Face Validity of Measures of Sexual Orientation and Family Functioning Among Hispanic Sexual Minority Youth

Abstract

Measures of sexual orientation and family functioning are widely used among sexual minority populations. However, data on whether these measures are culturally syntonic and responsive to the needs of a particular population, such as Hispanic sexual minority youth (HSMY), are lacking. Therefore, this study assessed whether HSMY understand measures of sexual orientation and family functioning as intended. Authors conducted individual interviews with five HSMY to evaluate the face validity of a measure of sexual orientation (i.e., Klein Sexual Orientation Grid) and measures of family functioning (i.e., Parent–Adolescent Communication Scale, Parenting Practices Scale, Parental Monitoring of Peers). Data were analyzed using a general inductive approach. For the sexual orientation measure, five themes were identified related to the: (1) clarity of questions, (2) challenging nature of questions, (3) difficulty of responses, (4) suggestions to improve response options, and (5) need for questions to include gender identity. For family functioning, three themes were identified: (1) relevance of the measures to sexual minority youth, (2) the importance of understanding family history and cultural context, and (3) capturing the context of how sexual minority status and disclosure impact family functioning. HSMY had generally positive feedback regarding these measures; however, they also suggested specific changes associated with wording and specificity of the measures to make them more relevant to HSMY’s unique needs.

1. Introduction

Sexual orientation and family functioning are important constructs to measure among sexual minority populations such as Hispanic sexual minority youth (HSMY). Measuring sexual orientation requires a multidimensional approach wherein the various conceptualizations of sexual orientation (e.g., identity, attraction, behavior) are evaluated due to their distinct nature and ability to elucidate different patterns of health outcomes across dimensions of sexual orientation assessed (behavior, identity, attraction [1]). Although there are existing measures of sexual orientation used among youth to capture the multiple dimensions of sexual orientation, certain populations, such as HSMY, may interpret these questions differently than they were intended to be understood [2]. Moreover, cultural context and understanding of sexual orientation have vastly changed in the past several decades [3], and definitions of sexual orientation may also consequently change over time. Therefore, established measures of sexual orientation, such as the Klein Sexual Orientation Grid (KSOG), may require reimagining (to more accurately measure) for contemporary understandings of sexual orientation, particularly for youth who are identifying with sexual orientations not based on the binary construction of gender [2]. For example, current conceptualizations of sexual orientation fail to capture identity labels such as pansexual, queer, and fluid [4].

This is particularly true for HSMY, who live at the intersection of several marginalized identities as sexual, ethnic, and, at times, racial minorities. Intersectionality theory posits people are often marginalized by multiple, intersecting sources of oppression related to their own salient identity markers (e.g., sexual orientation, race/ethnicity, cultural values/beliefs), and that this in turn shapes health outcomes and well-being [5]. These multiple-minoritized youth may not understand questions on mainstream measures of sexual orientation and subsequently skip questions due to language barriers and/or different cultural constructions of sexual orientation stemming from their country of origin [6]. Moreover, it may be that adherence to Hispanic cultural values (e.g., familismo, machismo, and marianismo) upheld by Hispanic parents may limit youths’ exposure to sexual orientation-related terminology [7]. For example, prior research among Hispanic youth in South Florida indicated that a multidimensional measure of sexual orientation was noninvariant across nativity (i.e., US-born and foreign-born) among this minoritized group [2]. This suggests that measures of sexual orientation are not being interpreted in the same way by US born and foreign-born Hispanic youth, warranting further investigation as to why these measures are not equivalent between the two groups. Accurate measurement of sexual orientation is paramount, given the significant health disparities that exist between non-sexual minority youth and sexual minority youth (SMY) in regard to substance use, risky sexual behavior (e.g., condomless sex, multiple sex partners, early sex initiation), and depressive symptoms [8,9,10]. Inaccurate measurement of sexual orientation may therefore lead to inaccurate results and erroneous conclusions pertaining to these health outcomes and subsequently compromise prevention efforts [2,11].

Family functioning behaviors, such as parent–adolescent communication, parental monitoring of peers, parental investment, and positive parenting, are central to human development across the lifespan. These behaviors are also associated with adolescent substance use, risky sexual behavior, and depressive symptomatology [12,13,14]. Assessing family functioning is critically important in understanding the risk and protective factors associated with HSMYs’ adverse health outcomes. In fact, although measures of family-level variables are frequently utilized by sexual minority populations such as HSMY, most were created for the general population and not SMY specifically, limiting the measures’ ability to truly capture the unique needs of HSMY [15,16]. Moreover, prior work has found that non-HSMY-specific measures of family functioning do not perform equivalently among HSMY and heterosexual Hispanic youth. [17] Measures of family functioning may have different meanings for HSMY compared to non-HSMY, potentially due to ingrained cultural and gender norms that exist within Hispanic families relative to non-Hispanic SMY [18].

