Mental Health: Global Challenges Journal
https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138
Exploring Nursing Students' Attitudes Toward
Transgender Individuals and Dehumanization of
Transgender People: The Role of Psychological
Characteristics
Evangelos C. Fradelos
1
, Vissarion Bakalis
2
, Aikaterini Toska
1,
Maria Saridi
1
, Evridiki Kaba
3
Foteini
Tzavella
4
, Kyriakos Souliotis
5,6
1
Laboratory of Clinical Nursing, Department of Nursing, University of Thessaly, Larissa Greece
2
Department of Nursing, University of Thessaly, Larissa Greece
3
Department of Nursing, University of West Attica, Athens Greece
4
Department of Nursing, University of Peloponnese, Tripoli Greece
5
Department of Social and Education Policy, Korinthos, Greece
6
Health Policy Institute, Athens, Greece
Address for correspondence: Evangelos C. Fradelos, University of Thessaly.
Gaiopolis Campus, Larissa - Trikala Ring Road, 41500, GREECE
Email: efradelos@uth.gr
This work is licensed under a Creative Commons Attribution License International CC-BY – 4.0.
©Copyright: Fradelos et al., 2025
Publisher: Sciendo (De Gruyter)
DOI: https://doi.org/10.56508/mhgcj.v8i1.252
Submitted for publication: 11
September 2024
Revised: 21 January 2025
Accepted for publication: 24
January 2025
1
Mental Health: Global Challenges Journal
https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138
Introduction
The term "transgender" refers to individuals
whose gender identity does not align with the sex
they were assigned at birth. This term can
encompass a wide range of gender identities and
expressions, from individuals who have undergone
medical sex reassignment procedures to
individuals who self-identify with a different gender
identity without any changes to their bodies.
According to research by Collin and colleagues
(2016), the perception of what it means to be
transgender depends on the definition adopted,
with significant variations in prevalence rates
depending on the methodology. Also, as pointed
out by Buck (2016), misconceptions and a lack of
understanding of the concept of gender identity can
lead to prejudice and discrimination.
The discrimination and dehumanization that
transgender people face are particularly intense,
both in society and in health services. According to
research, transgender people are often targeted by
microaggressions, objectification, and
discrimination, which lead to the loss of their
humanness through the rejection of characteristics
that are considered uniquely human, such as
emotional sensitivity and moral conscience
(Kcomt, 2019; Haslam, 2006; Cascalheira & Choi,
2023). In the context of health services, this
dehumanization manifests itself in the indifference
to the subjectivity and needs of patients, but also in
the objectification of them as passive recipients of
treatment. At the same time, these experiences
lead to increased internalized negativity, shame,
and mental health problems, which are often
associated with poorer mental health (Cascalheira
& Choi, 2023; Safer et al., 2016). Transgender
individuals face higher rates of anxiety, depression,
and suicidal ideation due to societal stigma and
discrimination. Experiences of rejection, workplace
bias, and inadequate healthcare contribute to
chronic stress and psychological distress. Minority
stress theory explains how cumulative
discrimination leads to poor mental health
outcomes. A systematic review highlights that
transgender people are at significantly increased
risk of mental health disorders compared to
cisgender individuals (Budge et al., 2013).
Addressing these issues requires strengthening
legislative protections and raising awareness
among health professionals to provide
comprehensive and humane care.
Nursing students' attitudes towards transgender
people vary, but most studies show that they are
characterized by a lack of knowledge (Fradelos et
al.,2022), prejudices, and stereotypical
perceptions, which affect them in providing
provision of quality care. According to the study by
Derbyshire and Keay (2023), many students show
confusion about gender and gender identity, with
many agreeing with statements such as "the
male/female dichotomy is natural" and "a person
can never change their gender". Furthermore, they
exhibit higher levels of implicit bias compared to
other health professional groups, while education
about trans health remains limited. Similarly,
research by Day and Nicholls (2019) highlights that
students use language that heteronormatively
treats trans people, positioning them as “other” and
reinforcing social stereotypes, while there is a lack
of understanding of the complexities of trans
identity. The findings highlight the need for targeted
education that will reduce bias and enhance
inclusive health care (Albani et al, 2022; Day &
Nicholls, 2019; Derbyshire & Keay, 2023).
Nursing students’ attitudes toward transgender
people are influenced by several factors, with
education playing a central role. Research
suggests that curricula often lack sufficient
information about the needs of the transgender
community, leading to students being inadequately
prepared to provide quality care. Lack of
knowledge about issues such as psychological
support, management of transgender patients, and
their medical needs reinforces prejudices and
stereotypes (Gentil et al., 2023). Furthermore, the
lack of specialized educational tools and clinical
scenarios limits students’ ability to fully understand
the challenges transgender people face in the
healthcare system (Mizock & Lundquist, 2016).
