Lost in Translation: Collecting Data on Sexual Orientation
New research explores patterns of non-response to sexual orientation questions.
Posted Jun 29, 2020
Measuring sexual orientation in research can be challenging. The likelihood of participants responding accurately can change based on how the question about sexual orientation is worded.
For example, if you include the now-outdated term "homosexual" as an option, gay men and lesbian women may opt for the “other” box, because they don’t identify with the term homosexual and may even find it offensive. Often there is more to someone's orientation than a quick label. Identities, behaviors, relationship statuses, and attractions don't always align. One study found that while roughly 2.5 percent of respondents indicated that they experienced attraction to members of the same sex, nearly double the number of respondents reported same-sex sexual experiences.
The general solution is to ask about sexual identity, behavior, and attraction, as well as current relationship status and gender of partner(s) in order to get a well-rounded picture of the diverse facets of an individual’s sexual orientation. However, in many population health studies, this isn’t always possible given strict limitations on survey length.
But even if you include multiple questions, there’s still the possibility that some participants will choose not to respond to any of them. A recent study published in the Journal of Sex Research sought to explore patterns associated with participants avoiding questions concerning sexual orientation in survey research. Using data from nine cycles of Statistics Canada’s Canadian Community Health Survey (CCHS) collected between 2005 and 2014, researchers from Quebec explored demographic patterns associated with non-response to sexual orientation questions. In the past, non-response has often been assumed to be related to people not wanting to disclose their sexual identity on a survey; however, the researchers in this study wanted to explore other potential explanations, such as associations with culture or language.
The CCHS is a survey conducted by Statistics Canada to assess the population’s health status, health care utilization, and a variety of determinants of health. Participants are contacted by phone to complete a computerized survey that is available in a wide range of languages, given Canada’s multicultural population.
The CCHS has included a question about sexual orientation since 2003, using a single item that provides participants with the options of heterosexual (straight), gay man, lesbian, or bisexual. Participants can indicate that they don't know the answer or do not want to respond. The researchers were interested in learning more about the participants who indicated they didn't know or did not want to respond to the sexual orientation question.
Changes in Sexual Orientation Responding Over Time
Although the time period studied—2005 to 2014—has seen the advancement of LGBTQ rights and acceptance in Canada, the researchers did not find a significant change over time in the number of respondents who did not answer the sexual orientation question on the CCHS, with anywhere from .87 percent to 1.4 percent not responding. The non-response rate was higher among immigrants than non-immigrants, but the degree to which it was higher remained stable across all time points. Roughly the same percentage of participants identified as gay or lesbian over the years, but self-identification as bisexual has increased from 2005 to 2014. Overall, roughly 2.3 percent of the participants in the CCHS survey from 2004 to 2014 identified as being lesbian, gay, or bisexual.
Predictors of Not Providing a Sexual Orientation Response
Although immigrants were more likely to say they didn’t know the answer or didn’t want to answer the question about sexual orientation, the difference between immigrants and non-immigrants reduces the longer an immigrant has lived in Canada. The researchers also explored cultural group affiliations and found that individuals who self-declared being Chinese, South Asian, Southeast Asian, Arab, West Asian, Aboriginal, or other were more likely to be non-responders to the sexual orientation question when compared to individuals who self-identified as White. Other factors that predicted a greater likelihood of non-response included being a woman, older, less educated, answering the survey in English (as opposed to French), or being in a relationship.
Unfortunately, the brief nature of the Statistics Canada CCHS survey does not allow for greater insight as to the reasons why participants do not respond to the sexual orientation question. The authors of the study speculate that there could be a wide variety of reasons, including not understanding the question or being familiar with the terminology used by Statistics Canada, holding an identity not listed on the survey (e.g., queer), or language barriers.
The response options may appear particularly challenging to trans and non-binary individuals, as straight, gay, lesbian, and bisexual all depend upon a binary interpretation of gender, and thus preclude an accurate response option for anyone who does not identify within the gender binary.
Whatever the reasons for non-disclosure of identity on the CCHS, the ultimate consequence may be that the survey is not accurately reflecting the health experiences of sexual and gender minorities in Canada. This can be an important oversight to consider, given that past research has found that up to 10 percent of gay men and lesbian women do not disclose their sexual identity to their health care providers, and more than one in every three bisexual men and women do not disclose. A lack of discourse within a health care setting is often the result of LGBTQ individuals feeling that their sexual or gender identity will not be properly understood or respected, and thus can serve as a barrier to accessing culturally competent health care.
While the questions used by Statistics Canada may need to be updated over time to provide a more exhaustive and inclusive list of options, the general trends from the CCHS do not suggest that the sexual orientation question is "too controversial" to be included in national health studies. The authors of the JSR article suggest that more researchers include sexual orientation questions in their research in order to improve the availability of health research data to inform our understanding of LGBTQ health disparities.
Brabete, A. C., Doray-Demers, P., & Vissandjée, B. (2020). Where Sexual Orientation Has No Name: Sexual Orientation Missing Data in the Canadian Community Health Survey (2005-2014). The Journal of Sex Research, 1-8.
Hoskin, R. A., Blair, K. L., & Jenson, K. E. (2016). Dignity versus diagnosis: Sexual orientation and gender identity differences in reports of one’s greatest concern about receiving a sexual health exam. Psychology & Sexuality, 7(4), 279-293.
Galupo, M. P., Mitchell, R. C., Grynkiewicz, A. L., & Davis, K. S. (2014). Sexual minority reflections on the Kinsey Scale and the Klein Sexual Orientation Grid: Conceptualization and measurement. Journal of Bisexuality, 14(3-4), 404-432.
Geary, R. S., Tanton, C., Erens, B., Clifton, S., Prah, P., Wellings, K., ... & Johnson, A. M. (2018). Sexual identity, attraction and behaviour in Britain: The implications of using different dimensions of sexual orientation to estimate the size of sexual minority populations and inform public health interventions. Plos one, 13(1), e0189607.