Hispanic parents may have negative attitudes toward sexual minorities due to cultural and religious factors that may not align with acceptance of HSMY within their communities [19]. Family rejection of HSMY often reflects a complex interplay of cultural values, religious teachings, and broader societal norms [20,21]. Within many Hispanic families, strong familism values promote loyalty and unity. Despite strong familism values, traditional beliefs around gender roles and sexuality, often informed by religious teachings, can create internal conflicts [22]. For example, while the Catholic Church advocates for compassion toward LGBTQ+ individuals, family members may still struggle to reconcile these teachings with entrenched social norms, sometimes leading to tension, alienation, or conditional acceptance.

Negative family functioning behaviors, such as lack of support and poor communication, that may emerge as a result of HSMYs’ disclosure of their sexual orientation and their parents’ subsequent attitudes and behaviors can perpetuate health disparities in substance use, sexual risk-taking, and depressive symptoms [23]. Thus, measurement of family functioning variables such as parent–adolescent communication, parental monitoring of peers, parental investment, and positive parenting is particularly important for HSMY. Considering that most measures of family functioning were not specifically developed for SMY or HSMY, it is necessary to ascertain whether these are valid and practical measures for use with HSMY to inform behavioral and sexual health prevention efforts.

To effectively work across different populations, measures of sexual orientation and family functioning should be culturally syntonic such that they are responsive to the needs and lived experiences of a particular population while also maintaining face validity [24]. Defined as the extent to which a test is subjectively viewed as covering the concept it purports to measure, face validity is crucial when assessing the utility of any measurement tool [25]. Therefore, the purpose of this study was to assess the face validity of several existing measures of sexual orientation and family functioning among HSMY. This study utilized cognitive interviewing to evaluate the extent to which measures of sexual orientation (i.e., Klein Sexual Orientation Grid [26]) and family functioning (i.e., Parent–Adolescent Communication Scale [27], Parental Monitoring of Peers [28], and Parenting Practices Scale [29]) were perceived by HSMY as covering the concepts they are purported to measure.

2. Materials and Methods

2.1. Participants and Procedures

Participants included five HSMY who participated in individual cognitive interviews. HSMY were recruited from a consent-to-contact database of participants who had enrolled in prior studies [30,31]. Youth were eligible to participate if they (1) were between 13 and 17 years old at the time of the interview; (2) self-identified as being attracted to an individual of the same sex or both sexes, reported same-sex behavior or behavior with both sexes, and/or identified as gay, lesbian, or bisexual; and (3) were of Hispanic origin, as defined by having one parent born in a Latin American country.

Table 1. Sociodemographic characteristics for interview participants.

Variable	Overall Sample N = 5
Age M (SD)	17 (0.00)
Gender N (%)
Male	1 (20)
Female	3 (60)
Non-binary	1 (20)
Country of Origin N (%)
U.S.	3 (60)
Foreign-born	2 (40)
Time in U.S. N (%)
Less than 3 years	0
Between 3 and 10 years	1 (20)
More than 10 years	4 (80)
Sexual Orientation N (%)
Bisexual	2 (40)
Lesbian	2 (40)
Gay	1 (20)

highlights relevant participant characteristics.

Recruitment took place from October 2022 to January 2023 in Miami-Dade County, Florida. A pre-screening process was used to determine whether potential participants met the inclusion criteria. Eligible participants were contacted via phone and asked if they would like to participate in a one-time interview. Participants received USD 40 for completing the interview.

2.2. Ethical Considerations

All phases of this study were approved by the University of Miami Institutional Review Board (Approval #20220643, Approval Date: 25 July 2022). We first obtained written parental consent from the parents of participating youth since they were under 18. Once parents provided consent for their youth to participate, we obtained informed assent from the youth. Given that participants were under the age of 18, a team member was present throughout the informed consent/assent process. Participants were reminded that their participation was voluntary, and thus, they were free to withdraw at any time. Participants were provided a study description and could ask questions to alleviate concerns. Furthermore, to guard against potential issues with study understanding, interviewers asked youth participants to describe the study back to them before proceeding with the interviews.