At the same time, personal contact and clinical
experience play an important role. When students
can meet and care for transgender people, they
form more positive and well-informed views about
the needs of this group (Jecke & Zepf, 2024). On
the other hand, the lack of such experiences often
leads to uncertainty and insecurity when providing
care, which highlights the importance of adapting
educational programs (Roy & Clark,2024; Jecke &
Zepf, 2024). By incorporating interactive seminars,
partnerships with transgender organizations, and
internship opportunities, educational institutions
can reduce prejudice and enhance students’
cultural sensitivity (Stewart & O’Reilly, 2017).
Personality traits and empathy play a central
role in shaping nursing students’ attitudes toward
transgender people individuals. Individuals with
high emotional stability, openness to experience,
and a heightened level of social responsibility tend
to express greater acceptance of diversity.
Empathy, as the ability to understand and share the
feelings and experiences of others, is a catalyst for
reducing prejudice. Studies show that educational
programs aimed at enhancing empathy can
significantly reduce negative attitudes toward
LGBTQ+ individuals, including transgender
individuals (Ozturk & Demirden, 2023).
Beyond theoretical knowledge, experiential
learning plays an equally important role.
Educational interventions based on experiential
exercises, such as participating in virtual scenarios
or personal contact with trans people, enhance
empathy and reduce discrimination. At the same
Mental Health: Global Challenges Journal
https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138
time, promoting openness through diversity
courses helps reduce internalized bias that can
affect professional behavior. Lack of empathy, on
the contrary, can reinforce stereotypes and lead to
phenomena of professional distancing, which
negatively affects the quality of care for
transgender people (Adams, 2019). Therefore,
educational institutions should emphasize the
cultivation of empathy and sensitivity towards
diversity through targeted interventions that
enhance both interpersonal skills and knowledge.
Although nursing students’ attitudes towards
LGBTQI+ people have been studied (Fradelos et
al., 2022; Cornelius & Carrick 2015), attitudes
specifically towards transgender people remain
unexplored in the Greek academic space. Lack of
focus on the trans community indicates a
significant gap in the relevant literature.
Furthermore, in Greece, there are no valid and
reliable tools to measure attitudes towards trans
people or to assess transphobia, which limits
scientific understanding and the possibilities for
intervention to reduce prejudice.
Purpose
The purpose of the study is to investigate
nursing students' attitudes toward transgender
individuals as well as to examine the role of
demographic, personality, and cognitive
characteristics in shaping attitudes toward
transgender individuals and their dehumanization
by nursing students. In addition, the study aims to
weigh and culturally adapt the Genderism and
Transphobia Scale.
Methodology
Study setting and participants
This study employed a cross-sectional design. 294
Nursing students from two nursing departments
were recruited.
Data collection
Data were collected via an anonymous
questionnaire consisting of five parts:
A sheet containing social and demographic
characteristics.
The Genderism and Transphobia Scale (GTS)
is a psychometric instrument developed by Hill and
Willoughby (2005) to measure prejudice,
discrimination, and negative attitudes toward
transgender individuals and those who do not
conform to traditional gender norms. The
instrument is designed to assess different aspects
of transphobia and radical gender bias. The GTS
includes a total of 32 statements that cover a wide
range of behaviors, perceptions, and feelings
toward transgender individuals. Participants are
asked to rate their level of agreement or
disagreement with the statements, usually on a 7-
point Likert scale (from 1 = I strongly disagree to 7
= I strongly agree). This scale consists of two
factors: Transphobia/genderism and Gender-
bashing.
To evaluate the dehumanization of transgender
individuals, a modified and culturally adapted
Greek version of the Dehumanization Scale was
utilized (Fradelos et al., 2022). "Human
Uniqueness" refers to characteristics that
differentiate humans from other animals, including
attributes such as delicacy, politeness, self-control,
and advanced cognitive abilities. "Human Nature"
encompasses universal and fundamental human
traits such as sensitivity, autonomy, kindness, and
cognitive flexibility. When individuals are denied
"Human Uniqueness," they are often compared to
animals and described as puerile, immature,
impolite, irrational, or backward. Conversely, the
denial of "Human Nature" traits leads to
comparisons with inanimate objects or machines,
rendering individuals emotionless, rigid, passive,
and lacking in feelings or agency. The scale
consists of seven-point items, with eight
statements in total. For example, one item is "they
are open-minded and can think things through",
where "1" indicates total disagreement and "7" total
agreement. Higher scores reflect stronger
dehumanizing tendencies, whereas lower scores
suggest the absence of such tendencies. The scale
measures two forms of dehumanization:
animalistic dehumanization (assessed by four
items) and mechanistic dehumanization (also
assessed by four items) (Bastian & Haslam, 2010).
