Determining the Relationship Between People's Explicit and Implicit Preferences for Gender-Inclusive Sexual and Reproductive Health Content: Randomized Controlled Trial.

Background: Inclusive health education content has been shown to increase acceptability and accessibility for lesbian, gay, bisexual, transgender, queer, intersex, and asexual, as well as other sexual and gender minority (LGBTQ+) individuals. However, there has been some backlash among general audiences, with claims that such inclusive content is "woke" or otherwise problematic. Objective: The goal of this study was to test whether individuals across the political spectrum notice when sexual and reproductive health content is written with inclusive language in order to demonstrate the acceptability of inclusive content to a broader audience. Methods: This study included 454 adults assigned female at birth from the United States, one-third of whom identified as LGBTQ+, reviewed 2 sets of reproductive health educational handouts designed for adolescents, with 1 gender-inclusive and 1 gender-specific version in each set, randomized in order. Individuals were asked to rate each document and state a preference within each pair (implicit preference). They were then debriefed on the study's purpose and asked if they had an explicit preference for gender-specific or gender-inclusive content. Results: Preferences for explicit content tended toward gender-specific content: always gender-specific (n=184, 40.5%), sometimes gender-specific (n=59, 13%), no preference (n=131, 28.8%), sometimes gender-inclusive (n=39, 8.6%), and always gender-inclusive (n=41, 9%). However, most people (n=273, 59%) did not notice differences between the first pair of documents they viewed or rate them differently (mean difference -0.19, SD 2.17, range -10 to 12). Furthermore, the majority of individuals who had a stated preference for gender-specific health education documents did not choose the gender-specific document as their preferred version for either the first (n=45, 24%) or second pair of documents (n=69, 38%). Individuals who preferred content to always be gender-inclusive were significantly more likely to choose the concordant version of their document (n=20, 49% for the first pair; n=24, 58% for the second pair). A total of 58% (n=262) of the participants stated they did not notice the study design until the debrief. Conclusions: Most participants did not notice when sexual and reproductive health educational content had been made gender-inclusive-even when they had an explicit preference for gender-specific content. This suggests that when inclusive language is not directly called to readers' attention, inclusive sexual and reproductive health content is broadly acceptable to individuals across a range of political beliefs. The use of inclusive language may therefore be a means of increasing the accessibility and applicability of educational materials to diverse recipients, including LGBTQ+ individuals.