Gender-Independent, Intersex, Non-Binary, and Transgender (GIaNT) Youth’s Perceptions of an Online Educational Resource for Puberty Health and Sex Education: A Pilot Multi-Method Study

Abstract

Puberty health and sex education (PHSE) curricula are not comprehensive or inclusive towards gender-independent, intersex, non-binary, or transgender (GIaNT) youth. A majority of this population seeks this information in online settings. Over the past two years, our research team, in collaboration with GIaNT communities, has developed an open-access online educational resource (OER) intending to bridge this gap in comprehensive PHSE for GIaNT youth in a gender-affirming, fun, and interactive way. After the OER was developed, our team recruited participants (aged 16–26) to navigate our website and complete a multi-method survey to gain their feedback, insights, and perceptions on this new OER. The survey responses indicated two key themes for the development and use of the OER: facilitators and strengths, and areas for improvement. The findings from this study were used to better meet the wants and needs of this population vis-à-vis changes to be made to our OER before its public launch for open-access, free use.

1. Introduction

Gender-independent, intersex, non-binary, and transgender (GIaNT) youth have unique puberty health and sex education (PHSE) needs that may have similarities to, but are distinguishable from, the PHSE needs of cisgender youth (Action Canada for Sexual Health and Rights, 2019; Bradford et al., 2013; Glynn et al., 2016; Warwick et al., 2022; Newman-Seymour & Haghiri-Vijeh, 2025). Furthermore, GIaNT youth’s PHSE needs are different from those of lesbian, gay, and bisexual youth (Haley et al., 2019). Because of the common practice for researchers to conflate transgender identities (Darwin & Hines, 2020; Staples et al., 2018), the researchers for this project decided to specifically name the identities to be taken up in this research as a gesture to recognize each of these identities as unique, resulting in the GIaNT acronym. Across the United States and Canada, sexual education curricula are created and administered only within the context of cisgender youth, positioning GIaNT youths’ specified PHSE needs as unconsidered and unattended to (Bradford et al., 2013; Glynn et al., 2016). A few studies have used focus groups and interviews with this population and topic to determine what is missing in existing curricula and to learn from such youth what relevant content they would like included in PHSE curricula (Bradford et al., 2013; Glynn et al., 2016). These studies found that GIaNT youth exhibited a critical need and desire for inclusive PHSE curricula to be made accessible for them, especially in online settings (Bradford et al., 2013; Craig & McInroy, 2014; Glynn et al., 2016; Steinke et al., 2017; Haghiri-Vijeh et al., 2023; Newman-Seymour & Haghiri-Vijeh, 2025). GIaNT youth perceive online spaces to be “safe” (Craig & McInroy, 2014; Glynn et al., 2016; Steinke et al., 2017), because they can traverse them without outside influences like parents and/or caretakers, figures of authority, and homophobic and/or transphobic judgment (Bradford et al., 2013; Craig & McInroy, 2014; Haghiri-Vijeh et al., 2023; Newman-Seymour & Haghiri-Vijeh, 2025). Due to these factors, a majority of GIaNT youth access PHSE information online (Bradford et al., 2013; Craig & McInroy, 2014). To this end, our team created an online educational resource (OER) focused on comprehensive PHSE that caters to GIaNT youths’ specific needs. In line with findings from the previous literature, it was crucial to distribute this information in a way that was gender-affirming, fun, interactive, and educational (Newman-Seymour & Haghiri-Vijeh, 2025). This paper reports on the multi-method survey findings on the usability of the newly developed OER. It includes GIaNT youth participants’ feedback, insights, and perceptions on the OER that were used to improve the resource before making it open access to the public. The findings inform researchers, web developers, and PHSE educators in curriculum building to better meet the needs of GIaNT youth.