Participant responses/statements were not linked to their identity, and all identifiable electronic data was maintained on an encrypted device requiring a password for access. Qualitative data (i.e., audio files and transcription files) were deidentified and only available to study staff. Participants were asked not to use their real names and instead to identify themselves by numbers or pseudonyms to protect their confidentiality and safety. De-identified data were stored until all study analyses and publications were complete, and audio files were destroyed once they were transcribed.

3. Measures

3.1. Sexual Orientation

Each adolescent participant was shown the Klein Sexual Orientation Grid [26]. Questions were related to present self-identification with respect to attraction, behavior, identity, emotional connection, and fantasies on a 7-point scale, ranging from “heterosexual only” to “homosexual only”.

3.2. Family Functioning

Youth were presented four family functioning measures that captured parent–adolescent communication, parental involvement, positive parenting, and parental monitoring of peers. Parent–Adolescent Communication [27] is a 20-item measure that asked youth how they communicate with their primary caregiver, for example, “My primary caregiver is always a good listener” and “I am very satisfied with how my primary caregiver and I talk together”. For all items, youth rated each item on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Two subscales from the Parenting Practice Scale [29], parental involvement (11 items) and positive parenting (6 items), were shown to youth. Parental involvement items included the following: “How often did your primary caregiver talk with you about how things are going in school?” and “How often do you and your primary caregiver do things together at home?” Positive Parenting asked youth questions such as the following: “When you have done something that your primary caregiver likes or approves of, how often does your primary caregiver say something nice about it; praise or approval?” Parental monitoring of peers [28] was assessed with six items that asked youth questions such as the following: “How often during a typical week do your parents spend time talking with you about your friends?” and “How well do your parents know your best friends?”

4. Interviews

A semi-structured interview guide was developed by the first and last authors to assess the face validity of existing measures of sexual orientation and family functioning. The interview guide was developed based on cognitive interviewing principles, which examine how participants understand, mentally process, and respond to surveys (i.e., measures of sexual orientation and family functioning [32]). We presented participants with the measures of sexual orientation and family functioning and asked about their general thoughts (e.g., “What did that question mean to you?”, “Was it easy to understand, or did you think it might have meant something else?”). We probed participants on how to make the questions more relevant to HSMY and their unique experiences. Best practice indicates that cognitive interviews should be conducted iteratively to allow for the organic revision of questions and elimination of problems (e.g., problematic wording/response options) with presented questions throughout the data collection period [32]. These processes typically require between 5 and 15 interviews to achieve these analytic goals [32,33]. The cognitive interviews were conducted via Zoom [34], lasted about 60 to 90 min, were all conducted in English (at the participants’ preference), and were audio-recorded and transcribed. Although transcripts were not returned to participants and no repeat interviews were carried out, participants were given the opportunity to reach out to the interviewer to provide additional comments after the interview.

4.1. Research Team

The first author conducted all interviews and had significant training in qualitative research methods. The interviewer was a Hispanic doctoral candidate and in a position to understand Hispanic values and beliefs based on lived and research experience. Although the interviewer did not identify as a sexual minority, she has extensive experience working with HSMY in prior qualitative studies [7,35]. To balance these positionalities, the study design and interview guide were developed in collaboration with the senior author, who is a Hispanic sexual minority man whose input helped ensure cultural and identity-related relevance and responsiveness. Analyses were conducted by one doctoral-level student in clinical psychology (White non-Hispanic sexual minority man) and one public health master’s student (Hispanic straight female) who were both trained in qualitative research methods and had experience working with HSMY populations. Team discussions explicitly incorporated reflections on how each researcher’s background, both shared and different from those of the participants, might shape the interpretation of participant narratives, helping to mitigate individual bias and promote reflexive, collaborative analysis and presentation of the findings.

4.2. Qualitative Analysis

The general inductive approach was used to condense the raw data into a structured summary of participant feedback (i.e., identifying themes from participant interviews as opposed to a priori frameworks) to inform item development, rather than to build an overarching theoretical model [36]. The first author read all study transcripts in detail (i.e., line by line) and created an initial codebook for the interviews based on both the study objectives and emergent content (see Supplementary Table S1). Upper-level categories for organizing the data were derived from the study objectives, and lower-level subcategories were derived directly from participant responses.

The second and third authors, both graduate-level analysts, independently coded each transcript using the preliminary codebook, where lower-level subcategories were applied as codes. The analysts met with the first author to reconcile differences and refine definitions, reaching 100% consensus on all final codes and themes after one consensus meeting. Throughout the data collection and analysis, the first author tracked the identification of new codes to monitor saturation, which was achieved after three interviews, as the final two interviews did not yield novel codes or themes [37]. Final codes and themes were entered and organized in NVivo (Version 12), a qualitative data analysis software program used to structure and analyze qualitative data [38]. All results were reviewed by the co-authors.

