and skills of nursing students in providing care for SWSM. By promoting non-judgmental and equitable care, the research aims to contribute to the overall well-being and health outcomes of SWSM. These results will inform future nursing education curricula and clinical practice, facilitating the development of more inclusive and patient-centered care for marginalized populations in Hong Kong and beyond.

### Conditions Module

**Conditions:**

- Stigmatization

- Sex Work

- Homosexuality

- Transgenderism

**Keywords:**

- gender and sexual minority

- sex workers

- cultural competency

- nursing students

### Design Module

#### Design Info

**Allocation:** NA

**Intervention Model:** SINGLE_GROUP

**Intervention Model Description:** A single group with outcome assessments will be taken at baseline, post-intervention, and at 3-month follow-up.

##### Masking Info

**Masking:** NONE

**Primary Purpose:** HEALTH_SERVICES_RESEARCH

#### Enrollment Info

**Count:** 52

**Type:** ESTIMATED

**Phases:**

- NA

**Study Type:** INTERVENTIONAL

### Arms Interventions Module

#### Arm Group 1

**Description:** This is a one-day workshop with four sessions.

**Intervention Names:**

- Other: sex workers and sexual minorities education workshop

**Label:** Education workshop

**Type:** OTHER

### Interventions

#### Intervention 1

**Arm Group Labels:**

- Education workshop

**Description:** The participants will receive a one-day workshop (four sessions). The generic content aims at enhancing the understanding of sexual orientation, gender identities, social stigma, sex work and sexual orientation and human rights (session 1), the lived experience of SWSM (session 2), the content specifically related to the medical and healthcare field, including be familiar with the professional and ethical obligations (session 3), the skills that can be adopted when providing services to SWSM (session 4).

**Name:** sex workers and sexual minorities education workshop

**Type:** OTHER

### Outcomes Module

#### Primary Outcomes

**Description:** The Attitudes Toward Lesbians and Gay Men Scale (ATLG) is an instrument designed to measure the attitudes of heterosexuals toward lesbians and gay men. It consists of 20 items, the first 10 about lesbians and the next 10 about gay men, and can be used as a single scale or two distinct subscales. Items are scored using a 4-point Likert scale, from 1 (strongly disagree) to 4 (strongly agree). The total score range for both the lesbian and gay subscale is from 10 to 40. The ATLG was validated in Hong Kong.

**Measure:** Attitudes toward lesbians and gay men scale (ATLG)

**Time Frame:** baseline, immediately after the intervention, 3-months post-intervention

**Description:** The Genderism and Transphobia Scale (GTS) is a questionnaire consisting of 32 items measuring cognitive, behavioral, and affective dimensions of genderism, transphobia, and gender-bashing. The statements are rated on a 7-point Likert scale (1 = strongly agree to 7 = strongly disagree), with higher scores denoting strong negative feelings and behaviors toward transgender individuals. The GTS was validated in Hong Kong and included an additional item 33, and the total score ranges from 33 to 231.

**Measure:** Genderism and Transphobia Scale (GTS)

**Time Frame:** baseline, immediately after the intervention, 3-months post-intervention

**Description:** The scale will measure nursing students' attitudes towards sex workers, which was adopted from a scale developed by Melby et al. (1992) to determine nurses' attitudes towards prostitutes (Melby et al., 1992). The scale on nursing students' attitudes was comprised of eight items on attitude, with three related to morals, two to control, and three to sympathy. A 5-point Likert-type scale was used, with 1 = strongly disagree, and 5 = strongly agree. Negative items (items 2 and 7) will be reversely coded, with higher score representing positive attitudes. The total score ranges from 8 to 40.

**Measure:** Attitudes Toward sex workers with HIV and sexually transmitted diseases (STDs)

**Time Frame:** baseline, immediately after the intervention, 3-months post-intervention

#### Secondary Outcomes

**Description:** LGBT-DOCSS will be used to assess nursing students' clinical skills in caring for sexual minorities. It includes 18 items crossing three domains: clinical preparedness, attitudinal attitudes, and basic knowledge. A 7-point Likert-type scale was used, with 1 = not at all true, 4 = somewhat true, and 7 = total true. The total score ranges from 18 to 126. Higher scores are indicative of higher levels of clinical preparedness and rudimentary knowledge and less prejudicial attitudinal awareness regarding LGBT clients/patients. LGBT-DOCSS was back-and-forth translated by the research team.

**Measure:** LGBT development of clinical skills scale (LGBT-DOCSS)

**Time Frame:** baseline, immediately after the intervention, 3-months post-intervention

**Description:** Sex worker development of clinical skills scale (SW-DOCSS) is developed based on LGBT-DOCSS. It will be used to assess nursing students' clinical skills in caring for sexual minorities. It includes 10 items crossing three domains: clinical preparedness, attitudinal attitudes, and basic knowledge. A 7-point Likert-type scale was used, with 1 = not at all true, 4 = somewhat true, and 7 = total true. The total score ranges from 10 to 70. Higher scores are indicative of higher levels of clinical preparedness and rudimentary knowledge and less prejudicial attitudinal awareness regarding sex worker clients/patients. A pilot test will be conducted to establish the reliability of the SW-DOCSS.

**Measure:** Sex worker development of clinical skills scale (SW-DOCSS)

**Time Frame:** baseline, immediately after the intervention, 3-months post-intervention

**Description:** The measurement of nursing students' knowledge of sex workers and sexual minorities is developed from previous studies. It includes 14 items, where students will be asked to rate each statement as either right or wrong. The total score ranges from 0 to 14, with a higher score indicating more accurate knowledge of sex workers and sexual minorities.

**Measure:** Self-developed questionnaire regarding knowledge of sex workers and sexual minorities

**Time Frame:** baseline, immediately after the intervention, 3-months post-intervention

### Eligibility Module

**Eligibility Criteria:** Inclusion Criteria:

* aged 18 years of age or above;
* studying in the clinical phase (i.e., year 3 to year 5);
* are able to speak, read, and write Cantonese or Putonghua;
* are willing to participate in the study and share their experience of the education initiative with the research group;
* have informed consent to participate in the study.

Exclusion Criteria:

* Those who have completed a similar workshop or discussion of sex workers and sexual minorities in previous nursing education will be excluded from this study.

**Maximum Age:** 50 Years

**Minimum Age:** 18 Years

**Sex:** ALL

**Standard Ages:**

- ADULT

### Contacts Locations Module

#### Central Contacts

**Contact 1:**

**Email:** phxma@hkmu.edu.hk

**Name:** Haixia Ma, PhD

**Phone:** 39702990

**Role:** CONTACT

### IPD Sharing Statement Module

**Description:** Participants' privacy, confidentiality, and voluntary participation of the study will be ensured. Participants' information will be kept in a password-protected computer. Only the research team could access the original data.

**IPD Sharing:** NO

## Derived Section

### Misc Info Module

- Version Holder: 2024-05-31
