# The ATHENA Study: Evaluating the impact of an educational intervention on Greek midwives’ knowledge and attitudes toward LGBTQ+ reproductive and perinatal care

## TL;DR

A 3-hour educational session improved Greek midwives' knowledge and attitudes toward LGBTQ+ care, with most improvements lasting six months.

## Contribution

Demonstrates the effectiveness of a brief educational intervention in improving midwives' attitudes and knowledge about LGBTQ+ reproductive and perinatal care.

## Key findings

- Midwives showed significantly more positive attitudes toward LGBTQ+ individuals after the intervention, with improvements sustained at 6 months.
- Knowledge scores increased significantly and remained higher at the 6-month follow-up.
- Affirmative practice scores improved immediately after the intervention but not at the 6-month follow-up.

## Abstract

Inclusive reproductive and perinatal midwifery care for LGBTQ+ individuals requires adequate knowledge and positive attitudes. This study evaluated the impact of a structured educational intervention on Greek midwives' short- and long-term knowledge, and attitudes toward LGBTQ+ individuals and related health issues.

A longitudinal pre- and post-intervention study was conducted within the ATHENA Study in Greece. Seventy midwives attended a 3-hour, small-group session combining lecture, case-based discussion, and group dialogue on inclusive and gender-affirming care. Knowledge and attitude scores (reflecting attitudes toward LGBTQ+ individuals and patients) were assessed at baseline, post-intervention, and follow-up at 6 months, using the Greek PKSGMH survey. Analyses used Friedman’s test with Bonferroni correction (p<0.05).

Data from 70 midwives (mean age 42.1 years, 97.1% women) were analyzed. Most were heterosexual (87.1%), married (62.9%), and had LGBTQ+ acquaintances (75.7%); only 18.6% had prior training. Post-intervention attitude scores toward gay men and lesbians decreased significantly (p=0.016 and p=0.011), indicating more positive attitudes, with improvements sustained at 6 months (p>0.999). Attitudes toward transgender people improved (p=0.034), remaining stable (p>0.999). Total and patient specific attitude scores decreased post-intervention (p=0.003 and p<0.001), sustained at follow-up (p>0.999). Knowledge scores increased (p=0.048 and p<0.001) and remained higher at 6 months (p=0.011 and p<0.001). Affirmative practice scores improved post-intervention (p=0.043) but not long-term (p=0.189).

A brief educational intervention significantly improved midwives’ knowledge and attitudes toward LGBTQ+ individuals, with most effects sustained for six months. Embedding LGBTQ+-inclusive education in midwifery programs is essential for equitable reproductive and perinatal care.