Into Inclusion: Increasing Trans-Inclusive Practices with Behavior Analysis

Abstract

Promoting an inclusive culture can be critical to the progression of diverse groups. Practicing inclusive behavior is one important step toward fostering inclusion. Applied behavior analysis can contribute much to this topic given its use of practical methods to encourage socially significant behavior change (Baer et al., 1968). Proper pronoun use is one inclusive behavior that helps support gender minorities. Whereas self-assessment has been recommended to increase cultural awareness, this has not been confirmed through research. Thus, the purpose of the present study was to assess the effects of a specific approach to self-assessment (behavioral self-monitoring; BSM) on the percentage of correct pronouns used by graduate students during a simulated work task. Results indicate that BSM was effective in promoting proper pronoun use when it followed BSM training, and the effects maintained over time.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-021-00669-2.

The Social Significance of Promoting Inclusion

There is a need to explore topics related to social justice and inclusion within the field of behavior analysis (Akpapuna et al., 2020; Li, 2021; Sundberg et al., 2019). Concerning gender specifically, authors have discussed the importance of equal opportunity for women in the field (Gravina et al., 2019; Li et al., 2019; Sundberg et al., 2019). Gender identity is another topic related to gender that is gaining more attention (Capriotti & Donaldson, 2021; Conine et al., 2021; Leland & Stockwell, 2019; Morris et al., 2021). The term transgender refers to an individual whose gender identity does not match the sex assigned to them at birth (Gay & Lesbian Alliance Against Defamation, 2021). For example, a person may be assigned female at birth but identify as a man or other gender that may be within or outside the gender binary. Gender nonconforming refers to individuals whose gender expression, behaviors, or identity is different from the societal or cultural roles of men or women. The term transgender and gender nonconforming (TGNC) has been used when discussing transgender and gender-nonconforming people collectively. However, a person may identify with one, both, or neither of the aforementioned terms, and exact definitions may vary depending on the person (Leland & Stockwell, 2019).

Discrimination is commonly experienced by TGNC people and other gender minorities in the workplace. Many transgender people may be harassed and bullied at work, which can contribute to higher rates of depression and anxiety (Beauregard et al., 2018). Furthermore, studies indicate high rates of suicide attempts reported among transgender adolescents, with figures as high as 50.8% of certain gender identity groups attempting suicide at some point in their lives (Toomey et al., 2018). Given these concerning figures, there is a pressing need to identify interventions aimed at both reducing discriminatory behaviors and increasing prosocial behaviors (Binder, 2016; Houmanfar et al., 2015). This topic seems fitting for the field of applied behavior analysis (ABA), which focuses on developing practical interventions that lead to socially significant behavior change (Baer et al., 1968). It may be possible to use behavioral techniques to promote trans-inclusive behavior.

In the existing literature in behavior analysis, some experimental research was done in the 1970s with sexual and gender minorities. However, it was not focused on inclusion. Morris et al. (2021) completed a historical literature review, which examined the treatment of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals. The results indicate that representation of sexual and gender minorities is scarce within the behavior-analytic literature. Additionally, early experiments applied conversion therapy, which aimed to change a person’s gender identity or sexual orientation. Beyond being exclusionary, these experiments were damaging to the participants and perpetuated the harmful idea that one’s gender identity or sexual orientation could or should be changed.

There has been a strong shift in focus and a call for research related to LGBTQ+ topics with more inclusive goals. One goal is identifying techniques to increase gender-affirming practices (Capriotti & Donaldson, 2021; Conine et al., 2021; Leland & Stockwell, 2019; Morris et al., 2021). Despite the developing interest, no studies to date have explored the effects of a behavioral intervention on TGNC-affirming behaviors. To ensure inclusivity for all gender identities, more research is needed. Such research could offer a practical approach to promoting inclusion that could have important implications for TGNC people and other diverse groups.

Pinpointing an Inclusive Culture

One reason for the lack of research could be that terms such as “cultural inclusion” or “inclusive climate” are vague (Akpapuna et al., 2020). Targeting inclusive behaviors is one of the first steps to promoting inclusion. One must first pinpoint behaviors of interest and then follow a systematic process that enables desired behavior change (Akpapuna et al., 2020; Daniels & Bailey, 2014). Leland and Stockwell (2019) provide a tool that pinpoints behaviors to increase inclusivity toward TGNC people. Additionally, they present strategies to create an inclusive environment. Using individuals’ specified names, using gender-neutral language (e.g., saying “everyone” instead of “ladies and gentlemen”), and creating questions or scenarios that reflect various genders (e.g., examples using female and nonbinary students) are a few examples.