The Ten-Item Personality Inventory (TIPI),
developed by Gosling et al. (2003), is a concise
self-report measure containing ten items that
assess personality according to the Big Five
Factors Model, as proposed by Costa and McCrae
(McCrae & Costa, 1987). Each dimension of the
Big Five is represented by one item reflecting the
positive pole and another reflecting the negative
pole. Participants rate how each trait applies to
them using a seven-point scale. This scale has
demonstrated strong convergent validity, test-
retest reliability, and a high degree of agreement
between self-ratings and observer ratings
(Myszkowski et al., 2019). The scale has been
used in Greek students by Fradelos et al. (2022).
The Toronto Empathy Questionnaire (TEQ),
developed by Spreng et al. (2009), is a brief self-
report instrument designed to assess empathy as
an emotional process. The TEQ comprises 16
items that evaluate the behavioral, emotional,
cognitive, and physiological dimensions of
empathy across a wide spectrum of individuals
(Novak et al., 2021). The TEQ has been used in
numerous countries, languages, and psychological
contexts (Roth & Altmann, 2021). Furthermore, the
TEQ has been validated in Greece, with a
satisfactory Cronbach’s α coefficient of 0.72
(Kourmousi et al., 2017).
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The translation and cultural adaptation
process of the Genderism and Transphobia
Scale
Adhering to WHO's guidelines, the translation
and cultural adaptation of the Genderism and
Transphobia Scale involved several stages.
Initially, two independent bilingual translators, both
healthcare professionals, translated the English
version into Greek. These translations were then
merged and revised by a third translator to create
a single Greek version. This Greek version was
then translated into English by two separate
individuals who were proficient in English. The
resulting English versions were combined into a
single version and translated in Greek by a third
translator. This final Greek version was
administered to ten nursing students, and the
cognitive interview method was employed. During
this process, students shared whether they
encountered any confusing or challenging aspects.
Generally, nine out of the ten students reported no
such issues.
Statistical analysis
Descriptive and inferential statistics were are
applied to this study. The data was examined using
descriptive statistics (frequency, mean values, and
standard deviations) and inductive statistics to
address all the research questions. Analyses of
variance (ANOVA), independent t-tests, spearman
and Pearson correlation, regressions, internal
consistency (Cronbach's coefficient), and
confirmatory factor analyses were carried out using
SPSS26.0 and JASP. The significance level was
set to a p-value ≤0.05.
Ethics
This study received approval from the Ethics
Committee of the Department of Nursing of the
University of Thessaly University in Thessaly
(approval number 689DN/08.06.2023).
Furthermore, the study adheres to the principles
outlined in the Helsinki Declaration (2013) and
complies with the national ethical standards
established by the relevant national and
institutional committees overseeing human
experimentation. The anonymity of participants
was ensured using self-selected codes. Informed
consent was obtained from all participants before
their involvement in the study
Results
Table 1 presents the demographic
characteristics of the sample. Most participants
were women (78.6%), while men constituted 20.1%
and non-binary individuals constituted 1.4% of the
sample. The mean age of the participants was
23.09 years (SD ± 9.1). Regarding the year of
academic studies study, 36.7% of the nursing
students were in their 4th year, 28.9% in their 2
nd
,
and 15% in their 1
st
year of studies, respectively.
while the percentages for the 2nd and 1st years
were 28.9% and 15% respectively. Most students
Mostly, were single (53.1%), while 30.3% stated
that they were in a relationship. Regarding the
place of residence, 73.1% lived in urban areas,
13.9% in semi-urban, and 12.9% in rural areas,
.70.7% identified themselves as heterosexual,
while 15.6% chose not to answer about their sexual
preference. The education of the participants’
parents varied greatly with the mother and father of
the participants mostly having university or
secondary education. Finally, 93.9% of the
participants had not attended seminars on the care
of LGBTQ+ people.
