People may have both negative and positive attitudes about other people, their way of living and those attitudes can be influenced by various factors. LGBTIQ individuals are facing various difficulties and barriers to run their daily life due to different attitudes of people. Attitudes may be different from person to person influenced by their knowledge, acceptance behaviour and understanding. By finding out the associated factors that influences the attitude of people we can change people’s view towards LGBTIQ individuals. Each and every person deserves to be treated equally regardless of their gender, sexual orientation, and preferences.
This was a cross-sectional study in which the sample size was 423 and the study population was nursing students. A simple random sampling method was used to select sample for the study. Self-administered questionnaire was used to collect data. The collected data was entered in EPI 3.1 and analyzed using SPSS 25. A descriptive statistic was used to find out the frequency and percentage and analysis (chi-square) was used to find out the association between the dependent and independent variables. A p-value of <0.05 was considered statistically significant.
Results showed that 87.2% have positive attitudes towards LGBTIQ individuals, and the majority (56.6%) have knowledge about homosexuality. Similarly, more than two-thirds (82.7%) of respondents were not homophobic, and 50.4% showed positive stereotypes about LGBTIQ individuals. Religion (p=0.030), caste (p=0.001) and Family type (p=0.016) were statistically significant with regard to the attitudes of students towards LGBTIQ.
The majority of students had positive attitudes towards LGBTIQ individuals and few had negative attitudes. Almost half of the respondents had adequate knowledge about homosexuality. The majority of students were not homophobic and few were homophobic. Half had positive stereotypes and about other half had negative stereotypes.
Academic Editor: Qiang Cheng, Biomedical Informatics Institute, and Computer Science Department
Checked for plagiarism: Yes
Review by: Single-blind
Copyright © 2023 Sabita Dangi, et al.
The authors have declared that no competing interests exist.
The right to health, which is an extension of the basic human right, requires that services be provided to all people equitably and according to their needs. Certain venerable groups obtain health services in the community at a higher rate than others. These populations may be venerable, affectless, and helpless in the healthcare professional-patient interaction; thus, their rights must be properly maintained. A venerable person is a defenseless person who is on the weak side of a relationship, is more easily exposed to abuse and exploitation, and not be able to protect his\her rights; therefore, they can be more easily affected or injured. The age, gender, ethnic characteristics, health status, liberty, sexual orientation\preference, and other stances of the individual cause them to be more venerable; therefore, they need to be evaluated within the scope of a venerable person.1 Lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ) individuals are often physically and sexually assaulted and tortured. They face discrimination in workplace, education, access to health care, social security, and other areas.2 The constitution and legal text guarantee the fundamental rights and freedoms of individuals and communities. United Nations Universal Declaration of Human Right (1948) is an important text emphasizing the right to health for all. It is important to recognize the equal, indivisible, and non-transferable rights of all people in the context of freedom and justice. It is important for LGBTIQ individuals to be able to exercise their right to equally and without discrimination. Preventing and stopping discrimination and right violations of LGBTIQ individuals due to their sexual orientation or gender identities while receiving prevention and care services are among the elements to be considered.3 Therefore, topics related to vulnerable groups should be frequently included in nursing education.4 The right to health is within the scope of the fundamental rights and freedoms of all individuals, including LGBTIQ individuals and is untouchable, inalienable, and indispensable. In the application of these rights, the attitude, communication, and approaches of health professionals are important in preventing discrimination and providing good health services. From time to time, both LGBTIQ individuals and service providers face some problems related to medical ethics.
Our country Nepal is very traditional society; therefore, issues related to sexuality are not discussed within families and society. Talking about the sexual issue is usually avoided and considered taboo. LGBTIQ individuals experience disgrace, separation, and exploitation across them course of their lives. In setting of LGBTIQ, a large portion of them is as yet covered up. Even health service providers are not aware of the issues, and there is no or have rarely discussion on the topic on bigger forums.
