Knowledge, affirmativeness, and experience as factors associated with self-efficacy in LGBTQ+-affirmative services for individuals with IDD.

Introduction: Lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) individuals with intellectual and developmental disabilities (IDD) experience compounded discrimination stemming from the intersection of disability and sexual and gender minority identities. Direct support and service-providing professionals (DSPs) play a critical role in shaping inclusive service environments; however, perceived lack of competence may contribute to the avoidance of sexual identity-related topics and unmet support needs. Despite the importance of affirmative practice within disability services, limited research has examined factors associated with DSPs' self-efficacy in providing LGBTQ+-affirmative services and care to individuals with IDD. Methods: Guided by Bandura's self-efficacy theory, this cross-sectional study examined self-efficacy among 114 DSPs working with individuals with IDD, including special educators, teachers, recreational and occupational therapists, nurses, social workers, psychologists, and behavioral professionals and identified factors associated with variability in perceived competence. Participants completed adapted versions of the Lesbian, Gay, and Bisexual Affirmative Counseling Self-Efficacy Inventory and the Lesbian, Gay, and Bisexual Knowledge and Attitudes Scale. Correlation and hierarchical multiple regression analyses were conducted to examine associations between LGBTQ+-related knowledge, attitudes, experience, and self-efficacy. Results: LGBTQ+-specific knowledge demonstrated the strongest and most consistent associations with self-efficacy across domains. In multivariable analyses, knowledge emerged as the strongest independent correlate of self-efficacy, followed by prior experience working with LGBTQ+ individuals with IDD. General training specific to working with individuals with IDD alone was not associated with higher self-efficacy. Affirming attitudes were positively associated with self-efficacy, but this association weakened when knowledge and experience were included. Discussion: These findings highlight the domain-specific nature of self-efficacy in LGBTQ+-affirmative practice and stress the importance of targeted, intersectionally-informed training that integrates knowledge development with experiential learning. Strengthening DSPs' perceived competence may contribute to more inclusive service-providing settings and improved well-being for LGBTQ+ individuals with IDD.