Table 1. Demographic characteristics of the sample
Variable
Group
Frequency
Percentage
Gender
Female
231
78.6
Male
59
20.1
non-binary
4
1.4
Age (mean±SD)
23.09(9.1)
Year of Study
1st
44
15
2nd
85
28.9
3rd
19
6.5
4rth
108
36.7
5th <
38
12.9
Marital Status
In relationship
89
30.3
Single
156
53.1
Other
30
10.2
Married
19
6.5
Area of Residence
Urban (>10.000)
215
73.1
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Descriptive Analysis
Table 2 presents the descriptive statistics of the
study. The mean values for the different
dimensions examined varied range over a wide
range. Specifically, the Mechanistic and Animalistic
dehumanization scales presented similar mean
values (10.715 and 10.696 respectively) with high-
reliability coefficients (Cronbach's alpha = 0.849
and 0.817). Of Regarding the personality
dimensions, Extraversion had a mean of 7.48 with
a standard deviation of 2.803, while Agreeableness
and Conscientiousness presented means of
10.401 and 10.799 respectively. However, the
reliability for some of these dimensions such as
Agreeableness (0.260) and Emotional Stability
(0.210), was low. The total score in the Empathy
(TEQ) scale had a mean of 48.500 with a standard
deviation of 5.677, while the dimensions of Gender
Bashing and Transphobia/Genderism showed
higher fluctuations, with mean values of 11.456 and
56.228, respectively, and high reliability
(Cronbach's alpha = 0.865 and 0.961,
respectively).
Bivariate Analysis
The results of the ANOVA analysis revealed
significant differences in the scores for the Gender
bashing and Transphobia genderism categories of
the GTS scale between genders. The Gender
bashing category showed a mean value of 10.225
(SD = 4.214) for female participants, a mean value
of 16.576 (SD = 9.534) for male participants, In the
Gender bashing category, female participants had
a mean value of 10.225 (SD = 4.214), males
16.576 (SD = 9.534), while non-binary
individuals/others had the lowest mean value of
7.000 (SD = 0.000). The difference between
females and males was statistically significant (p <
.001), as was the difference between males and
non-binary individuals/other (p = 0.004). In the
Transphobia genderism category, female
participants had a mean score of 51.641 (SD =
26.560), male participants had a mean score of
75.831 (SD = 36.337), and non-binary/other
individuals had a mean score of 32.000 (SD =
5.715). Differences between females and males (p
< 0.001) and between males and non-binary
individuals (p = 0.010) were also statistically
significant, indicating the influence of gender on the
relevant attitudes. ANOVA analysis revealed
statistically significant differences in Mechanistic
dehumanization scores by gender (F(2. 288) =
5.261, p = 0.006). The mean score was higher for
men (M = 12.310, SD = 5.500) compared to women
(M = 10.380, SD = 4.534) and non-binary
individuals (M = 6.750, SD = 4.193). The
differences confirm the existence of variation in
perceptions according to gender. Similarly, in the
Animalistic dehumanization scale, the ANOVA
analysis also showed significant differences
Rural (<2000)
38
12.9
Semi-urban (2000 – 10.000)
41
13.9
Sexual Preference
Heterosexual
208
70.7
I don’t want to answer
46
15.6
Homosexual
24
8.2
Other
4
1.4
Bisexual
12
4.1
Mothers Educational status
Postgraduate
36
12.2
University
109
37.1
Highschool
108
36.7
J. Highschool
14
4.8
Elementary
21
7.1
Illiterate
6
2
Mothers Educational status
Postgraduate
20
6.8
University
102
34.7
Highschool
97
33
J. Highschool
31
10.5
Elementary
39
13.3
Illiterate
5
1.7
Have you attended an LGBTQ+ care course?
No
276
93.9
Yes
18
6.1
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between genders (F (2. 290) = 8.862. p < .001).
Men had the highest mean score (M = 13.034, SD
= 5.156), followed by women (M = 10.126, SD =
4.724) and non-binary individuals (M = 9.000, SD =
3.464). The statistically significant differences
highlight the differentiation of attitudes and
perceptions for this category.
The results of the ANOVA analysis also showed
statistically significant differences in the scores of
the categories Transphobia and genderism,
Mechanistic dehumanization, and Animalistic
dehumanization, depending on the personal
situation of the participants (p < .001 for all three
categories). Specifically, for the category
Transphobia genderism, married people presented
the highest mean score (M = 78.105, SD = 26.278).
while participants in the category "Other" had the
lowest (M = 41.367. SD = 15,370). Post-hoc tests
showed statistically significant differences between
married and other categories, as well as between
married and single (p < 0.05). In the Gender
bashing category, married people again had the
highest mean score. Statistical analyses revealed
significant differences between married people and
all other personal statuses (p < 0.001). The "Other"
category again had the lowest score, as in the other
categories. Married people also showed the
highest mean value in In the Mechanistic
dehumanization scale, married people also again
showed the highest mean score (M = 15.105, SD =
4.228), while the "Other" category had the lowest
value (M = 8.750, SD = 4.124). The differences
between married and the other categories were
statistically significant (p < 0.001). Finally, in the
Animalistic dehumanization scale, married people
had the highest score (M = 15.579, SD = 6.678),
while participants in the "Other" category had the
lowest (M = 9.200, SD = 4.089). The results of the
post-hoc tests showed significant differences
between married and all other categories (p <
0.001). Overall, personal status seems to
significantly affect the scores in the three
categories.