Materials and Methods
A descriptive cross-sectional study was conducted among nursing students of nursing college in Kathmandu metropolitan city. Data were collected from July 2022 to August 2022. The sample size was calculated using the formula z2pq/d2. The calculation was based on the assumption of prevalence 50%. Assuming a confidence level of 95% and at a precision of 5%, the total sample size was 423. Simple random sampling was used for the study. In the first stage, 4 colleges were randomly selected from the sample frame by lottery method. In the second stage, students from every four colleges were randomly selected. Pretesting was done in one of the non-study colleges. Following the pretesting, some modifications to the questions and terminology were made in the final questionnaire.
Approval for data collection was taken from respective nursing colleges, and data was collected using self-administered questionnaires. Nursing students, who had completed 18 years of age at the time of investigation and were willing to participate, were included in the study after taking informed consent and ensuring confidentiality. Those participants who were eligible for the study but were not willing to participate in the interview were excluded from the study.
After data collection, the collected data was cleaned manually, coded, and entered in EPI data 3.1. Data was transferred to SPSS 25, and analysis was done. A descriptive statistic was used to find out the frequency and percentage and analysis (chi-square) was used to find out the association between dependent and independent variables. A p-value of <0.05 was considered statistically significant.
The ethical approval was taken from the Institutional Review Committee before the commencement of the study.
The majority of respondents (85.1%) belongs to age group 20-30 years, followed by 10-20 years (14.2%). The mean age of students was 22.9 years. All of the respondents were female. The majority of students were Hindu (81.1%), followed by Buddhist (14.2%). The majority of respondents belong to Janjati (33.8%), followed by Chhetri (27%). Most of the students were from nuclear families (71.4%) and the rest 28.6% from joint families Table 1.Table 1. Socio – Demographic characteristics of students
|Age of Respondents|
|Below 20 Years||60||14.2|
|20 to 30 Years||360||85.1|
|Above 30 Years||3||0.7|
|Standard Deviation (SD)||2.426|
|Caste of Respondents|
Major students disagreed that homosexuality is immoral (29.6%), most homosexual men and women want to be heterosexual (31.2%), homosexuals doesn’t make a good role model for children and would do psychological harm to children with whom they interact as well as interfere with the normal sexual development of children (37.6%), LGBTIQ community people shouldn’t be treated in the same room with other people (34.5%) and LGBTIQ community people get what they deserve (33.6%). The majority of study participants agreed that homosexuals are usually identifiable by their appearance or mannerism (43%), gay men were more likely to be victims of violent crime than the general public (47.8%)
The scores on the Likert scale were added. A score of less than 54 was considered negative attitude and a score of more than or equal to 54 was considered a positive attitude. Hence, more than two-thirds (87.2%) had a positive attitude towards LGBTIQ individuals Table 2.Table 2. Attitude about LGBTIQ individuals
|Attitude||Strongly disagree(n/%)||Disagree(n/%)||Neutral(n/%)||Agree(n/%)||Strongly agree(n/%)|
|Homosexuality is immoral.||178(42.1)||125(29.6)||44(10.4)||39(9.2)||37(8.7)|
|Most homosexual men and women want to be heterosexual||34(8.0)||132(31.2)||120(28.4)||111(26.2)||26(6.1)|