1.1. OER Development and Background

In early 2024, our research team worked with Centennial College student web developers (frontend and backend) and a graphic designer to create the website. Prior to creating the content for the OER, a scoping review (Haghiri-Vijeh et al., 2026) and a literature review (Newman-Seymour & Haghiri-Vijeh, 2025) were conducted for this project. Through these processes, the research team developed the content for the website while consulting with the Advisory Committee. The Advisory Committee consisted of eight members and was made up of GIaNT-identifying members of the community, as well as a few researchers, and an employee representative for ACTION Canada for Sexual Health and Rights. The committee members were located across Canada, providing a variety of regional insights. The first author and the Advisory Committee members met once every other month on Zoom between April 2023 and April 2025. The purpose of the Advisory Committee was to hear from community members and experts in the field directly throughout all steps of the research process. The committee provided invaluable insights into our research and OER development from their diverse backgrounds and lived experiences. Through the OER’s development, our team aimed to create content that was as inclusive and intersectional as possible. This was one of the positive outcomes of working with a diverse team of GIaNT people on our Advisory Committee, who were able to provide intersectional insights and perspectives that may have been missed by the research team during the OER’s development. Members of the Advisory Committee (as well as the research team) were made up of people of diverse gender and sexuality identities, ages, social locations, races, and migrant statuses. These diverse backgrounds allowed us to approach creating the content for the website from multiple intersecting perspectives. Due to the scope of this paper, the details and rationale for all content inclusions will not be included, but can be found in our previous articles (Haghiri-Vijeh et al., 2026; Haghiri-Vijeh et al., 2023; Newman-Seymour & Haghiri-Vijeh, 2025). However, we will provide some relevant key components in this paper.

1.2. Positionality Statements and Theoretical Framework

The first author of this paper identifies as non-binary, transgender, and a migrant to Canada. They have worked extensively with GIaNT youth in their research endeavors, guided by a strong transfeminist methodology in their work. Grounded in the belief that comprehensive sex education is essential for people of all gender identities, Yan approached this study with a strong commitment to equity. This orientation guided her efforts to engage respectfully and thoughtfully in all aspects of the research. Dr. Purnima Tyagi draws upon an interdisciplinary background encompassing health sciences, applied research, and technology-enabled innovation. As a researcher and leader at the intersection of digital health and community-centered design, she applies a systems-level perspective to analyze structural barriers affecting equity-deserving populations. Her methodology emphasizes translating research into practical and accessible solutions, prioritizing co-creation, inclusivity, and measurable impact for diverse communities. Dr. Roya Haghiri-Vijeh conducted this research with an equity-oriented perspective, attentive to how researcher positionality and power dynamics influence knowledge about GIaNT youth. She engages in ongoing reflexivity to center youths’ lived and living experiences while respecting the diversity within GIaNT communities.

The decision to include participant feedback within the OER is inspired by three key methodological influences from the works of Alcoff (1991), Collins (1999), and Johnson (2015). Each of these works aims to challenge the positionality of the researcher in relation to the researched. They all question the researcher’s authority to speak on behalf of an entire community, and the problems that come from such hegemonic perspectives. Instead, these authors aim to nuance the positionality and relationship the researcher has with the communities that they are researching.

To begin, we would like to address Linda Alcoff’s concept of speaking for rather than speaking with community members. Alcoff writes that, “[a] speaker’s location (which I take here to refer to their social location, or social identity) has an epistemically significant impact on that speaker’s claims and can serve either to authorize or disauthorize one’s speech” (Alcoff, 1991, p. 7). In other words, a researcher is positioned in a powerful way to interpret and disseminate community members’ interviews. With this comes the potential to misinterpret, edit, or outright ignore (whether intentionally or not) important realities for the communities that they are studying. By aiming to speak with community members, rather than speaking for them, the researcher troubles the hierarchical relationship dynamics between the researched and the researcher.

Patricia Hill Collins’ concept of the “outsider within” status is also important and relevant. We understand this concept to mean that there are those who may be both “insiders” and “outsiders” to certain communities, cultures, lived experiences, and more. In some ways, our research team is made up of insiders and outsiders. Some of us are gender diverse and/or queer; however, many of us are cisgender.