Correlation analysis with the Pearson's r-
coefficient revealed the following results:
There was a positive and statistically significant
correlation between age and the Mechanistic
dehumanization (r = 0.206, p < .001) as well as the
Animalistic dehumanization (r = 0.174. p = 0.003).
suggesting that older ages are associated with
higher scores in these categories. The Gender
bashing category did not show a statistically
significant correlation with age (r = 0.016, p =
0.783), while the Transphobia category showed a
weak but statistically significant positive correlation
(r = 0.136, p = 0.022)
Table 3 presents the correlations between five
personality dimensions (Extroversion,
Agreeableness, Conscientiousness, Emotional
Stability, Openness to experiences) and four
themes (mechanistic, animalistic, sexist,
transphobic-generic behavior). Openness to
Experience was is negatively and significantly
correlated with all themes, with Pearson r values
ranging from -0.195 (mechanistic) to -0.337
(transphobic-generic), with all p- values being less
than 0.001, indicating that people with high
Openness are less likely to exhibit such behaviors.
Similarly, Technological Expertise (TEQ) was is
also negatively and significantly correlated with the
four examined themes, with Pearson r values
ranging from -0.332 (mechanistic) to -0.480
(transphobic-generic), and with p-values also being
less than 0.001, indicating a strong negative
relationship, conversely. The remaining personality
parameters (Extroversion, Agreeableness,
Conscientiousness, and Emotional Stability) did do
not show significant correlations, since as their p-
values were are greater than 0.05.
Multivariable Analysis
Table 4 presents the results of a linear
regression analysis where the parameters of
mechanistic and animalistic dehumanization,
sexist and transphobic behavior were used as
dependent variables, and empathy and personality
traits parameters were used as independent
variables. For mechanistic dehumanization, the
factors that had have statistically significant
correlations were are Agreeableness (β = 0.557, p
< 0.001), Openness to Experience (β = -0.414, p =
0.005), and Expertise (β = -0.385, p < 0.001), with
a R-Squared (R²) value (value defining the
proportion of variance in the dependent variables
explained by the independent variables) of 19.9%
the model explaining 19.9% of the variability (R²
= 19.9%). In animalistic dehumanization, the
significant factors include Agreeableness (β =
0.462, p = 0.004). Emotional Stability (β = 0.341, p
= 0.037) and Expertise (β = -0.415, p < 0.001) with
the model explaining 20.1% of the variability (R² =
Table 2. Descriptive statistics of the study
Mean
SD
Mini
Max
Chron.
a
Mechanistic
Dehumanization
10.71
4.8
4.00
26.00
0.84
Animalistic
Dehumanization
10.69
4.9
4.00
26.00
0.81
Extraversion
7.48
2.8
2.00
14.00
0.68
Agreeableness
10.40
1.9
5.00
14.00
0.26
Conscientiousness
10.79
2.2
3.00
14.00
0.49
Emotional Stability
10.22
2.0
3.00
14.00
0.21
Openness to
Experiences
10.49
1.9
3.00
14.00
0.26
TEQ
48.50
5.6
30.00
59.00
0.75
Gender bashing
11.45
6.2
7.00
46.00
0.86
Transphobia/
Genderism
56.22
30.2
25.00
153.00
0.96
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20.1%). In the case of sexism, the significant factor
was is Agreeableness (β = 0.374, p = 0.066),
Openness to Experiences (β = -0.523, p = 0.006),
and Expertise (β = -0.447, p < 0.001), with the
model explaining 19.1% of the variability (R² =
19.1%). Finally, for transphobic-generic behavior,
Agreeableness (β = 3.593, p < 0.001), Openness
to Experiences (β = -4.070, p < 0.001), and
Expertise (β = -3.045. p < 0.001), were are
statistically significant factors with the model
explaining 34% of the variability (R² = 34%).
