研究背景
性傾向及性別身份和其他社會身份相似，與健康、社會正義及經濟狀況存在相關性。因此，調查性傾向及性別身份可以提供有效的資訊。然而，調查性傾向及性別身份存在相當的挑戰，因為性及性別身份會隨著時間改變，並且受到社會文化影響。目前，如何有效測量性傾向及性別身份尚沒有共識，因此，建立標準化且具有效度及再現性的性傾向及性別身份測量工具有其必要性。
研究目的
本研究的目標是建立一個具有效度的中文工具以測量性傾向及性別身份，並期待未來可以利用此工具調查性傾向、性別認同及性別氣質的變化，以及對於健康狀態的影響，至少能運用於臺灣。
研究方法
本研究先以現有國外進行健康調查所使用的性傾向、性別認同及性別氣質題目為基礎，進行雙向翻譯，接著邀請專家評分，確認內容效度。第二部分，本研究透過線上平台招募受試者，納入不同的性別身份族群以最佳化了解問卷應用於臺灣族群的情形。在線上招募時初步將受試者分為跨性別組及順性別者，順性別者依照性傾向再分為異性戀男性、異性戀女性、男同性戀、女同性戀、雙性戀及其他性少數6個組，目標是每一個組別納入2位受者，亦即總共14位受試者參與本研究。願意參與的受試者由研究人員依照性別族群逐一邀請進入研究，所有的受試者需先自行填寫一份包含基本資料及性別身份問題的問卷，完成後隨即進行認知負荷晤談，以了解受試者先前在問卷填寫過程遇到的問題，以及問卷題目如何反應出個人的性別身份。訪談過程全程錄音，由訪員將語音資料彙整成文字資料，透過編碼分析歸納，逐步釐清不同性別族群在填答性別身份相關問卷時的情形，並進行問題修正提高臺灣族群的適用性。另外，訪談過程有四位評分員參與，負責針對受訪者的性別氣質進行額外的評分，比較自填性別氣質分數與他人觀點的性別氣質分數一致性。
研究結果
因為部分受試者在研究過程中更改答案，本研究共招募16位受試者，分別為7位順性別異性戀者及9位性及性別少數族群。順性別異性戀及性別少數族群在人口學上的差異並沒有達到統計顯意義。性傾向的三個面向研究顯示，受試者中有90%的生理女性曾被同性吸引的經驗，而生理男性僅有50％。曾與同性發生性行為的比率為31.2%，相較於曾被同性吸引的比率為低。在性別氣質的評分部分，自評他人對自己性別氣質的描述與實際由他人描述的性別氣質有中度至良好的一致性，在外表風格項目為的相關係數為0.81（良好的一致性，95% 信賴區間：0.47, 0.93），在舉止項目的相關係數為0.67（中度的一致性，95% 信賴區間：0.01, 0.89）。 認知負荷晤談分析顯示，雖然順性別異性戀族群不理解跨性別者的意思，該族群的受試者仍能正確填寫自己的性別認同。受試者在性傾向的三個項目存在不一致性及相關性。曾被同性吸引的受試者未必會認同自己是性別少數族群，部分受試者受到性傾向吸引題目的影響，而改變其性傾向認同的答案。幾乎所有的受試者皆能理解題目及選項含義，然而部分受試者認為追蹤問題的說明語意不清楚，影響填答。有些性別少數受試者亦針對選項當中的男性、女性所包含的是生理性別還是性別認同提出疑慮。整體而言，受試者對於性別身份問題是否應納入大型健康調查持中立至正面的態度。
結論
性傾向、性別認同及性別氣質的問題受到社會文化情境的影響，在問題的理解上，與西方社會存在差異。依據認知負荷晤談分析結果，本研究針對問卷用字進行了修正。整體而言，本研究所發展出之修正後的中文問卷至少可以應用在臺灣族群。

Background
The implementation of public policy relies on high-quality scientific data. One’s sexual and gender identities resemble other social identities which are related to health, social justice, and economic status. Some gender minorities are in poorer well-being, lower socioeconomic status, or even lower educational status resulting from social stigma, discrimination, and minority stress. Consequently, measuring sexual orientation and gender provides information on health disparities such as access to health care, the quality of care, the relation between health risk factors, and the prevalence of the disease. However, sexual orientation and gender may change over time, shift in different contexts, have multiple dimensions, and be affected by society and culture resulting in the challenges of investigation. To date, a consensus has not yet been reached. Therefore, standardized validated measurement tools should be developed.