|Heterosexuals generally have high sex drive than do homosexuals||32(7.6)||66(15.6)||189(44.7)||119(28.1)||17(4.0)|
|The homosexual population includes a greater proportion of men than of women.||10(2.4)||86(20.3)||154(36.4)||153(36,2)||20(4.7)|
|Homosexuals are usually identifiable by their appearance or mannerism||34(8.0)||96(22.7)||89(21.0)||182(43.0)||22(5.2)|
|Homosexuals doesn’t make good role model for children and would do psychological harm to children with whom they interact as well as interfere with the normal sexual development of children.||156(36.9)||159(37.6)||42(9.9)||49(11.6)||17(4.0)|
|Heterosexual men tend to express more hostile attitude towards homosexuality than do heterosexual women.||9(2.1)||116(27.4)||168(39.7)||119(28.1)||11(2.6)|
|Gay man is more likely to be victim of violent crime than the general public.||23(5.4)||86(20.3)||73(17.3)||202(47.8)||39(9.2)|
|If the media portrays homosexuality or lesbianism as positive, this could sway youths into becoming homosexual or desiring homosexuality as a way of life||49(11.6)||97(22.9)||117(27.7)||136(32.2)||24(5.7)|
|Gay men and lesbian women have an increased incidence of anxiety and depression compared to heterosexual men and women.||3(0.7)||23(5.4)||69(16.3)||119(47.0)||129(30.5)|
|The homosexuals usually disclose their sexual identity to friend before their parent.||6(1.4)||21(5.0)||44(10.4)||221(52.2)||131(31.0)|
|The experience of love is similar for all people regardless of sexual orientation.||10(2.4)||24(5.7)||43(10.2)||104(24.6)||242(57.2)|
|LGBTIQ community people shouldn’t be treated in same room with other people.||196(46.3)||146(34.5)||36(8.5)||32(7.6)||13(3.1)|
|LGBTIQ community people get what they deserve.||75(17.7)||142(33.6)||53(12.5)||65(15.4)||88(20.8)|
|Attitude Towards LGBTIQ individuals|
The majority of students agreed that homosexuality is a disease (52%), the most common mode of transmission of HIV virus is through gay male sex (29.8%) and majority of students disagreed that sex education offered in schools increases the amount of sexual activity among adolescents (37.1%). The scores on the Likert scale were added. A score of less than 24 was considered as inadequate knowledge, and a score of more than or equal to 24 was considered as adequate knowledge. Hence, 56.5% had adequate knowledge about homosexuality and 43.5% had inadequate knowledge Table 3.Table 3. Knowledge about Homosexuality
|Knowledge||Strongly disagree (n/%)||Disagree (n/%)||Neutral (n/%)||Agree (n/%)||Strongly agree (n/%)|
|Homosexuality is a disease||222(52.0)||166(39.2)||19(4.5)||12(2.8)||4(0.9)|
|Homosexual person’s identity does agree with his/her biological sex||23(5.4)||98(23.2)||139(32.9)||148(35)||15(3.5)|
|In the world as a whole, the most common mode of transmission of HIV virus is through gay male sex||76(18.0)||126(29.8)||78(18.4)||113(26.7)||30(7.1)|
|Sexual orientation is usually well established by adolescence.||11(2.6)||43(10.2)||93(22.0)||210(49.6)||66(15.6)|
|Boys breast typically grows during puberty.||62(14.7)||113(26.7)||69(16.3)||160(37.8)||19(4.5)|
|Testosterone is the hormone responsible for the growth of pubic hair on girls.||137(32.4)||74(17.5)||31(7.3)||138(32.6)||43(10.2)|
|Sex education offered in schools increase the amount of sexual activity among adolescents.||81(19.1)||157(37.1)||72(17.0)||93(22.0)||20(4.7)|
|In the last 25 years there has been increase in homosexuality.||16(3.8)||41(9.7)||118(27.9)||192(45.4)||56(13.2)|
|Knowledge about homosexuality|