Validation of Genderism and Transphobia
Scale
Reliability Analysis of the Genderism and
Transphobia Scale
The test-retest method was applied to explore
the test-retest repeatability of the Genderism and
Transphobia Scale. Twenty Nursing students
completed the questionnaire at baseline and two
weeks later. This interval is interposed so that the
individuals do not recall their answers. Upon the
analysis, significant correlations were observed
between the two-administration (p<0.001) facts
(Intraclass Correlation Coefficients = 0.545) that
reveal that the scale is stable through time. In
addition, Cronbach’s Alpha had values of 0.86 and
0.96 for the subscales suggesting acceptable
internal consistency of the scale. Moreover, the
value of Cronbach’s Alpha would not increase if the
scale discarded items. All items exhibited strong
correlations to the total score. This fact adds to the
excellent internal consistency of the scale.
Construct validity of Genderism and
Transphobia Scale
Finally, we performed a CFA to test the two-
factor structure of the scale. Regarding CFA, the
model tested was equivalent to the original factorial
structure of the Genderism and Transphobia Scale
as proposed by other authors. The model
presented a reasonably good fit to the data.
Tucker-Lewis index (TLI) was 0.850, the
comparative fit index (CFI) and goodness of fit
index (GFI) were nearly 0.9 and standardized root
mean square residual (SRMR) was 0.080. Those
values suggest an acceptable but not excellent fit.
Overall, our CFA confirmed the two-dimensional
structure of the scale.
Table 3. Pearson's Correlations
Variable
mechanistic
animalistic
Gender
bashing
Transphobia
genderism
Extraversion
Pearson's
r
0.055
0.095
0.011
-0.021
p-value
0.349
0.105
0.850
0.722
Agreeableness
Pearson's
r
0.005
-0.005
-0.137
-0.079
p-value
0.931
0.937
0.019
0.176
Conscientiousness
Pearson's
r
0.054
0.056
-0.058
-0.022
p-value
0.359
0.342
0.321
0.712
Emotional Stability
Pearson's
r
0.024
0.085
-0.142
-0.012
p-value
0.680
0.145
0.015
0.831
Openness to
Experiences
Pearson's
r
-0.195
-0.136
-0.233
-0.337
p-value
< .001
0.020
< .001
< .001
TEQ
Pearson's
r
-0.332
-0.331
-0.390
-0.480
p-value
< .001
< .001
< .001
< .001
Table 4. Linear Regression analysis with mechanistic and animalistic dehumanization and Genderism and
transphobia as dependent variables and empathy and personality traits as Independent
95% CI
Unstandardized
Standard
Error
Standardized
t
p
Lower
Upper
Model for Dehumanization
23.139
2.373
9.753
< .001
18.469
27.809
Extraversion
0.229
0.098
0.134
2.342
0.020
0.037
0.422
Agreeableness
0.557
0.157
0.231
3.557
< .001
0.249
0.865
Mental Health: Global Challenges Journal
https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138
Conscientiousness
0.203
0.141
0.095
1.438
0.152
-0.075
0.480
Emotional Stability
0.087
0.158
0.037
0.547
0.585
-0.225
0.398
Openness to Experiences
-0.414
0.146
-0.171
-2.842
0.005
-0.701
-0.127
TEQ
-0.385
0.055
-0.455
-6.999
< .001
-0.493
-0.277
Model summary: F(6,284)=11.749, p<0.001, R
2
=19.9%
95% CI
Unstandardized
Standard
Error
Standardized
t
p
Lower
Upper
Model for Animalistic
Dehumanization
22.132
2.423
9.133
< .001
17.362
26.902
Extraversion
0.279
0.100
0.159
2.781
0.006
0.081
0.476
Agreeableness
0.462
0.160
0.186
2.879
0.004
0.146
0.777
Conscientiousness
0.097
0.143
0.044
0.676
0.500
-0.185
0.379
Emotional Stability
0.341
0.163
0.141
2.097
0.037
0.021
0.662
Openness to Experiences
-0.260
0.148
-0.105
-1.750
0.081
-0.551
0.032
TEQ
-0.415
0.056
-0.478
-7.391
< .001
-0.526
-0.305
Model summary: F(6,286)=12.011, p<0.001, R2=20.1%
95% CI
Unstandardized
Standard
Error
Standardized
t
p
Lower
Upper
Model Gender Bashing
33.194
3.068
10.820
< .001
27.156
39.233
Extraversion
0.262
0.127
0.118
2.059
0.040
0.011
0.512
Agreeableness
0.374
0.203
0.120
1.842
0.066
-0.026
0.775
Conscientiousness
0.222
0.182
0.081
1.220
0.223
-0.136
0.580
Emotional Stability
-0.277
0.205
-0.091
-1.349
0.178
-0.681
0.127
Openness to Experiences
-0.523
0.188
-0.167
-2.778
0.006
-0.894
-0.152
TEQ
-0.447
0.071
-0.408
-6.265
< .001
-0.587
-0.306
Model summary: F(6,287)=11.302, p<0.001, R
2
=19.1%
95% CI
Unstandardized
Standard
Error
Standardized
t
p
Lower
Upper
Model Transphobia
Genderism
180.557
13.492
13.383
< .001
154.001
207.112
Extraversion
1.227
0.559
0.114
2.194
0.029
0.126
2.327
Agreeableness
3.593
0.894
0.236
4.020
< .001
1.834
5.352
Conscientiousness
0.692
0.799
0.052
0.865
0.388
-0.882
2.265
Emotional Stability
1.179
0.903
0.080
1.306
0.193
-0.598
2.956
Openness to Experiences
-4.070
0.828
-0.267
-4.915
< .001