5. Results

5.1. Klein Sexual Orientation Grid

Table 2. Feedback on KSOG and supporting quotes.

Theme	Sample KSOG Question(s)	Participant Quote(s)
1. Questions are clear if youth are sure of their sexual orientation and understand terms	How do you think of yourself? To whom are you sexually attracted? With whom have you actually had sex?	(1.1) “No, it’s very…no, I don’t think so. I think if the person knows why they feel it wouldn’t be hard for them to answer because it doesn’t, it’s not confusing”. (1.2) “I think they’re [questions] fine. As long as the person knows what heterosexual means”. (1.3) “So…especially people that are like bi-curious or something, and they haven’t really tried it. It might be a bit difficult for them to answer, especially because they’re still finding out their identity”. (1.4) “Yeah, like someone who’s exploring their identity hasn’t quite figured it out but feels like there might be something different. Might not be able to answer it 100%”.
2. Challenging nature of questions	Homosexuality should be… Some people describe their relationship to the rest of society differently than their personal sexual identity. For instance, a woman may have a heterosexual identity, but a lesbian political identity. How do you think of yourself politically? Emotions influence, if not define, the actual physical act of love. Do you love and like only members of the same sex, only members of the other sex, or members of both sexes?	(2.1) “Homosexuality should be…maybe a little bit more specific. I don’t know, I mean society, that’s kind of like a little vague, in my opinion, but cause like to me if I read that, I would only be thinking about like a specific group of people”. (2.2) “Uh but the one about uh a woman may have a heterosexual identity but a lesbian political identity. How do I think of myself politically? Like I don’t get that. How do you mix up uh sexuality with politics?” (2.3) “…‘Physical act of love.’ I’m not really sure what that like…does that refer to like sex? I think maybe or a hug?”
3. Difficulty with response options	How do you think of yourself? Heterosexual only Heterosexual mostly Heterosexual somewhat more Hetero/Gay-Lesbian equally Gay/Lesbian somewhat more Gay/Lesbian mostly Gay/Lesbian only Refuse to answer	(3.1) “ Because to me, seems like somewhat more somewhat…so I know what they’re asking, but I think it’s worded a little strangely”. (3.2) “Yeah, I think that there, because I’m bisexual. And so when I saw the hetero/gay-lesbian thing equally, I was like, what does that even mean? It’s like how are you straight and gay the same time”.
4. Ways to improve response options	Whom are your sexual fantasies about? (They may occur during masturbation, daydreaming, as part of real life, or purely in your imagination.) Other sex only Other sex mostly Other sex somewhat more Both sexes Same sex somewhat more Same sex mostly Same sex only Refuse to answer To whom are you sexually attracted? Other sex only Other sex mostly Other sex somewhat more Both sexes Same sex somewhat more Same sex mostly Same sex only Refuse to answer	(4.1) “…oh you could put for uh who are your sexual fantasies about, you could also put no one because if they are asexual..”. (4.2) “Also for are you sexually attractive, you can also put no one. Or neither sex..”. (4.3) “…Put opposite sex instead of other”.
5. Need for questions to include gender identity	N/A	(5.1) “If you’d also to add in gender because there’s a lot about sex but nothing about gender. Which, what do you categorize your gender as towards feminine, masculine, you know neither”. (5.2) “Well, along with the sexual identity one you could ask the gender identity of people, that people attracted to, instead of like uh gay or lesbian. Because um a lot of Lesbians also…like have crushes on people that are non-binary, even though um it’s not really included under the lesbian umbrella”. (5.3) “So that’s just like an extra question, because some people identify as cis-gender male or transgender males, or just non-binary, or even like other things. So this identity along with the gender identity as a question after that”.