The majority of students agreed that they would feel at ease talking with a homosexual person at a party (42.3%), followed by the fact that they would feel comfortable working closely with a female homosexual (40.2%). The scores on the Likert scale were added. A score of less than 74 was considered homophobic and a score of more than or equal to 74 was considered as not Homophobic. Hence, 82.7% were not homophobic, and 17.3% were homophobic (Table 4). The majority of students agreed that lesbians dress in a more masculine manner than other women (39.5%), gay men are associated with feminine speaking tones (43.5%), homosexuals are more exposed to unprotected sex (38.1%), bisexual people are often seen as being in a transitory or experimental phase between heterosexual and homosexual (40.2%), and being trans means having surgery (30.5%), LGBTIQ community member are mostly abandoned by their families (46.6%). And the majority of people neither agreed nor disagreed that gay men are more likely to use alcohol and illicit drugs than heterosexual men (35.2%), that most of the time gay men are considered sexual pedophiles (46.3%), that most trans genders are engaged in prostitution (26.7%), intersex is just another word for transgender (41.1%), and that gay people thrive working in the arts and media (45.4%). And the majority of people disagreed that many lesbians are associated with having short hair, wearing baggy clothes, and playing sports (30%), bisexual people are incapable of having steady or long-term relations (33.6%), bisexual people are most likely to transmit STDs (35.5%), and to some extent members of the LGBTIQ community are trying to convert others (31.2%). The scores on the Likert scale were added. A score of more than 45 was considered a positive stereotype of LGBTIQ individuals, and a score higher than 45 was considered a negative stereotype. Hence, 50.4% had positive stereotypes and 49.6% had negative stereotypes (Table 5).Table 4. Homophobic behavior
|Homophobia||Strongly disagree(n/%)||Disagree(n/%)||Neutral(n/%)||Agree(n/%)||Strongly agree(n/%)|
|I would enjoy attending social function at which homosexuals were present.||3(0.7)||34(8.0)||91(21.5)||161(38.1)||134(31.7)|
|I would feel comfortable if I feel myself attracted towards same sex||68(16.1)||135(31.9)||96(22.7)||77(18.2)||47(11.1)|
|I would feel comfortable if my partner was attracted to their same sex member.||89(21.0)||163(38.5)||83(19.6)||73(17.3)||15(3.5)|
|I would feel uncomfortable seen in a homosexual community.||107(25.3)||141(33.3)||99(23.4)||70(16.5)||6(1.4)|
|I would feel comfortable knowing that my friend was a homosexual.||19(4.5)||42(9.9)||58(13.7)||173(40.9)||131(31.0)|
|I would feel disappointed if I learn that my child was homosexual.||108(25.5)||150(35.5)||84(19.9)||68(16.1)||13(3.1)|
|If a member of my sex made advance towards me, I would feel angry.||38(9.0)||102(24.1)||139(32.9)||116(27.4)||28(6.6)|
|I would feel ease talking with a homosexual person at a party.||18(4.3)||35(8.3)||98(23.2)||179(42.3)||93(22.0)|
|I would feel comfortable working closely with a female homosexual.||23(5.4)||33(7.8)||73(17.3)||170(40.2)||124(29.3)|
|I would feel nervous being in a group of homosexuals.||89(21.0)||124(29.3)||133(31.4)||52(12.3)||25(5.9)|
|If I saw two man holding hands in public, I would feel disgusted||170(40.2)||147(34.8)||68(16.1)||28(6.6)||10(2.4)|
|I would disturb to find out my doctor was homosexual.||128(30.3)||168(39.7)||88(20.8)||29(6.9)||10(2.4)|
|I would feel uncomfortable if I learned that my neighbor was homosexual.||141(33.3)||191(45.2)||33(7.8)||45(10.6)||13(3.1)|
|I would feel comfortable if I saw same sex marriage.||40(9.5)||56(13.2)||86(20.3)||155(36.6)||86(20.3)|
|I would feel that I had failed as a partner if I learned that my child was gay.||136(32.2)||144(34.0)||85(20.1)||48(11.3)||10(2.4)|
