{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:47:42Z","timestamp":1782712062369,"version":"3.54.5"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Education on intersex health remains limited across healthcare professional training pathways, resulting in persistent gaps in workforce competencies. Existing educational initiatives are often fragmented, small in scale, and rarely evaluated beyond immediate post-training outcomes. Robust evidence on the sustainability of educational effects over time is still scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the immediate and six-month educational impact of a large-scale e-learning training program on intersex health among healthcare professionals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a longitudinal cohort study of a national asynchronous e-learning program delivered between February and August 2023. The program targeted physicians, psychologists, midwives, and healthcare assistants and was designed using a problem-based learning approach. Educational outcomes were assessed at baseline (T0), immediately after course completion (T1), and at six-month follow-up (T2), using self-reported measures of attitudes and perceived skills, a knowledge assessment test, and a training satisfaction questionnaire. Statistical analyses included paired t-tests, ANCOVA, and McNemar tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 6,332 participants completing both T0 and T1 assessments, 1,036 also completed the six-month follow-up. Participants were predominantly female (73.9%), with psychologists (47.8%) and physicians (39.1%) representing the largest professional groups. Significant improvements were observed at T1 in attitudes (+0.54), perceived skills (+1.45), and knowledge (+11.7 percentage points; all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Improvements were largely sustained at T2, with only modest declines across domains. Baseline differences by gender, geographic area, and professional group were substantially reduced following training. Overall satisfaction with the program was high (mean score 4.48\/5) across participant subgroups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides longitudinal evidence that a large-scale e-learning training program was associated with significant and sustained improvements in healthcare workforce competencies in a traditionally under-addressed area of care. Structured, cross-disciplinary training delivered through accessible digital formats may offer a scalable strategy to strengthen workforce preparedness and reduce educational gaps in intersex healthcare.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1809092","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:38:47Z","timestamp":1782711527000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intersex health training is associated with sustained competency gains in the healthcare workforce"],"prefix":"10.3389","volume":"14","author":[{"given":"Ughetta Maria","family":"Favazzi","sequence":"first","affiliation":[{"name":"Training Office, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Ruocco","sequence":"additional","affiliation":[{"name":"Reference Centre for Gender Medicine, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Manoli","sequence":"additional","affiliation":[{"name":"Reference Centre for Gender Medicine, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]},{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University of Catania","place":["Catania, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Borgi","sequence":"additional","affiliation":[{"name":"Reference Centre for Gender Medicine, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosilde","family":"Di Pirchio","sequence":"additional","affiliation":[{"name":"Reference Centre for Gender Medicine, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Malorni","sequence":"additional","affiliation":[{"name":"Reference Centre for Gender Medicine, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Carbone","sequence":"additional","affiliation":[{"name":"Training Office, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora","family":"Guerrera","sequence":"additional","affiliation":[{"name":"Training Office, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Molinaro","sequence":"additional","affiliation":[{"name":"Training Office, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica Maria","family":"Regini","sequence":"additional","affiliation":[{"name":"Training Office, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Vittozzi","sequence":"additional","affiliation":[{"name":"Training Office, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Meriggiola","sequence":"additional","affiliation":[{"name":"Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna","place":["Bologna, Italy"]},{"name":"Department of Medical and Surgical Sciences (DIMEC), University of Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiska","family":"Ristori","sequence":"additional","affiliation":[{"name":"Cognitive Behavioral Therapy Centre","place":["Florence, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra Daphne","family":"Fisher","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Multidimensional Medicine, Azienda USL Toscana Centro","place":["Florence, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Mazzaccara","sequence":"additional","affiliation":[{"name":"Training Office, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Ortona","sequence":"additional","affiliation":[{"name":"Reference Centre for Gender Medicine, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Marconi","sequence":"additional","affiliation":[{"name":"National Centre for Clinical Governance and Excellence in Care, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Pierdominici","sequence":"additional","affiliation":[{"name":"Reference Centre for Gender Medicine, Istituto Superiore di Sanit\u00e0","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"ref1","volume-title":"LGBTIQ Equality at a Crossroads \u2013 Progress and Challenges","year":"2024"},{"key":"ref2","volume-title":"Understanding the Well-Being of LGBTQI+ Populations","author":"Patterson","year":"2021"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"6533","DOI":"10.3390\/ijerph17186533","article-title":"A systematic review of the health and healthcare inequalities for people with intersex variance","volume":"17","author":"Zeeman","year":"2020","journal-title":"Int J Environ Res Public 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