Finally, we drew upon transfeminist methodologies throughout the research process. As Austin H. Johnson asserts, the “transfeminist standpoint should engage with… the ‘expert’ knowledge of transgender experiences in ways that actively resist cisgender privilege. That is, a transfeminist standpoint should do the methodological work of engaging with the multiplicity of lived experiences of transgender people in order to offer a more accurate understanding that does not impose and reproduce cissexist authority over transgender experience” (Johnson, 2015, pp. 24–25). This means that gender-diverse people, through their lived experiences, are the experts on research that is on them. Their insights provide valuable understanding into how to best serve this community. Taking Alcoff, Collins, and Johnson’s work into consideration, we find that the most respectful approach to the community members this research is for is to hear from them directly about their experiences. Instead of speaking for this community, we aim to speak with them. This ongoing decision and practice is also reflected in our team’s engagement with the Advisory Committee.

2. Materials and Methods

Our survey methods and study protocols were approved by Centennial College’s Research Ethics Board (REB #2023/24-31). Informed consent was obtained from participants. The data for this pilot study were drawn from a 2025 survey completed by GIaNT youth located in the Greater Toronto Area (GTA). The online exploratory survey was to gain an understanding of GIaNT youths’ perceptions of this newly developed OER.

2.1. Data Analysis

Quantitative data from Likert-scale questions were analyzed in a descriptive format. Qualitative data were reviewed following an inductive, exploratory, thematic analysis approach. The qualitative analysis followed Braun and Clarke’s (2019) six-step process, which allowed for the research team to identify codes and themes from the data. The researchers began by individually reading and re-reading each open-ended survey response, making notes of emerging themes. The first two authors then met to generate initial codes, which were collated into potential themes. Themes were then defined, reviewed, and named to ensure that they worked in relation to the coded data. The codes and themes were cross-checked by the third author, and agreement was reached among all researchers (Braun & Clarke, 2019). The third author then reviewed the analysis to reduce bias and strengthen trustworthiness in the analysis. Credibility was established by including verbatim quotes from the participants’ surveys and using researcher triangulation throughout data collection, coding, and analysis (Woo, 2017). The quantitative and qualitative analysis is provided in Section 3.

2.2. Eligibility Criteria

To participate in the study, youth needed to (1) self-identify as transgender, non-binary gender-independent/diverse/questioning/fluid, and/or intersex; (2) be between the ages of 16 and 26 at the time of the study; (3) live in Ontario, Canada; and (4) have access to reliable internet, and a laptop or a computer during the completion of the survey.

2.3. Recruitment

Purposive and snowball recruitment strategies were utilized in this study. Participants were recruited through existing 2SLGBTQI+ organizations located in the Greater Toronto Area (GTA) and word of mouth in their broader community. Primarily, potential participants were recruited through a digital poster that was sent to 2SLGBTQI+ organizations within the GTA along with an email asking the organizations to disseminate the flyer to their listserv and other networks, as well as to post on their social media accounts. The poster briefly described our project, detailed some potential risks/benefits for interested participants, included the compensation amounts for participating in the study, and the REB approval number. When potential participants contacted the research team, they were encouraged to share the information about our study with their contacts who might be interested in the study.

2.4. Study Design

All steps of the study design were carefully laid out for all members of the research team prior to beginning recruitment to ensure consistency and to attempt to increase safety and comfort for potential participants. The study protocol was designed by the first author, and a majority of participant communications were done by the second author. All members of the research team who came into direct contact with participants were required to obtain a Vulnerable Sector Check (VSC) prior to the recruitment. A VSC is a specific type of background check conducted by Ontario Provincial Police for those intending to work with vulnerable populations, in this case, with participants who are minors. The research assistant for this project, the second author of this paper, was trained extensively. This training included reading and reviewing the study protocol items, conducting mock screening calls with the first author, and responding to mock emails sent by the first author. Confidentiality and the safety of participants were highly regarded throughout the training period and during the study. All members of the research team identified with equity-deserving communities, with the first author identifying as an immigrant, non-binary, and transgender. This was disclosed to potential participants as a way to establish trust in the study.

Interested participants were provided with a consent form (signature not required), which detailed the study rationale and methods, as well as the potential risks and benefits of participating. All participants were screened during a 5 min phone call to determine that the respondents identify as GIaNT and are between the ages of 16 and 26. The eligibility screening questions were: “What is your preferred name (first name only)?”; “What are your pronouns?”; “What is your age?”; “Please answer “yes” or “no,” do you identify as transgender, non-binary, intersex, and/or gender-independent/diverse/questioning?”; “Do you live in Ontario?”; and “Do you have reliable internet, access to a laptop/computer, and the ability to complete the website content and survey in one sitting?” All text/phone call interactions were done using OpenPhone (Open Phone, 2025), a web-based phone application that is end-to-end user-encrypted. Additional correspondence took place via email, using a Gmail account set up for this project.

