Phase Two methods

Phase Two of the Trans Pregnancy Care Project received Ethics approval from Te Herenga Waka – Victoria University of Wellington's Human Ethics Committee in August 2022 (#0000029879). In this phase, we developed and carried out an online anonymous survey to assess the current knowledge, beliefs and clinical preparedness of health professionals in the perinatal workforce in Aotearoa New Zealand.

Survey design

The perinatal workforce survey was collaboratively designed with input from all research team members. SM wrote a first draft of the survey, on which SB, GP and AK gave iterations of feedback. We sent the first draft to our wider research team and our project’s parent advisor Scout Barbour-Evans and integrated their feedback. We also sought and received feedback from Gender Minorities Aotearoa, Intersex Aotearoa (ITANZ), Te Kāreti o ngā Kaiwhakawhanau ki Aotearoa: New Zealand College of Midwives, and Dr Edward Hyde (an obstetrics and gynecology consultant).

Our survey was structured in four sections: demographic information; what is currently happening in respondents’ community-based practices and institutional work settings; education and professional development on gender diversity; and individual knowledge and beliefs about gender and sexuality diversity. We considered the advantages and limitations of using validated scales to assess healthcare professionals’ knowledge, beliefs and clinical preparedness for working with trans people. After assessing the existing validated scales, we found that most were either irrelevant to our research questions and research context, or they included harmful language and stereotypes about trans people that we did not want to reinforce through our survey. They also did not reflect any consideration of Indigenous perspectives, a strong focus within our own research.

We decided to develop new questions directly relevant to our research questions and aims, given the unique perinatal care model in Aotearoa and our intentions to develop an educative and strengths-based survey. The questions in the survey were largely informed by the priorities and issues that interview participants named in Phase One. To finalise the survey questions, each research team member individually ranked their perceived importance and relevance of each item in a matrix, and then removed the least ranked items from the scale.

Questions included a range of response types. Some required a yes/no response with options for don’t know and prefer not to say as appropriate; others required a numeric or categorical response from a drop-down menu; while the majority of questions asked for responses on a Likert-type scale. These included five-point scales with options from never to frequently and from never to always, as well as questions that asked respondents to rate their agreement with statements using a five-point scale from strongly agree to strongly disagree. A number of questions provided the option for free-text responses in addition to the quantitative response.

Data collection

The final survey draft was loaded into Qualtrics and survey logic was used to create a survey flow that showed questions only relevant to participants based on their previous answers. The survey was translated into Te Reo Māori by kaimahi recommended by the Kaitohutohu Office (Māori research office at Te Kura Matatini ki Otago / Te Pūkenga) and participants could choose to take the survey in Te Reo Māori or English.

Before disseminating the survey, we asked eight colleagues, who had expertise in health but would not be eligible to take the survey, to test the survey for comprehension, timing, survey logic and general feedback. We then implemented this feedback where applicable.

People were eligible to participate if they were 18 years or older and were currently practising as a perinatal care provider in Aotearoa, defined in the survey as “provid[ing] care related to fertility, pregnancy, birth and the postpartum period (up to 6 weeks after birth) to people in Aotearoa NZ”.

We sent an invitation to take the survey to various professional bodies, organisations, and individuals related to perinatal care in Aotearoa, as well as posting about the survey on our social media pages. Various professional organisations agreed to share the invitation to participate with their membership. These included Te Kāreti o ngā Kaiwhakawhanau ki Aotearoa: New Zealand College of Midwives (NZCOM); Royal Australian and New Zealand College of Obstetricians and Gynaecologists (through their newsletter Pānui); Perinatal Society of New Zealand; Physiotherapy New Zealand; Royal New Zealand College of General Practitioners; Ngā Maia - Māori Midwives Aotearoa; Pasifika Midwives Association. The invitation was also shared on social media by other supporting organisations including Women’s Health Action Trust and Parents Centre.

Data analysis

Three respondents started the Te Reo version of the survey but two switched to the English version. The third person’s data was removed during data cleaning due to no data added beyond the demographics. All analysis was therefore conducted from the English version.

Data was extracted from the Qualtrics platform after removal of duplicate entries. It was then anonymised by the Research Assistant who had signed a confidentiality agreement. Data was uploaded into IBM SPSS Statistics (Version 28.0.1.0) and cleaned by removing data from respondents who had not progressed past the demographic questions.

The remaining data set comprised 476 respondents. Data was analysed to produce descriptive statistics such as frequency tables and, as appropriate, means and standard deviations. The qualitative responses within the survey were summarised to present key content areas and illustrative comments were included in the findings.