|I would feel uncomfortable to share my food with a group of homosexuals.||186(44.0)||162(38.3)||42(9.9)||17(4.0)||16(3.8)|
|Organizations which promote gay rights are not necessary||241(57.0)||137(32.4)||15(3.5)||27(6.4)||3(0.7)|
|Homosexual behavior should not be against the law.||81(19.1)||71(16.8)||46(10.9)||94(22.2)||131(31.0)|
|I tease and make jokes about gay people||270(63.8)||111(26.2)||27(6.4)||9(2.1)||6(1.4)|
|I make derogatory remarks like "faggot" or "queer" to people I suspect are gay.||223(52.7)||116(27.4)||62(14.7)||13(3.1)||9(2.1)|
|Stereotype||Strongly disagree (n/%)||Disagree (n/%)||Neutral (n/%)||Agree (n/%)||Strongly agree (n/%)|
|Many lesbians are associated with having short hair, wearing baggy clothes and playing sports.||56(13.2)||127(30.0)||98(23.2)||114(27.0)||28(6.6)|
|Many lesbians dress in more masculine manner than other women.||25(5.9)||107(25.3)||111(26.2)||167(39.5)||13(3.1)|
|Gay’s men are associated with feminine speaking tones.||17(4.0)||83(19.6)||101(23.9)||184(43.5)||38(9.0)|
|Homosexuals are more exposed to unprotected sex.||30(7.1)||104(24.6)||116(27.4)||161(38.1)||12(2.8)|
|Gay men are more likely to use alcohol and illicit drugs than heterosexual men.||72(17.0)||133(31.4)||149(35.2)||58(13.7)||11(2.6)|
|Most of the time Gay men are consider as sexual pedophiles||44(10.4)||111(26.2)||196(46.3)||61(14.4)||11(2.6)|
|Bisexual people are often seen as being in a transitory or experimental phase between heterosexual and homosexual.||13(3.1)||88(20.8)||127(30.0)||170(40.2)||25(5.9)|
|Bisexual people are incapable of having steady or long-term relations.||49(11.6)||142(33.6)||103(24.3)||109(25.8)||20(4.7)|
|Bisexual people are most likely to transmit STDs.||52(12.3)||150(35.5)||102(24.1)||103(24.3)||16(3.8)|
|Most of the Transgender are engaged in prostitution.||74(17.5)||105(24.8)||113(26.7)||107(25.3)||24(5.7)|
|Intersex is just another word for Transgender.||44(10.4)||90(21.3)||174(41.1)||102(24.1)||13(3.1)|
|To some extend members of LGBTIQ community are trying to convert others.||100(23.6)||132(31.2)||122(28.8)||59(13.9)||10(2.4)|
|Being Trans means having surgery.||53(12.5)||101(23.9)||79(18.7)||129(30.5)||61(14.4)|
|Gay people thrive working in arts and media.||31(7.3)||99(23.4)||192(45.4)||81(19.1)||20(4.7)|
|LGBTIQ community people are mostly abandoned by their families.||22(5.2)||44(10.4)||96(22.7)||197(46.6)||64(15.1)|
Findings revealed that religion, caste of the respondent and family type were statistically significant with the attitude of students towards LGBTIQ individuals (p<0.05) whereas age and education level showed no significant association with the attitude of students towards LGBTIQ individuals [Table 6]. Similarly, religion, caste, education level are statistically significant with knowledge about homosexuality (p<0.05). The age of the student showed no significant association with knowledge about homosexuality [Table 7].Table 6. Factor associated with attitude of students towards LGBTIQ individuals
|Characteristics||Attitude towards LGBTIQ individuals||Chi square value||P-value|
|Less than 20 years||7(11.7)||53(88.3)|
|Above 30 years||0(0.0)||3(100)|
|Characteristics||Knowledge about Homosexuality||Chi-square value||P-value|
|Less than 20 years||31(51.7)||29(48.3)|
|Above 30 years||0(0.0)||3(100)|
The majority of respondents were Hindu (81.1%), followed by Buddhist (14.2%). The majority of the respondents belong to Janjati (33.8%), followed by Chettri (27%). Most of the students were from nuclear families (71.4%) and rest 28.6% from joint families. Regarding fathers’ occupations among students, 47.5% were involved in business, 5% were involved in other occupations, and the least (0.9%) were involved in labor.