summarizes the five themes related to feedback on the Klein Sexual Orientation Grid (KSOG), highlighting relevant participant quotes (quotes correspond to numbers in the parentheses). Pertaining to Theme 1, participants noted that the questions in the KSOG are clear if youth are sure of their sexual orientation and understand what the terms mean. However, HSMY did note that someone who was still exploring their identity may have difficulty answering the questions because they are still not entirely sure of their sexual orientation (1.1–1.4). Although HSMY found the KSOG to be generally straightforward, they still noted that there were several items that were challenging to understand because of how the questions were worded, as highlighted in Theme 2. Questions were seen as vague (2.1), and some of the wording was seen as overly confusing (2.2, 2.3). Theme 3 focuses on the fact that there were also challenges with the response options for the questions in the KSOG, such that they were not clear, and the wording caused confusion (3.1, 3.2). Related to Theme 4, HSMY suggested that responses could be improved by adding options for youth who may be asexual and remarked that rewording response options may make the questions more comprehensible for HSMY. For example, HSMY noted that youth may be asexual (4.1) or perhaps not attracted to anyone (4.2). Simple changes from “other” to “opposite” would also be helpful for youth (4.3). Finally, in Theme 5, HSMY noted that the questions in the KSOG did not include any questions related to gender identity. HSMY highlighted that future measures should also assess youths’ gender identity and include response options related to gender identity (5.1–5.3).

5.2. Familiy Functioning

Table 3. Feedback on measures of family functioning and supporting quotes.

Theme	Sample Question(s)	Participant Quote(s)
6. Relevant but missing context of sexual orientation or being a sexual minority youth	My primary caregiver has a tendency to say things to me which would be better left unsaid. My primary caregiver is always a good listener. I am very satisfied with how my primary caregiver and I talk together.	(6.1) “…Some of them could come off as a bit broad and just something that just relates to whatever experience, whatever experience”. (6.2) “…Let’s say, like my primary caregiver is always a good listener…that, I think that’s a good question because a lot it could very much vary…you know, being listen[ed] to when you’re coming out and stuff”. (6.3) “I feel like they’re good questions if phrased differently and added more…scenario”. (6.4) “…They’re all pretty relevant…and I mean the primary caregiver has a tendency to say things to me that would be better left unsaid, and it’s probably pretty vague, because there’s a lot of things that could be left unsaid…”
7. Understanding family history and cultural context	N/A	(7.1) “Um, if there’s any past, um, motive of why they can’t talk to their parents now, or if they don’t trust their parents or if their parents don’t choose them because of something that they did. Um…um if there’s any like trauma in…their relationship that made this so hard to um express”. (7.2) “In Hispanic culture, one of the things that is very prevalent is like machismo. Like very macho man, very feminine in the kitchen woman. So I was saying, like, am I comfortable showing…characteristics of the opposite sex in front of my caregiver, like, am I comfortable wearing make-up in front of my dad if I’m a guy…?”
8. Capturing the context of how sexual minority status and disclosure impacts family functioning	How well do your parents know your best friends? My primary caregiver has a tendency to say things to me which would be better left unsaid. I am very satisfied with how my primary caregiver and I talk together. When you have done something that your primary caregiver likes or approves of, how often does your primary caregiver not say anything about it, or ignores it?	(8.1) “Yeah, I think there’s difference when you have a gay friend or a straight friend. I think there is difference”. (8.2) “I think something you want to add if you are really trying to dig in is also like our self-esteem…have your parent affected your self-esteem? Because I feel like something that is um, especially if you are a gay guy in the Hispanic community”. (8.3) “Uh you can ask if, coming out to your parents has made the relationship stronger, or if it has weakened the relationship. Um…does this experience um has bring you closer to them? Or does that separate you? Does this relationship with um a really big impact in both of you guys’ life. Like how does it change the relationship that you can ask of after coming out what has happened”. (8.4) “[recommended item] My parent has a tendency to say things that are homophobic or transphobic or something along those lines, or like derogatory toward sexual and/or gender orientation”.

highlights the three themes related to feedback on the measures of family functioning with relevant participant quotes (quotes correspond to numbers in the parentheses). HSMY noted the significance and relevance of questions about family functioning (e.g., “My primary caregiver has a tendency to say things to me which would be better left unsaid”. “My primary caregiver is always a good listener”. “I am very satisfied with how my primary caregiver and I talk together.”). However, as seen in Theme 6, they expressed the feeling that these questions lacked the necessary context related to their sexual orientation or their identity as SMY. Although capturing important domains, the measures were perceived by HSMY to be broad and vague (6.1–6.4). Additionally, the measures of family functioning were perceived as limited in relevance to HSMY, lacking questions that provide an understanding of family history and cultural context and how that may relate to their intersectional identities, seen in Theme 7. For example, understanding the history of youth’s relationships with both parents and perceived level of parental acceptance could provide context to HSMYs’ responses to the measures of family functioning (7.1, 7.2). To improve the measures of family functioning and make them more relevant to the needs of HSMY, Theme 8 focused on capturing the context of how sexual minority status and disclosure of sexual orientation impact family functioning was identified as an urgent priority (8.1–8.4).