2.5. Data Collection

Study participants were asked to explore the online educational resource: (https://giantyouth.com/, accessed 15 April 2026). During the process of navigating the site and reviewing the website content, research participants simultaneously completed our Qualtrics survey that included demographic information, Likert-scale questions, and open-response questions for short answer feedback. Following the completion of the survey, participants were paid a $30 Amazon e-gift card, and one participant received an additional $250 Amazon e-gift card as a part of a randomized prize draw. The survey data was collected between February and March of 2025 and included exploratory quantitative and qualitative questions. All participants’ personal information was de-identified, with provided names replaced with a randomized 3-digit code, to maintain anonymity and participant safety during data collection and analysis stages.

3. Results

3.1. Demographic Characteristics

A total of seven GIaNT youth participated in this pilot study. The mean age was 23 years old, with the lowest age being 20 and the highest being 25. The most common gender identity reported was transgender (n = 2) and non-binary (n = 2), followed by non-binary and gender-questioning (n = 1); gender-independent/gender-diverse (n = 1); and gender-questioning (n = 1). A majority of participants reported that they are not intersex (n = 6), and one reported that they are unsure. An equal number of participants indicated their race to be Asian (n = 3) and White (n = 3), with one (n = 1) participant indicating that they prefer not to say. Additionally, an equal number of participants reported their ethnicity to be South Asian (n = 3) and White (n = 3), with one (n = 1) participant indicating that they prefer not to say. Additional demographic information can be found in

Table 1. Characteristics of participant pool.

	n	%
Age (n = 7; Mean = 23.1)
20	1	14.3
22	1	14.3
23	2	28.6
24	1	14.3
25	2	28.6
Gender identity (n = 7)
Transgender	2	28.6
Non-binary	2	28.6
Non-binary & gender-questioning	1	14.3
Gender-independent/gender-diverse	1	14.3
Gender-questioning	1	14.3
Intersex or not (n = 7)
No	6	85.7
Not sure	1	14.3
Ethnicity (n = 7)
Asian	3	42.9
White	3	42.9
Prefer not to say	1	14.3
Race (n = 7)
South Asian	3	42.9
White	3	42.9
Prefer not to say	1	14.3

and

Table 2. Demographics of participants.

Participant Number	Age	Gender Identity? (Multiple Answers Allowed)	Intersex or Not	Ethnicity (Multiple Answers Allowed)	Race (Multiple Answers Allowed)
1	22	Non-binary; Gender-questioning	No	White	White
2	20	Non-binary	No	Asian	South Asian
3	23	Gender-questioning	No	Asian	South Asian
4	25	Transgender	No	White	White
5	25	Gender-independent/gender-diverse	No	Asian	South Asian
6	24	Non-binary	Not sure	Prefer not to say	Prefer not to say
7	23	Transgender	No	White	White

.

3.2. Analysis

3.2.1. Quantitative Analysis

Quantitative data were analyzed from Likert-scale question responses. Depending on the structure of the question, participants had the option to respond on a five-point scale ranging from agree to disagree, likely or unlikely, and high to poor. All Likert-scale question responses can be found in

Table 3. Quantitative responses.

Rated on a 5-Point Likert Scale	n	%
Question 6. Did you find the website to be engaging and educational? (n = 7)
Agree	7	100.0
Question 16. Did you find the website to be affirming to your gender identity? (n = 7)
Affirming	6	85.7
Neither affirming nor un-affirming	1	14.3
Question 17. How likely are you to use the website again? (n = 7)
Likely	4	57.1
Unlikely	2	28.6
Neither likely nor unlikely	1	14.3
Question 18. How likely are you to recommend the website to a friend? (n = 7)
Likely	6	85.7
Neither likely nor unlikely	1	14.3
Question 19. How would you rate your overall experience of using the website? (n = 7)
High	3	42.9
Neither poor nor high	4	57.1

.