Objectives
The objective of this study is to construct a validated sexual orientation and gender measurement tool in Chinese that can be applied to Taiwanese at the very least.
Method
We selected questions of sexual orientation, gender identity, and gender expression from questionnaires used in previous studies and translated them into Chinese. An expert panel validated the translation, and the content validity index (CVI) was caculated. Candidates willing to participate in the research were recruited from social platforms or online LGBTQ+ communities. Initial screening separated them into a transgender group and six cisgender groups, including heterosexual females, heterosexual males, lesbians, gay men, bisexual people, and other gender minorities. In order to demonstrate major concerns in a pretest questionnaire, we selected candidates from variant demographic backgrounds from the seven gender groups. Two individuals from each gender group were invited sequentially to yield a targeted sample size of 14 to complete the translated questionnaire. After participants filled out the translated questionnaire, the interviewer carried out cognitive interviews immediately to assess participants’ experiences of completing the questionnaire. We then utilized MAXQDA to analyze the performance of sexual orientation and gender questions. In addition, to assess the consistency between self-rated gender expression and gender expression from a bystander perspective, four raters rated the masculinity and femininity of each participant independently during the interview process. Intra-class correlation coefficient (ICC) was used to examine the self-rated gender expression and gender expression from a bystander perspective.
Results
A final sample of 16 participants was recruited due to the fact that some of the participants changed their sexual identity during the study. Cognitive interviewing analysis confirmed that those who changed their sexual identity after initial screening were affected by the sexual attraction question. Results showed that gender minorities were significantly younger and had a higher educational level. Regarding the three dimensions of sexual orientation, 12 (85.71%) of the participants reported some form of same-gender/sex attraction with only 8 (57.14%) choosing to maintain an LGBQ+ identity. A relatively confined group with four participants (28.57%), reported same-sex behavior in the past five years. That is, participants experiencing same-gender/sex attraction might not identify as LGBQ+ or experienced same-sex behavior. In terms of gender expression items, the appearance item demonstrated good agreement (ICC = 0.81) while the mannerisms item showed only moderate agreement (ICC = 0.67). However, a wide range of confidence intervals (CIs) was observed in both appearance (95% CI: 0.47, 0.93) and mannerisms items (95% CI: 0.01, 0.89). The cognitive interviewing process disclosed several concerns about gender and sexual orientation questions. Response patterns of gender minorities were different from those of sexual and gender majorities. In addition, gender minorities interpreted terms related to sexual orientation and gender disparately. In the context of the gender identity question, although cisgender heterosexual participants were unable to define the term “transgender,” they generally labeled their gender identity correctly. Answers to the sexual orientation questions indicated that all participants could understand the terms in the question stems and response options. However, some participants reported that instructions for follow-up questions were vague. The aspects related to the terms “male” and “female” were also discussed by participants. In general, participants took neutral to positive attitudes regarding whether sexual orientation and gender questions should be included in health surveys.
Conclusions
This study observed complexities associated with measuring sexual orientation, gender identity, and gender expression in the Taiwanese context. The result of cognitive interviewing showed discrepancies in interpretation between the gender majorities and minorities. As several concerns in assessing these concepts were discovered, minor revisions in terms of the wording were made to improve its applicability. In conclusion, the questionnaire was able to capture the sexual orientation and gender of the participants and the revised version of the questionnaire can be applied to investigate sexual orientation and gender in Chinese-speaking populations, in Taiwanese at least.

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