Polish validation of the LGBTQ+ Healthcare Experiences Scale (LGBTQ+ HCES)

The Lesbian, Gay, Bisexual, Transgender, and Queer individuals frequently encounter disparities in healthcare access, quality and inclusivity. Despite growing awareness of these challenges, Poland has lacked a psychometrically validated tool to assess the experiences of sexual and gender minorities in clinical settings. This study aimed to develop and validate the LGBTQ+ Healthcare Experiences Scale (LGBTQ+ HCES) tailored to the Polish context. A multi-phase cross-sectional study was conducted in 2025. The initial pool of items was developed through a narrative literature review and refined by 4 researchers with clinical and academic experience in LGBTQ+ health. Content validity was assessed using a 2-round Delphi process involving a multidisciplinary panel of experts (n = 12), who rated item clarity and relevance using Aiken's V. A pilot test with 30 LGBTQ+ participants confirmed comprehension and technical usability. The final 15-item instrument, comprising 3 subscales (Respect and Inclusivity, Discrimination and Microaggressions, Trust and Comfort), was administered to 172 LGBTQ+ individuals recruited via social media. Psychometric evaluation included descriptive analysis, confirmatory factor analysis (CFA) and reliability testing (Cronbach's á, McDonald's ů). Confirmatory factor analysis supported a 3-factor model comprising Respect and Inclusivity, Discrimination and Microaggressions, and Trust and Comfort. Model fit indices met recommended thresholds (root mean square error of approximation = 0.041, standardized root mean square residual = 0.057, comparative fit index = 0.998). All subscales demonstrated acceptable to strong internal consistency (á = 0.745-0.778; ů = 0.92). No significant floor or ceiling effects were found to compromise the scale's performance. All items showed positive item-total correlations and contributed meaningfully to their respective subscales. The LGBTQ+ HCES is a valid, reliable and culturally grounded instrument for assessing healthcare experiences among LGBTQ+ populations in Poland. It holds promise for research, public health surveillance and health system quality improvement efforts to promote inclusive and equitable care.