For the question, “did you find the website to be engaging and educational?” all participants (n = 7) responded “agree”. When asked, “Did you find the website to be affirming to your gender identity?” a majority (n = 6) responded affirming, while one participant responded neither affirming nor un-affirming. Participants were asked, “How likely are you to use the website again?” A majority (n = 4) answered “likely”, some (n = 2) answered “unlikely”, and a minority (n = 1) answered “neither likely nor unlikely”. When asked, “How likely are you to recommend the website to a friend?”, a majority (n = 6) of participants responded “likely”, with a minority (n = 1) responded “neither likely nor unlikely”.

3.2.2. Qualitative Analysis

Qualitative data were analyzed using an inductive, thematic analysis approach. The following section details two key themes: (1) facilitators and strengths of the OER and (2) areas for improvement.

(1)

Facilitators and strengths of the OER

Our analysis of participants’ perceptions revealed facilitators and strengths of the OER. The facilitators and strengths that the participants identified are that the OER is interactive, the map, as well as the world feature, is engaging, and the content is useful.

1.1

Interactive

Some participants (n = 3) positively noted the interactive and immersive nature of the website. Participant 3 noted, “Starting with the ‘World of Introduction,’ I appreciate its highly interactive design, where the character Finn serves as a friendly guide, making the experience engaging and immersive. I also like how Finn asks for the user’s name and pronouns, ensuring a personalized and inclusive interaction. The friendly tone of the conversations helps create a relaxed atmosphere. Additionally, I enjoy the ability to set and change themes, the interactive role-playing games, and the detailed visualizations that enhance the overall experience.” The research team found this to be a positive outcome, as an interactive design was prioritized during the development of the OER. Participant 7 echoed this by stating, “I liked that the topics were laid out as an interactive map.” Our team did not explicitly ask about the interactive design in the survey; however, this theme emerged from the participants’ perceptions of the resource.

1.2

Map and World feature

Each learning module was designed to be its own “world” to be accessed by any user from an interactive map. This was to break up the content to make it more approachable and to ensure that users are navigating the content in a way that builds upon the previous learning modules. All participants (n = 7) responded that they enjoyed the “worlds” feature of the website. Participant 2 wrote, “I enjoyed the ‘Worlds’ feature. It provided a fun and engaging way to explore content, making learning more interactive and efficient while preventing boredom.” Participant 1 noted, “I think it makes it more gamified, which might encourage young people to access more resources.” Participant 6 noted, “I liked the graphics and the maps. It’s a good transition of [the] different topics. I found the graphics and colours to be very cute.” Additionally, Participant 4 responded, “Thank you for creating this! As a [career redacted to maintain participant anonymity], I often see trans and gender diverse youth who have many questions and do not know where to begin to ask them. Resources can be overwhelming to look through, and having an interactive guide or map that can help tailor information to their specific experiences [is] so needed!” These responses highlight that the overall design of the OER is well-liked and received.

When asked, “Were there any ‘worlds’ you particularly liked? (for example, the ‘mental health’ world?),” responses to this question were varied and were not limited to a single response for any participant. The most commonly noted world that the surveys indicated was “Social Transition” (n = 3). The second most commonly liked world was split between: “Community Connection” (n = 2), “Sex Education” (n = 2), and “Legal Transition” (n = 2). Other worlds that were noted were: “Mental Health” (n = 1), “STBBIs” (n = 1), and “Medical Transition” (n = 1). The research team interprets this as a positive outcome to this question, as it indicates the wants, needs, and likes of this diverse population to be met.

1.3

Understanding and usefulness of the content

A majority (n = 6) of participants responded that they understood all of the content. Participant 7 agreed that they understood the content and added, “Understood everything! Although some of the definitions may be a bit long and complicated for people who have never been exposed to this language.” A majority (n = 5) of respondents found the resources to be relevant to them. Participant 1 added, “Yes, I like the specifications when providing resources, such as depending on identity or assigned sex at birth.” All participants (n = 7) indicated that they enjoyed the “resources for support” feature of the website. Participant 4 stated, “Yes! Particularly that you can save certain resources for later and curate a sort of support network that is relevant and tailored for you, as choosing resources to access can be overwhelming.” Participant 6 wrote, “Definitely, I am thinking to check out some resources that I didn’t know about before.” These findings indicate that the surveyed population found the developed OER to be useful, relevant, and understood among a range of identities, ages, and comprehension levels for this population. This was a key goal during the development stage of the OER.

