The experience of stigmatization based on group membership can lead to negative effects on physical and mental health via repeated experiences of stress which, in the long term, accumulate to impact health negatively (minority stress model) [1]. Stigmatization can occur based on membership in any group that is discriminated against. In this research, we focus on LGBT+ (lesbian, gay, bisexual, and transgender people. The “+” symbol represents individuals whose identities do not fit typical binary notions of male and female [nonbinary]) stigmatization and its reduction in Romania.

Among European countries, Romania tends to fare poorly when it comes to LGBT+ inclusion. A recent survey [2] showed that 45% of Romanian LGBT+ respondents felt discriminated against in at least 1 area of life during the year before the survey. Similarly, 43% of respondents experienced harassment due to being LGBT+, a rate that ranks second among all European countries. Much of this discrimination and harassment happens in schools for young people, with 44% of LGBT+ students (15-17 years of age) in Romania saying they are hiding being LGBT+ at school, a rate that is 3 to 4 times higher than in countries such as Luxembourg (11%), the Netherlands (16%), or Malta (17%). Indeed, schools seem to be a fertile ground for LGBT+ harassment, with 51% of incidents involving perpetrators from schools [2], a finding reinforced by a UNESCO (The United Nations Educational, Scientific and Cultural Organization) report on school violence [3].

Such high rates of LGBT+ discrimination among Romanian students are concerning, because stigma impacts young LGBT+ people’s mental and physical health. A meta-analysis [4] including 35 studies of over 2 million heterosexual young people and over 100,000 LGBT+ young individuals (age range 12-20 years) showed that suicide risk was higher for LGBT+ young people compared to those who were not LGBT+. For every heterosexual young person, the chance of suicide was 3.71 higher for gay and lesbian young people, 4.87 higher for bisexual youth, and 5.87 higher for young transgender people. This risk is paired with a higher likelihood for sexual minority youth to experience mental health issues such as anxiety and depression but also impaired academic performance [5]. The findings for sexual minority youth are consistent with sexual minority individuals in general—a systematic review showed that the majority of studies revealed a higher risk for mental health issues, substance abuse, and suicide risk for sexual minorities [6]. LGBT+ people are also more likely to endure physical health issues due to minority stress, including an increased risk for cancer, cardiovascular disease, and chronic conditions such as asthma and diabetes [7].

Importantly, although minority stress can affect all LGBT+ people, younger sexual minority individuals seem to be most vulnerable to the negative effects of stigma on their mental and physical health. A meta-analysis indicated age as a significant moderator, such that youth younger than 17 years of age experienced higher negative outcomes due to LGBT-related victimization compared to those older than 17 years of age [8].

Together, these findings indicate a strong need to implement effective interventions to reduce LGBT+ stigma and bias in Romanian schools, to improve the mental and physical health of LGBT+ students in Romania. These interventions may be most efficient particularly among teachers, as they can impact their students’ experiences either directly or indirectly, via establishing inclusivity norms in the classroom.

To be effective, interventions should not only focus on reducing teachers’ biases toward LGBT+ students, but also on learning, implementing, and modeling behaviors that would equip them to intervene when students experience LGBT+-related victimization. A meta-analysis [9] showed that interventions can be moderately successful in reducing sexual prejudice, resulting in changes ranging from one-third to one-half of an SD in size. Moreover, the meta-analysis specified the most effective strategies in reducing different outcomes—educational interventions, contact with LGBT+ individuals, and interventions combining education with contact. A more careful analysis reveals that most intervention studies have been conducted on undergraduate students in Western countries and none in Eastern Europe or other countries with strong antigay attitudes. Although more recent research has started to test interventions in other countries such as Jamaica [10] or Brazil [11], no such adaptation exists in Romania (or Eastern Europe), particularly for teachers. Adapting interventions to the cultural and institutional context seems vital, given that a recent qualitative analysis suggests that participants tend to criticize many interventions for their mismatch with the context in which they are conducted, possibly as a rationale for resisting change [12].

The primary goal of this research line is to design and test an intervention that is geared toward Romanian teachers. Importantly, we plan to achieve this goal by deliberately taking into account specific cultural and institutional characteristics, rather than indiscriminately applying previous intervention strategies. More specifically, although we plan to use education and contact as primary training elements, consistent with meta-analytic findings [9], we plan to design the educational components to respond to the needs of our particular target group. For example, we drew from recent research conducted in Russia [13], a country with a similar culture and history regarding LGBT+ attitudes. Building on these findings, we propose that the educational component should include information regarding the biological (vs social) causes of homosexuality, given that attributions of causality are related to perceived threat, and subsequently lead to biased outcomes. In addition, given the importance of threat in predicting antigay bias, and consistent with intergroup threat theory [14], education should explicitly address potential feelings or perceptions of threat (for example, the perception that exposure to LGBT+ people will “make” children gay).