-5.699
-2.440
TEQ
-3.045
0.314
-0.571
-9.711
< .001
-3.662
-2.428
Model summary: F(6,284)=24.693, p<0.001, R
2
=34%
Discussion
The purpose of the study was to investigate
nursing students' attitudes toward transgender
individuals as well as to examine the role of
demographic, personality, and cognitive
characteristics in shaping attitudes toward
transgender individuals and their dehumanization
by nursing students. In addition, the study aimed
aims to weigh and culturally adapt the Genderism
and Transphobia Scale. This study highlighted
differences in attitudes towards transgender
people between genders, with male participants
having significantly higher scores on the
Transphobia/Genderism scale than non-binary
individuals, with statistically significant differences.
Similar results were observed in the Mechanistic
and Animalistic Dehumanization categories, with
males showing higher mean values. Another
finding was a strong negative correlation between
empathy (TEQ) and dehumanization, . Particularly
in the Transphobia/Genderism scale, participants
with higher levels of empathy had lower levels of
prejudice and dehumanization. Finally, concerning
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personality traits, Openness to Experiences was
negatively correlated with Transphobia/Genderism
and Mechanistic Dehumanization, indicating that
students with higher openness were less likely to
express prejudice. 93.9% of participants stated that
they had not attended seminars on caring for
LGBTQ+ individuals. Lack of this education is
generally associated with higher levels of prejudice
and dehumanization.
According to our results, nursing students
exhibit moderate to low levels of discrimination
towards trans people. The results of the study
disagree with previous studies like Derbyshire and
Keay (2023), which highlight higher levels of
subconscious bias and confusion among nursing
students regarding gender discrimination and
gender identity. The present study was conducted
in Greece, while many of the previous studies were
conducted in countries with different cultural
contexts and social norms regarding trans people.
The use of different measurement tools, such as
the Genderism and Transphobia Scale (GTS) in
the present study, may lead to differences in
results. In addition, the tools used may capture
explicit bias and not implicit bias, which usually
reaches presents higher levels.
The results of the study show that male
participants reported higher levels of
Transphobia/Genderism compared to women and
non-binary individuals, with the difference being
statistically significant (p < 0.001). This difference
highlights the influence of gender on attitudes
towards transgender individuals, which is
consistent with previous findings.
In particular, according to a study by Sequeira
et al. (2020), men are more likely to exhibit
prejudice and discrimination against transgender
people, due to deep-rooted social perceptions of
gender and gender identities. Exposure to
educational initiatives and programs that promote
acceptance of diversity appears to reduce these
negative attitudes, especially at younger ages.
Furthermore, as Castellini et al. (2017) report,
women and non-binary individuals tend to show
greater empathy and acceptance towards
transgender individuals. This is attributed to social
and cultural factors that enhance solidarity and
understanding between groups facing
discrimination. This data highlights the need for
targeted interventions, such as educational
programs and awareness campaigns, that focus on
gender bias and enhancing empathy. Promoting
intercultural understanding can contribute to
reducing transphobia and creating a more inclusive
social environment.
Another important finding of our study was that
empathy is a factor that plays an important role in
shaping positive attitudes towards transgender
people. This agrees with the study by Ozturk &
Demirden, (2023), who support the importance of
empathy in reducing prejudice and transphobia,
findings that strengthen the main hypothesis of the
present study. Empathy helps individuals
understand the experiences, feelings, and needs of
transgender individuals, reducing dehumanization
and discrimination. Through empathy, transgender
people are perceived not as “different” or “other,”
but as people with shared feelings and rights.
Studies, such as Bastian & Haslam (2010), show
that cultivating empathy reduces the tendency
toward mechanistic and animalistic
dehumanization, allowing for the creation of more
positive attitudes.