(2)

Areas for improvement

In addition to facilitators and strengths of the OER, the participants’ responses indicated a few areas of improvement. The sub-themes for areas of improvement included understanding and usefulness of the content, bugs/glitches/mistakes, and content change suggestions. Our team has implemented the identified areas of improvement on our OER. Any specific changes mentioned in this section have been undertaken to the best of our research team’s and web developers’ abilities.

2.1

Understanding and usefulness of the content

While understanding and usefulness of the content was included as a facilitator and strength of the OER, the responses were varied, which indicated to our team that while some participants understood the content and found it useful to them, others did not. The participants were asked to elaborate on their response in an open-ended format. Here, we have included the responses that indicated the content was not understood and/or was not useful to the participants.

To the question, “Did you understand all of the content? Were there any words used that you did not understand (please list them)?” Participant 3 responded, “I did not understand the STBBI acronym. There can be more definitions about what this acronym stands for. For the information about the STBBI, it can be beneficial to include images or external resources about what the terms such as HIV or PrEP (for additional information). Additionally, the STBBI section can be divided based on the type of STBBI (such as HIV, Syphilis).” While a majority (n = 6) of the participants indicated the content was understood by them, the research team did not want to overlook the one participant who indicated it was not, due to the small sample size.

Furthermore, throughout the website, users are asked a series of questions in which they can indicate if they would like additional resources to learn about any given topic more in-depth. Because the OER was developed for a generalized GIaNT audience, spanning a vast range of identities and ages, we would not be able to delve into extreme depth on any given topic, so we opted to provide each user with a customized external resource page that they can use at any given time while navigating the website. These resources have each been vetted by a member of our research team. This function allows for a more personalized experience when using the resource, as not all GIaNT youth’s PHSE needs will be the same. A few participants responded that they did not find the customized resources to be relevant to them. Participant 5 wrote, “I didn’t find them particularly relevant for me,” and Participant 6 noted, “I did not [use it], but it was more of a general knowledge on the website, which is helpful to most people.” While this is noteworthy, this finding was useful as only a few of the participants indicated that the customized resources were not relevant to them.

2.2

Bugs/glitches/mistakes

The participants were asked to “Please note any bugs/glitches/mistakes you noticed while using the website,” and were asked to keep a running list as they navigated the website. Bugs, glitches, and mistakes were included as one category to provide more specificity to the user as to what would be helpful for the researchers and web developers during the editing stage of the OER. In other words, our team did not want to potentially miss out on valuable feedback from the participants if they interpreted a bug to be separate and not relevant to a glitch.

Some participants (n = 3) identified some bugs, glitches, and mistakes throughout the website. Participant 4 stated that they were “Unable to scroll down to view [the] entire map, unable to scroll through themes to try the different themes.” This indicated that when viewing our homepage, the participant could not see all of the learning modules that were displayed in the form of a map. Participant 6 wrote, “The quiz section error,” which indicated that none of the interactive quizzes were working for this participant.

2.3

Content change suggestions

A couple (n = 2) of participants provided suggestions to strengthen the content on the OER. These suggestions generally included requesting more content on specific sections, like the puberty health, sex education, and STBBI sections, and wanting more clarifying information to be added on certain topics, like STBBIs. In regard to content on sexual health, Participant 3 stated, “I would like to see more information from the puberty, sexual education and STBBI sections and medical transition sections.” For content pertaining to medical transition, Participant 3 asserted, “In the medical transition section, for example, I would like to see more information on the side effects of the different gender affirming hormone therapies (divided based on the masculinizing gender affirming hormone therapies and feminizing gender affirming hormones). It would generally be nice to [have] more pictures for example in the medical transition sections, there’s a lot of information about the details, having little pictures with a corresponding short sentence about the type of change would be more effective (think infographic style).” These responses indicated to our research team the desire from participants to have more information and clarity around puberty health, sex education, and STBBIs.