A second novel aspect is that the intervention will aim not only to improve attitudes and knowledge as an outcome but also target behavioral change by imparting tools that teachers can use to address LGBT+-related victimization in schools. This strategy has been used successfully in the past in a web-based intervention program for Brazilian health practitioners [11]. As a result, we are likely to increase the impact of the intervention of LGBT+ students, not only by improving the inclusion climate within the schools but also by improving teachers’ actual behavioral intentions and skills that may improve LGBT+ students’ outcomes.

In this research, we design and report the protocol of a randomized controlled trial (RCT) intervention and evaluation. The intervention is based on existing evidence about the efficacy of strategies identified in Bartoş et al’s [9] meta-analysis. According to their results, the most effective strategies in reducing LGBT+ stigma combine educational elements with contact with LGBT+ people. We also add elements that were found to be useful in other bias-reducing interventions such as perspective taking [15] and self-efficacy [16,17], and which we deem culturally appropriate. A summary of intervention components, subcomponents, and contents is presented in Table 1. For each element, we include the supporting reference, as an evidence base for their efficiency in reducing bias.

Using an RCT in which teachers are randomly assigned to complete the intervention before assessing outcomes (experimental) or after assessing outcomes (control), we predict that the intervention will have a positive effect on attitudinal, cognitive, behavioral, and affective measures of LGBT+ bias among teachers. Specifically, we predict that teachers randomly assigned to the experimental condition, compared to those randomly assigned to the control condition will experience (1) more positive attitudes toward LGBT+ individuals, (2) more factual knowledge about LGBT+ issues, (3) stronger behavioral intentions and self-efficacy about addressing LGBT+ issues in the classroom, and (4) more positive affect toward LGBT+ individuals.

We plan to collect data exclusively from teachers or counselors working in Romanian public schools. All participants will be required to speak Romanian because of the language used in the intervention and measures. Participants who complete the intervention will be sent a participation certificate which could be used for continuing education credits and are given the option to enter a raffle where they can win a 500 RON (equivalent to US $110) gift certificate.

Our recruitment strategy is to ask the local Center for Educational Resources and Assistance to distribute a message nationally, to all their members who are teachers or counselors employed in Romanian schools. If interested, they have the opportunity to sign up for 1 of the several sessions depending on their availability. The sessions are capped at 30, with an average of 25 participants signing up for each (range 24-27). We will advertise a total of 17 sessions across 3 months at different times during the day.

This intervention’s experimental design is an RCT. We use a 2-group random assignment design, such that participants are randomly assigned to either the experimental condition in which they receive the intervention first and then complete the outcome measures, or to a control condition in which they complete the outcome measures first and then receive the intervention. From an ethical perspective, we chose this design so that all participants will receive the intervention and associated resources by the end of their participation. From a validity perspective, the outcome measures of those in the control condition are not affected by the intervention, thus serving as an appropriate control comparison to participants in the experimental condition.

Participants will join sessions in groups of up to 30 participants, depending on their availability. Cluster randomization will be done at the session level, such that each session will be randomly assigned to either experimental or control conditions. Individual randomization within the session is not possible given that the intervention will be presented to all participants at the same time. Sessions will be scheduled across different times and days outside typical working hours, so we do not anticipate any systematic biases arising from participants’ session choices. To ensure experimental control, each session will be led by 2 researchers who deliver scripted instructions, answer questions, and ensure all participants complete the study at a similar pace and with minimal distraction.

The intervention is designed for internet-based delivery and is multimedia, containing a recorded presentation, animations, testimonials of LGBT+ people, as well as 2 exercises. Whereas the intervention is rooted in empirical evidence, we also ensured cultural sensitivity by collaborating with local LGBT+ educational and advocacy nongovernmental organizations who offered feedback on intervention components. A detailed summary of the evidence-based components, as well as timestamps and duration for each subcomponent, are included in Table 1.

Ethics approval was obtained from the West University of Timisoara, Romania, ethical panel (74505/10.11.2022), based on an application containing the procedure, measures, and materials used. Upon being presented with detailed information regarding the study, informed consent will be obtained from all participants before starting their participation. All data will be anonymously collected, with no personal or identifiable information being recorded. All fully anonymous data will be stored on password-protected computers and servers. Compensation consists of a participation certificate which could be used for continuing education credits and the option to enter a raffle where they can win a 500 RON (equivalent to US $110) gift certificate. There is no identification of individual participants in any images within the paper.