The Italian Version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS): Validation Among Mental Health Professionals"

Sexual and gender minority (SGM) individuals experience substantial health inequalities, and clinical competence among healthcare providers is a key determinant of equitable care. The Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) is a validated instrument for assessing SGM-related clinical competence, but no Italian version has been available. This study aimed to translate, adapt, and validate the Italian LGBT-DOCSS among mental health professionals.
A cross-sectional online survey was administered to clinicians and trainees across Italy between June and December 2024. Psychometric analyses were conducted on 345 participants with complete data on all 18 items. Internal consistency, confirmatory factor analysis (CFA), scalar multi-group CFA for measurement invariance across sexual orientation subgroups, and Spearman correlations with external measures of authoritarianism were examined.
The original three-factor structure (Clinical Preparedness, Attitudinal Awareness, Basic Knowledge) was replicated with acceptable model fit (CFI = 0.967, TLI = 0.962, RMSEA = 0.058). Internal consistency was strong across all subscales (Cronbach's α ranging from 0.81 to 0.89; ordinal α ranging from 0.87 to 0.95). Scalar multi-group CFA provided preliminary evidence consistent with measurement invariance across heterosexual and non-heterosexual subgroups (CFI = 0.944, RMSEA = 0.074), with non-heterosexual professionals demonstrating greater attitudinal affirmation and stronger awareness of SGM health disparities. Authoritarianism showed small-to-moderate associations with Basic Knowledge and Attitudinal Awareness. Significant differences by gender, sexual attraction, and profession were observed, with nurses showing lower self-perceived SGM-related competence than other professional groups.
The Italian LGBT-DOCSS demonstrates promising psychometric properties and is a useful tool for assessing SGM-related clinical competence among Italian mental health professionals, supporting identification of training needs and development of targeted educational interventions.