The participants were provided a general, final question, which asked, “Is there anything else you would like to share?”, to which Participant 7 indicated additional desired changes, “FMS [facial masculinization surgery] is very rare and inaccessible for most of us (only a few surgeons worldwide), but it’s presented as equivalent to FFS [facial feminization surgery] in frequency and accessibility; If you include that cis women produce T, you should also note that cis men produce E in their gonads and through aromatization; V rare for transfems to take P w/o E; While they do not menstruate, many transfems experience cyclical period symptoms on E; Cishet women have higher new infection rates, but not highest rates of HIV overall; Images (e.g., repro system diagrams) sometimes cover text; Pop up boxes sometimes appear before their associated text.” This open-ended question was asked in case the participants wanted to add any more information that may not have been directly questioned and addressed by the previous survey questions. The participant responses indicated valuable feedback, insights, and perceptions of the OER’s usability.

4. Discussion

This multi-method exploratory pilot study aimed to receive insights, perceptions, and feedback on our OER’s usability from GIaNT youth. Our analysis of the responses revealed facilitators and strengths of the OER, which indicated that the OER is interactive, the map/world feature is engaging, and it contained useful content. It also revealed some areas for improvement, which included understanding and usefulness of the content, bugs/glitches/mistakes, and content change suggestions.

The findings in the present study are in line with other studies which revealed GIaNT youths’ need and desire for inclusive PHSE materials (Bradford et al., 2013; Craig & McInroy, 2014; Glynn et al., 2016; Steinke et al., 2017). All seven participants (n = 7) found the website educational, which indicates to our team that our OER is a promising resource for GIaNT youth to learn more about their unique PHSE needs. This study adds to the body of literature that demonstrates the urgent need to provide a comprehensive and inclusive PHSE curriculum that caters to GIaNT youths’ unique needs, benefits of which include reducing sexual risks and enhancing mental health (Haley et al., 2019), particularly in an online format (Bradford et al., 2013; Craig & McInroy, 2014; Glynn et al., 2016; Steinke et al., 2017). The results from this exploratory multi-method survey, which had participants review and provide feedback, as well as provide insights on their perceptions of our OER, indicate this resource to be relevant, interactive, and affirming to GIaNT youth and their PHSE needs.

At the same time, some areas for improvement were identified by the participants. To the best of the research and web developer teams’ abilities, these changes were implemented. For example, Participant 3 indicated that they desired more clarity around the term STBBI. From this feedback, more clarifying sentences around this acronym were included in the OER on the homepage, and a few reminders were added throughout to indicate to the user that STBBI has previously been known as STIs/STDs. Any bugs/glitches/mistakes identified by the participants were corrected for the final version of the OER. We have strived to implement any content changes that were identified as needed to be changed by the participants. For example, as suggested by Participant 7, more information about access to facial masculinization surgery was added. However, not all content changes were able to be made due to time and resource constraints. The changes that were not able to be made will be addressed in the following section.

4.1. Limitations

This study provides data using an online, multi-method survey. The feedback and insights we received from our sample size served as beneficial to the usability of the newly developed OER. To have a deeper understanding of participants’ perception, we encourage future research to include individual interviews and focus groups with GIaNT youths (Singh & Thirsk, 2022). To be clear, we advise research groups to use our methods and methodological approaches where applicable in their future research endeavors in research pertaining to GIaNT people and their PHSE needs. At the same time, our methods may not be appropriately replicable by other teams depending on the aims and scope of their project. To return to our previous section on the theoretical framework, following the works of Alcoff (1991), Collins (1999), and, particularly, Johnson (2015), the need to conduct research that focuses on GIaNT people with members of this community directly is needed, in general, in academic research.

