Measurement Co-Design and Content Validation of a Sexual Health Knowledge Measure With Transgender and Gender Expansive Youth

Sexual health education for transgender (trans) youth has rarely been studied and very few evidence-based gender-affirming sex education tools exist for this community. We describe a community-engaged approach to co-develop and content validate a sexual health knowledge measure for trans youth. In collaboration with a trans youth advisory board (YAB), we used a community-driven instrument development process to co-design a new sexual health knowledge measure to allow for trans-inclusive assessment of an online interactive sexual health education tool. Cognitive interviewing techniques were used to gather feedback on sexual health measures, considering overall importance, relevance, and understandability of the questions. The YAB was involved in decision-making around the measure throughout each phase. The co-design process yielded a final sexual health knowledge measure assessing the following content areas: puberty; STI prevention; fertility and pregnancy; contraception; desire and pleasure, and consent. YAB members worked closely with the research team to ensure that the resultant measure aligned with current terminology and topics important to trans youth. For researchers to develop studies that resonate with the lived experiences of participants and establish trust, community collaboration is critical.