6. Discussion

The purpose of the current study was to examine the face validity of existing measures of sexual orientation (i.e., the KSOG) and family functioning (i.e., the Parent–Adolescent Communication Scale, Parental Monitoring of Peers, and the Parenting Practice Scale) and investigate whether these measures accurately capture sexual orientation and family functioning for HSMY and how they could be improved. Although HSMY had positive feedback overall regarding the measures of sexual orientation and family functioning, most HSMY stated that these measures should be modified to make them clearer and more relevant to both their racial and ethnic identities and sexual orientation identities. These findings are not surprising given that HSMY are embedded in intersecting sources of oppression, including their sexual orientation and racial/ethnic identity.

For the KSOG, HSMY indicated that question and response option wording should be improved to make the questions clearer. Although HSMY felt as though the measure was clear if youth were sure of their sexual orientation and understood common terms associated with sexuality, there were certain questions that were confusing to HSMY and could therefore be confusing to youth who were still exploring their sexual identity. As an example, HSMY stated that it would be important for participants who were responding to this measure to know what the term heterosexual meant to accurately answer the questions and select responses. Similarly, questions could be improved by adding specific definitions and examples and clarifying what the question is referring to with more background text. One participant noted that it would be important to clearly define what “physical act of love” refers to in the emotional connection question of the KSOG. In this example, the participant was unsure if physical acts of love, referred to hugs or other more intimate forms of physical love highlighting the ambiguity experienced by HSMY as they navigated answering these sexual orientation-related questions.

Some of the response options were also unclear to HSMY, such that they were worded strangely or did not have a response that would match their own identity. Responses to items in the KSOG should also be adjusted to provide more straightforward options for HSMY. To illustrate this sentiment, the use of the term “somewhat more” was confusing for one participant, and another participant noted that there was not a valid response option to indicate that she was bisexual. Several other participants also noted the limited nature of the response options—presently, the response options do not include options for youth who may be asexual, bisexual, pansexual, or another polysexual identity. Therefore, in surveys that use the KSOG, there may be erasure of these populations because it is not possible to classify asexual, bisexual, and/or pansexual youth from the current response options. These youth may therefore be grouped into broader or inappropriate categories, such as “other” or “queer”, which can subsequently mask distinct patterns of risk behaviors or health outcomes, preventing researchers from identifying specific needs of this population [4]. Similarly, questions and responses did not include options for youth with gender identities outside a cisnormative binary to accurately answer. This is troubling, as 9.54% of youth between the ages of 13 and 17 and 15.9% of young adults between the ages of 18 and 23 embrace identities outside of gender binaries [39,40]. Including non-binary and fluid identities in research measures acknowledges that gender identity is complex, dynamic, and not strictly limited to traditional categories. Adapting these response options to be more inclusive of all facets of sexual and gender minority communities will significantly improve data collection associated with furthering the reach of behavioral and sexual health prevention efforts for HSMY [41]. Such changes are also consistent with recommendations from the National Academies of Sciences, Engineering, and Medicine’s (NASEM) report on Measuring Sex, Gender Identity, and Sexual Orientation [41], which states that survey measures evaluating sexual orientation and gender identity should be simple to administer and understandable to both sexual minority and non-sexual minority populations.

Regarding measures of family functioning, these measures would also need to consider family history and cultural context to appropriately assess family-level dynamics. Participants mentioned that it would be important to ask HSMY if their relationship with their parents changed because of sexual orientation disclosure and to what extent the changes were positive, negative, or both. This is particularly important because all HSMY interviewed noted that they either did not have a father who was regularly present in their lives, had a father who was unaware of their sexual orientation, or did not talk to their father about their sexual orientation. HSMY alluded to cultural values such as machismo that influenced the way they acted around their parent(s) [42], particularly fathers, which would subsequently impact responses to family functioning questions. Thus, questions about relationships with parents should ask about each parent separately.