To this end, we recognize our sample size of seven participants to be small. Therefore, the findings from this research are not intended to make broad generalizations about this complex and diverse community. Instead, they offer in-depth insights that strengthen our OER. While our team initially set out to recruit 10–15 participants, we were successful in recruiting seven. Our recruitment methods may have largely influenced the smaller sample size; however, the safety of potential participants was the research team’s utmost concern with this project. Due to the potential for harassers and bots, direct communications in the form of snowballing and community organization communications were elected as the safest possible way to recruit participants. While the sample size was seemingly small, our team believes we did reach data saturation. We understand data or code saturation as the moment when new data collection produces minimal or no changes to the codebook (Guest et al., 2006). The meaning-making that occurred as a result of our data was useful in reporting our findings here.

An additional limitation is that there was an equal number of White and Asian participants; however, more racial and ethnic diversity would improve the intersectional needs of potential website users. This contributes to an already recognized issue in research, particularly for GIaNT populations, that there is limited representation from equity-deserving communities within the GIaNT population (Le et al., 2022; Roberts & Christens, 2021; Warner & Shields, 2013; Newman-Seymour & Haghiri-Vijeh, 2025). Future research should strive to include participants with diverse ethnicity and migration identities.

Within our participants, we found there to be a well-versed representation of a variety of transgender, non-binary, gender-diverse, and gender-questioning participants. This is a strength of this study, as, typically, studies that include this population are oversaturated with transgender participants (Kearns et al., 2021; Means & Morgenroth, 2024). However, another limitation is that none of the participants in this study (n = 6) identified themselves as intersex, with one (n = 1) participant indicating not sure to this question. This lack of representation in this study is similar to a larger issue of a lack of adequate research on intersex individuals (Raz, 2024; Roen, 2019; Zeeman & Aranda, 2020).

4.2. Implications for Future Research

As previously stated, we were not able to conduct individual interviews or focus groups. As such, we suggest that future studies conduct interviews and focus groups with a larger cohort study. Having a large sample size will help to potentially diversify the responses from participants. The majority of the participants were equally White and Asian, and a question about the participants’ migration status was not included in the demographic. Understanding the complex intersection of youth, migration, cultural impact, BIPOC identities, and GIaNT youth, future research should intentionally capture best approaches in meeting the unique needs of youth with intersecting identities of GIaNT, race, ethnicity, and migration status (Haghiri-Vijeh, 2023; Haghiri-Vijeh & Clark, 2022). Special care to recruit intersex and a diversified BIPOC and migrant population is suggested for future research.

Due to the scope of this project and the end of our funding period approaching, our team analyzed the feedback provided by the participants and determined what changes would be feasible to undertake before the completion of this project. All of the bugs and glitches that the respondents identified were modified. Some content changes were made, including: adding more dialogs that address the user by their name; adding more clarity in the medical transition world, particularly around concepts dealing with hormones, gender-affirming hormone therapy, and gender-affirming surgeries; and providing reminders of the term STBBIs throughout the website, i.e., on the “map” and again in the content, clarifying terminology and also referring to the previously known terms STIs/STDs. Our research team plans to apply for additional funding to continue improving the website to include longer-form suggestions provided by survey respondents, like adding avatar customization, extending the resource pages to be applicable to folks living outside of Ontario and expanding current sections like adding more on intimate partner violence, and optimizing the website for mobile use.

5. Conclusions

While the sample size for this study was small, the study and its findings suggest that this OER is a promising mode of disseminating PHSE knowledge. This paper can be beneficial to researchers, website developers, and other PHSE educators and curriculum builders. The findings from the data can be used to enhance the emerging body of literature centering GIaNT youth and their PHSE needs, particularly in an online format.

Overwhelmingly, the research team found the responses to be positive. We conclude that GIaNT youth found the website to be engaging, educational, and relevant to the needs of this population. On one hand, key areas of strengths noted were: the interactive design; vibrant colors, graphics, and the map feature; resources for support; and the generally fun and positive feeling of the website. On the other hand, some key areas of improvement include: using the personalized name/pronouns of each user more throughout the website; more content and information provided in the sex education, puberty health, and medical transition sections; and fixing some technical issues that the respondents experienced throughout. To conclude, the findings from our survey responses found the website to be a valuable resource for GIaNT youth to learn more about puberty health and sex education in ways that are relevant to them. Upon the incorporation of changes, the OER is now available publicly (https://giantyouth.com/, accessed on 15 April 2026).