Measuring Stigma In the Gender-Affirming Care Workforce: Adaptation and Validation of a Provider Stigma Scale

Background and Purpose

Amid increasing politicization of gender-affirming care in the United States, providers—particularly those serving children and adolescents—face escalating stigma, harassment, and institutional constraints. While prior research has qualitatively documented these experiences, no validated measure exists to assess stigma among providers of gender-affirming care. This gap limits the ability of social work and interdisciplinary health services researchers to quantify workforce challenges, identify providers at risk of burnout or attrition, and develop interventions to sustain access to care. This study aimed to adapt and preliminarily validate a measure of provider stigma for use among pediatric gender-affirming care providers, drawing on the Revised Abortion Providers Stigma Scale (APSS).

Methods

We adapted the APSS (Martin et al., 2017), a 35-item, five-factor scale assessing stigma across domains of disclosure management, internalized stigma, judgment, social isolation, and discrimination. Items were modified to reflect gender-affirming care contexts, and a reduced 15-item version (three items per factor) was tested for feasibility. Providers were recruited via professional listservs, clinical networks, and snowball sampling. Eligible participants were U.S.-based clinicians (including physicians, social workers, nurse practitioners, and therapists) who had provided gender-affirming care within the past five years. Of 427 providers contacted, 172 responded (40% response rate). Confirmatory factor analysis (CFA) assessed model fit. Internal consistency was evaluated using Cronbach’s alpha, and convergent validity was examined through associations with job satisfaction, burnout, intention to leave the field, and commitment to continued practice.

Results

CFA supported a stable 14-item, five-factor solution following removal of one cross-loading item. Model fit indices indicated good fit (RMSEA=0.048, CFI=0.973, TLI=0.963, SRMR=0.056). The chi-square statistic was marginally significant (p=.038), consistent with sensitivity to sample size. Internal consistency across subscales ranged from 0.67 to 0.89. Convergent validity analyses demonstrated significant associations between stigma scores and job satisfaction, burnout, intention to leave the field, and commitment to continued practice, supporting the construct validity of the adapted scale.

Conclusions and Implications

Findings suggest that this adapted measure is a promising tool for assessing stigma among pediatric gender-affirming care providers. For social work research and practice, the ability to systematically measure provider stigma is critical for understanding workforce sustainability, particularly within interdisciplinary teams delivering care to marginalized populations. These findings highlight stigma as a measurable, system-level factor shaping provider wellbeing and retention, with implications for access to gender-affirming services. Social workers—who often play key roles in care coordination, advocacy, and organizational leadership—are uniquely positioned to address these challenges through workforce support interventions, policy advocacy, and organizational change efforts. Future research should further validate this measure in more diverse samples and examine its utility in informing multilevel interventions to mitigate stigma and strengthen the gender-affirming care workforce.