The personality dimension "Openness to
Experience" appears to function as a protective
factor, showing a negative correlation with
transphobia. That is, individuals with higher levels
of openness to experience tend to have less
prejudice against trans people. According to
previous studies (Cullen et al., 2002; Godø et al.,
2024), the adoption of feminist beliefs and
openness to experience are independent negative
predictors of transphobia. That is, individuals who
embrace feminist values and/or have high
openness to experience show reduced levels of
transphobia. However, openness to experience did
not moderate the relationship between feminist
beliefs and transphobia, suggesting that it functions
independently as a factor in reducing prejudice.
Furthermore, openness to experience is
associated with traits such as imagination,
aesthetic sensitivity, attention to emotions,
preference for variety, and intellectual curiosity.
These traits may enhance an individual's ability to
understand and accept different gender identities,
thereby reducing the likelihood of developing
transphobic attitudes (Cullen et al., 2002; Godø et
al., 2024). Overall, openness to experience
appears to play an important role in reducing
transphobia, acting as an independent protective
factor. Cultivating this dimension of personality,
through educational and experiential interventions,
could contribute to reducing prejudice and
promoting a more inclusive society. Our study
revealed that 93.9% of participants had not
attended any training on LGBTQ+ care. This lack
of specialized training is directly related to the
findings of previous research, which indicates
shortcomings in nursing curricula regarding the
care of LGBTQ+ populations (McGregor et al.,
2023). Specifically, McGregor et al. point out that
the inclusion of LGBTQ+ care in curricula is still
limited, which creates challenges for healthcare
professionals in providing appropriate and
equitable care.
Similar findings are reported in other studies.
Research by Khanal et al. (2023) highlights the
importance of including LGBTQ+ care issues in
basic health studies, highlighting that the lack of
specialized education exacerbates health
inequalities. Similarly, Carpenter et al. (2023) found
that nursing and medical students reported limited
knowledge and confidence in caring for LGBTQ+
patients, highlighting the need for targeted training
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through workshops and clinical programs.
Furthermore, Carr et al. (2023), provide evidence
that including such topics in training enhances the
skills and awareness of health professionals. In
summary, the findings highlight the need to review
nursing curricula and incorporate targeted thematic
modules related to the care of LGBTQ+ individuals.
Providing specialized training is not only a matter
of scientific completeness but also of social justice.
Mental health practitioners must provide
affirming and culturally competent care to
transgender individuals to mitigate the effects of
discrimination. Training programs should
emphasize gender-affirming approaches and the
impact of minority stress on mental health.
Therapists should advocate for inclusive policies
that reduce systemic barriers to care. Creating
safe, nonjudgmental therapeutic spaces can help
transgender clients build resilience and self-
acceptance. Integrating peer support and
community resources into treatment plans
enhances social support and well-being.
Research-informed interventions should address
the unique needs of transgender individuals to
improve mental health outcomes (Budge et al.,
2013).
Strengths and Limitations
Despite the originality and methodical design of the
study, there were some limitations. First, the
sample came exclusively from two Universities,
nursing departments in Greece, which limits the
generalizability of the results to other geographical
areas or cultural environments. The study used a
cross-sectional design, which does not allow for
causal inferences about the relationships between
the variables. Finally, the data were collected
through self-report questionnaires, which may lead
to socially desirable responses or be influenced by
the subjective perception of the participants.
Conclusions
Empathy is proven to be a critical factor in
understanding the needs and eliminating
prejudices against transgender people. Health
professionals with increased levels of empathy are
better able to provide comprehensive, inclusive,
and humane care. At the same time, cultural
sensitivity, the ability to understand cultural
differences and adapt care to the specific needs of
the individual, is a fundamental principle of modern
health care. The lack of these skills leads to
inequalities in care, which highlights the need to
train nursing students in these areas. Personality
traits, such as Openness to Experience and
Agreeableness, play an important role in shaping
attitudes toward diversity. Students with high levels
of openness show greater adaptability to the needs
of transgender individuals and lower levels of
prejudice. Conversely, the absence of these traits
is associated with increased transphobia and
negative attitudes. Understanding the impact of
personality traits can contribute to the development
of individualized interventions that will enhance the
receptivity of nursing students to diversity.
The findings of the study highlight the urgent
need for educational interventions that aim to
reduce transphobia and dehumanization.
Experiential exercises, such as role-playing
scenarios and encounters with trans people, can
promote empathy and break down stereotypes. In
addition, the integration of LGBTQ+ care topics into
nursing curricula is essential, not only for
information but also for the cultivation of cultural
sensitivity. At the same time, collaboration with
LGBTQ+ organizations can strengthen teaching
and provide real-life examples of the complexity of
these people’s needs.
Conflict of interest
The authors declare no conflict of interest.
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