LAUSR

PURPOSE The goal of this research is to advance the study of health disparities faced by older sexual and gender minorities by assessing comprehension of and improving measures of sexual and gender identity in surveys. METHODS Cognitive interviews were conducted by expert interviewers with 48 non-lesbian, gay, bisexual, and transgender (non-LGBT) and 9 LGBT older English and Spanish speakers. RESULTS All respondents were able to answer questions about their sex assigned at birth and current gender identity successfully despite some cisgender respondents' lack of clear understanding of the transgender response option. On the contrary, while the vast majority of English speakers could answer the question about their sexual identity successfully, almost 60% of the non-LGBT Spanish speakers did not select the "heterosexual, that is, not gay (or lesbian)" response category. Qualitative probing of their response process pointed mainly to difficulties understanding the term "heterosexual," leading to their choosing "something else" or saying that they didn't know how to answer. A second round of testing of alternative response categories for the sexual identity question with Spanish speakers found a marked improvement when offered "not gay (or lesbian), that is, heterosexual" instead of beginning with the term "heterosexual." CONCLUSION This research adds to our understanding of gender and sexual identity questions appropriate for population surveys with older adults. Inclusion of these measures in surveys is a crucial step in advancing insights into the needs of and disparities faced by LGBT older adults.