This study shows that more than two-thirds of the respondents had a positive attitude towards LGBTIQ individuals (87.2%). Similarly, respondents displayed adequate knowledge about homosexuality, obtaining a percentage of 56.5 % on the knowledge about homosexuality question, and the remaining 43.5% didn’t have knowledge about homosexuality. A study conducted to compare the level of attitude towards homosexuality among nurses in Taiwan between 2005 and 2017 showed that some dimensions of negative attitude towards lesbian and gay individuals decreased, but some dimensions deepened among nurses between 2005 and 2017.5 A similar study was conducted in four Italian regions among nurses in inpatient and outpatient settings, from May 2015 to January 2016, which showed the respondent seemed to have only a moderately positive attitude towards lesbian and gay patients, as the mean score of the ATLG was 2.25 (±0.73). Italian nurses also displayed inadequate knowledge about homosexuality, obtaining a mean score of 12.97 (±3.01) on the Knowledge About Homosexuality Questionnaire (the highest possible score being 20).6
In contrast to this study, a study conducted at a public university in the Mediterranean region of Turkey concluded that more than half of the students considered being LGBT as a disease and didn’t have sufficient knowledge.7
More than two-thirds of respondents were not homophobic (82.7%), while the remaining 17.3% were homophobic. A similar descriptive, cross-sectional study designed to investigate the effects of homophobia in Korean nursing students showed that 42.3% had highly homophobic responses, while 134 (50.6%) had low homophobic responses. Only 1 (0.4%) participant had a highly non-homophobic response.3
The result showed that the factors associated with the attitude of students towards LGBTIQ individuals were religion and caste of the respondent. Likewise, respondents’ families attitudes were also statistically significant. Respondents living in joint families had more positive attitudes (93.4%) than respondents living in nuclear families (84.8%). Other variable such as age, education level, fathers’ occupation, and family income showed no significant association with the attitudes of students towards LGBTIQ individuals. In bivariate analysis, factors associated with knowledge about homosexuality were religion, caste, education level, fathers’ occupation, and family.
The majority of students had a positive attitude towards LGBTIQ individuals, and few had a negative attitude. Almost half of the respondents had adequate knowledge about homosexuality. The majority of students were not homophobic and almost half had positive stereotypes. Religion, caste, and family type were statistically significant with the attitude of students towards LGBTIQ individuals. Age, education level, fathers’ education, and family income type show no significant association.
I would like to express my humble thanks to all those who have supported and aided in accomplishing this thesis.
First and foremost, I would like to express my sincere thanks to Nobel College for providing the opportunity to pursue this task as a partial fulfillment of the curriculum of the Bachelor’s Degree in Public Health.
I would like to express my sincere thanks to Ms. Amisha Bhattarai for her valuable support throughout the research process.
At the same time, I would like to express my earnest thanks and appreciation to all the BPH faculty members of Nobel College for their cooperation, suggestions, and continuous encouragement to complete this report. Equally, I would also like to thank the Institutional Review Committee of Nobel College for the ethical review and approval.
Last but not least, my thanks and appreciations go to the study participants and those who helped, encouraged, and supported me directly or indirectly to complete this thesis.
- 1.Aslam A F, Hulieta E I, Katon A B. (2022) Gender Construction in Southeast Asia Through a Social Constructivism Perspective. Insignia: Journal of International Relations. 9(1), 37-59.
- 2.PCI Green, Mead J F, Eckes S E. (2020) Covenants to Discriminate: How the Anti-LGBT Policies of Participating Voucher Schools Might Violate the State Action Doctrine. UNH L Rev. 19, 163.
- 3.Kwak H W, Kim M Y, Kim M Y. (2019) Severity and Influencing Factors of Homophobia in Korean Nursing Students. , International Journal of Environmental Research 16(23), 4692.
- 4.McEwing E. (2020) Delivering culturally competent care to the lesbian, gay, bisexual, and transgender (LGBT) population: Education for nursing students. Nurse Education Today. 1, 104573.
- 5.Lin H C, Lin Y C, Chang Y P, Lu W H, Yen C F. (2021) Attitudes toward Homosexuality among Nurses in Taiwan: Effects of Survey Year and Sociodemographic Characteristics. , International Journal of Environmental Research 18(7), 3465.
- 6.Della Pelle C, Cerratti F, P Di Giovanni, Cipollone F, Cicolini G. (2018) Attitudes Towards and Knowledge About Lesbian, Gay, Bisexual, and Transgender Patients Among Italian Nurses: An Observational Study. , Journal of Nursing 50(4), 367-74.