HSMY noted that scenario-based assessments of family functioning could help elucidate the impact of sexual minority status-related experiences on family functioning. As an example, the parent–adolescent communication measure asks whether a youth’s primary caregiver is a good listener. HSMY youths’ response to this item could vary depending on circumstances; thus, adding context to this item (e.g., was the primary caregiver a good listener during the coming out process?) can provide insight as to how parent–adolescent communication might be impacted by disclosure of HSMYs’ sexual orientation. Similarly, several of the measures of family functioning included items pertaining to parental monitoring of peers. HSMY stated that monitoring may vary depending on whether youths’ friends are heterosexual or LGBTQ+, in that youth may not be allowed to spend time with friends that are LGBTQ+, or parents would monitor activities with LGBTQ+ friends more closely. This is likely due to the fact that in many Hispanic families, cultural norms emphasize strong family bonds and respect for authority, often leading parents to closely monitor their children’s behavior [43]. For HSMY, parental monitoring that is focused on excluding LGBTQ+ peers can become problematic, potentially causing feelings of rejection and isolation among the youth. Therefore, adding context around peer monitoring items regarding friend types (e.g., SMY or heterosexual) could help to clarify these family functioning indicators for HSMY.

7. Implications

The findings of this study provide preliminary data that have implications for the development and/or cultural adaptation of existing measures of sexual orientation and family functioning for HSMY. See

Table 4. Summary of themes, issues, and sample question and/or response changes.

Theme	Issue	Sample Modified Question and/or Response
1. Questions are clear if youth are sure of their sexual orientation and understand terms	Youth who are still exploring their identity may have difficulty answering the questions.	Definitions of terms provided throughout the survey.
2. Challenging nature of questions	Wording of the questions was challenging.	Emotions play a significant role in shaping the physical experience of love (e.g., hugs, kisses). Do you feel romantic and physical attraction exclusively toward the same sex, exclusively toward the other sex, or toward both sexes?
3. Difficulty with response options	Wording of the responses was challenging.	Exclusively heterosexual/straight Predominantly heterosexual/straight Mostly heterosexual/straight Equally attracted to both genders Mostly gay/lesbian Predominantly gay/lesbian Exclusively gay/lesbian Prefer not to answer
4. Ways to improve response options	There were no responses for youth who may be asexual.	With whom have you actually had sex? Other sex only Other sex mostly Other sex somewhat more Both sexes Same sex somewhat more Same sex mostly Same sex only No one Prefer not to answer
5. Need for questions to include gender identity	No questions related to gender identity.	What is your current gender? Female Male Transgender I use a different term: [free text] Don’t know Prefer not to answer
6. Relevant but missing context of sexual orientation or being a sexual minority youth	Questions lacked the necessary context related to sexual orientation or their identity as SMY.	How do expectations around gender roles, as well as expectations regarding sexual orientation, affect the relationship between you and your parent?
7. Understanding family history and cultural context	No understanding of family history and cultural context and how that may relate to HSMY’s intersectional identities.	How does your parents’ Hispanic culture, including attitudes towards sexual orientation, impact your relationship with them?
8. Capturing the context of how sexual minority status and disclosure impacts family functioning	Questions failed to capture the context of how sexual minority status and disclosure of sexual orientation impacts family functioning.	Are there certain topics, including those related to sexual orientation, that you avoid talking to your parent about because of their cultural values?

for a summary of the themes that emerged in the study, related issues, and a sample modification of a question and/or response option. Pertaining to sexual orientation, these findings call for refinement of multidimensional measures of sexual orientation to clearly state which domain is being assessed (e.g., platonic or romantic emotional connections) and provide clear response options for HSMY who are questioning their sexual orientation, are asexual (i.e., not attracted to anyone), and/or may have a different gender identity (e.g., identifying as transgender or non-binary).

Furthermore, measures of family functioning for HSMY would need to address the unique experiences of this population. Specifically, measures should focus on how the various components of family functioning are impacted by sexual minority status-related experiences (e.g., coming out), keeping in mind the importance of family background (e.g., family structure, relationships). Similarly, measures of family functioning that are operationalized within a lens of culturally determined factors may better capture the family-level processes that are unique to HSMY and their families than existing published measures. It would also be important to validate these measures in Spanish-speaking countries (e.g., Latin America) to verify that measures are properly translated and account for country-specific terminology/colloquialisms that appropriately capture the content of the questions.

In future research, it is critical that measures of sexual orientation and family functioning undergo review and refinement with direct input from end-users prior to use to ensure their clarity, relevance, and cultural sensitivity. Additionally, ongoing efforts should focus on developing updated, empirically tested measures that reflect evolving understandings of identity, family dynamics, and cultural context among HSMY. The NASEM report on Measuring Sex, Gender Identity, and Sexual Orientation also acknowledges the need for continued psychometric testing of the measure to incorporate changes in response category terminology, particularly as the social meaning of sexual orientation identity continues to evolve, particularly among diverse’ age, language, racial, and ethnic groups [41]. In line with NASEM recommendations, other instruments developed for LGBTQ+ populations, such as the Sexual Minority Identity Emotion Scale [44] and the Sexual Minority Adolescent Stress Inventory [45], should be evaluated in exclusively Hispanic/Latino samples to assess their psychometric properties.

Once such measures are developed or identified, interventions for HSMY should include these refined, culturally sensitive tools that ask clear, inclusive questions about sexual orientation and family functioning. These measures should be quantitatively evaluated over time to assess how they may evolve and how they are related to health outcomes. Policymakers should therefore prioritize research initiatives that focus on validating inclusive measures and promoting policies that ensure equitable and responsive care for HSMY. Relatedly, clinicians can use updated measures of sexual orientation to ensure that they are providing culturally competent care to HSMY, while updated measures of family functioning can not only be used to screen for and address the specific challenges HSMY experience but also potentially refer HSMY to family-based interventions. Although not assessed in this study, the Youth and Young Adult Questionnaire may serve as a useful complementary tool to support a more holistic understanding of adolescent well-being when used alongside measures of sexual orientation and family functioning. Such measures can subsequently elucidate the impact of family functioning for HSMY and identify intervention targets and mechanisms that can help address adverse health outcomes, including drug use, sexual risk behavior, and depressive symptomatology among HSMY.

8. Limitations and Strengths

There are important limitations and opportunities for future research to consider. First, participants in this study were from one geographic area in South Florida and do not account for the full heterogeneity of Hispanic communities across the globe. Relatedly, all interviews were conducted in English, and cognitive interviewing in Spanish may reveal additional considerations that were not identified in English. As noted, we encourage validation of these measures in Spanish-speaking countries. Second, we were only able to conduct interviews with five HSMY; thus, although generalizability is not the goal of qualitative research in general [46,47], additional qualitative work may help to elucidate further revisions to the measure to inform its cultural relevance for a broader group of HSMY (e.g., Spanish-speaking HSMY). Further, past research indicates that cognitive interviews should be conducted in iterative processes to revise questions and eliminate problems with analytic goals achieved with as few as five interviews [32,33], and we reached saturation at three interviews, such that no new additional information emerged in the final two interviews, and it is unlikely that new information would have emerged in subsequent interviews. As the purpose of this set of interviews was to assess HSMYs’ opinions on the measures, next steps include developing a revised item pool of measures of family functioning based on participant feedback and conducting focus groups with larger samples of HSMY to assess the face validity of the newly developed measures. Future research should interview larger samples of HSMY with diverse sexual identities and also include HSMY who may not have disclosed their sexual identity to parent(s), given that participants who chose to participate may differ from those who did not, potentially limiting the range of experiences captured. The participant recruitment challenges may be attributed to the recruitment period that ran from October 2022 to January 2023—this is a time period with several holidays that may have prevented participants from enrolling. Additionally, we were unable to recruit in schools, which may have provided a broader pool of eligible participants, and therefore, had to rely on alternative recruitment methods (e.g., criterion and snowball sampling, consent-to-contact database). Among our interviewees, social desirability bias is a potential concern given the sensitive topics covered; however, conducting individual interviews in private settings with a specific emphasis on building rapport likely mitigated this risk by fostering a confidential environment where participants could speak openly.

Third, although not intentional, all participants were older youth (age 17) that had disclosed their sexual orientation to at least one parent and had been “out” for several years. Many reported overall positive relationships with at least one of their parents and attributed this to a positive disclosure experience. This subsequently limits the variability of our findings. However, youth were probed to think about their family relationships immediately following disclosure, which may have been a fragile time for parent–adolescent relationships [7] and also may have occurred at different ages. Additionally, family functioning may also encompass other, both negative and positive dimensions, such as family conflict and family cohesion. The measures used in this study may therefore not be generalizable because they only capture certain domains (i.e., communication, monitoring, positive parenting, and involvement). Finally, although participants provided generally positive feedback on the measures, some noted occasional ambiguity in question wording or terminology. While this does not undermine the overall validity of our findings, this interpretive variability should be considered when assessing the results. Future research should prioritize additional refinement and pre-testing of measures to enhance clarity and ensure that items are fully accessible and meaningful to diverse groups of HSMY.

9. Conclusions

Despite these limitations, this study used an approach wherein the population subgroup of interest (i.e., HSMY) provided direct insight into how sexual orientation and family functioning should be measured. This approach provides insight into the types of questions that should be asked of HSMY regarding sexual orientation and family functioning and ensures that future measures are responsive to the needs and experiences of HSMY.