Proper pronoun use is another behavior within the tool that may be an effective target. It should be noted that the terms “preferred pronoun” and “preferred name” have been used to describe when an individual begins using an alternate name or pronouns instead of the name and pronouns assigned at birth. However, some have argued the term “preferred” may not demonstrate the importance of using indicated pronouns and could result in more frequent incorrect name or pronoun usage. Thus, we use “proper pronoun” or “correct pronoun” to refer to the pronouns an individual indicates they use and “proper name,” “correct name,” or “chosen name” to refer to the name a person indicates they want to be called.

Regarding social validity, proper pronoun use is a common behavior that offers validation of and support for the individual’s gender identity. There are higher instances of stress, depression, and anxiety in those exposed to misgendering, but less so with social support through gender validation (McLemore, 2018). Furthermore, proper pronoun and name usage is correlated with improved outcomes, such as a lower likelihood of suicide and depression (Russell et al., 2018).

Additionally, this topic is relevant within many settings. For instance, there is a need for research on gender-affirming practices in hospitals among administrative staff and doctors toward patients. Examples include indicating proper pronouns on forms and changing the gender on one’s medical record (Dolan et al., 2020). Regarding universities, an interview with TGNC students revealed that although they felt they could express themselves and be more open with their identities, experiences with misgendering still occurred (Storrie & Rohleder, 2018). Given the increase in openness of TGNC people, universities must adopt inclusive practices.

A Behavioral Explanation for Improper Pronoun Use

Before identifying interventions to promote correct pronoun use, one must first understand why incorrect pronoun use occurs. Training experts have identified two reasons for inadequate performance. The first is due to a lack of knowledge or awareness, whereas the second involves a lack of motivation (Mager & Pipe, 1997). Each reason requires a different approach to performance improvement. The first should be addressed through antecedent interventions such as task clarification and training, whereas the second requires adjusting consequences (Daniels & Bailey, 2014; Mager & Pipe, 1997).

Considering pronouns, many individuals may make errors due to the first reason. In other words, they lack awareness or have not become proficient in consistently emitting the correct pronouns based on information provided. It is possible to explain these errors through learning history. A person may provide a pronoun based on someone’s appearance alone given that, in the past, they were reinforced for classifying certain characteristics as either “male” or “female” (Cartwright et al., 2017). Through time, characteristics typically associated with being either masculine or feminine may come to act as discriminative stimuli evoking the use of she/her or he/him pronouns.

In other cases, the name alone may act as the discriminative stimulus and evoke pronouns that typically relate to a certain gender. During a child’s language development, a parent may say “Frank is a boy’s name” and provide corrective feedback when their child uses she/her pronouns when referring to Frank. This and similar patterns of word usage are then reinforced throughout the child’s life. Through time, when the child encounters a stimulus or stimuli that possess certain characteristics, they emit pronouns based on this established learning history.

Although shaping and learning history may help explain one reason for misgendering behavior, it is important to point out that, regardless of the specific reason, the impact is still the same. Misgendering is damaging to the person being addressed, and it is a topic worthy of attention. Although this pattern of responding may be difficult to change, with proper information and feedback, it may be possible for a person to learn to respond differently. However, further research is needed to confirm this theory.

Applying Behavioral Self-Monitoring (BSM) to Increase Correct Pronoun Use

Authors have noted the importance of self-assessment in promoting an inclusive environment (Akpapuna et al., 2020; Leland & Stockwell, 2019). BSM is a specific approach to self-assessment that involves repeatedly observing and recording one’s behavior (Olson et al., 2011). BSM, in combination with other components, has proven effective when addressing a variety of performance-related concerns (Olson & Winchester, 2008).

One benefit is that it can be done privately (Godat & Brigham, 1999). This benefit may be ideal for inclusive behaviors given the sensitivity of the topic. It may be difficult to receive corrective feedback from a supervisor or TGNC person on proper pronoun use. Additionally, it may not be possible to have another individual present each time someone engages, or fails to engage, in inclusive behavior. Professors or academic advisors, for instance, are frequently reminded to be inclusive and attend to pronouns. However, many class sessions may be completed without a supervisor present. In these circumstances, BSM may be a viable alternative to supervisor-delivered feedback.

Although there are benefits, it would not be practical for a professor, advisor, or peer to make a note each time they used the proper pronoun immediately after doing so. However, research suggests that results can be obtained through recording estimations of performance. Critchfield (1999) analyzed swimmers and determined that recording less frequently (after each session) resulted in higher performance than doing so after every two or four laps. These findings are similar to Olson and Austin (2001), who saw performance increases by having bus drivers record and graph data only once or twice a day. Considering these results, a professor could self-monitor overall pronoun use following a class session.

Frequent recording may not always be critical, as other factors can influence the effects of BSM. For instance, results are improved when the individual values the behavior and is motivated to change (Chase et al., 2013; Olson et al., 2011; Olson & Austin, 2001). Thus, the approach would be ideal for a person who supports correct pronoun usage and makes errors due to a lack of understanding or proficiency. It may be less likely to work for someone who is aware of the proper pronouns but is not motivated to change. The effects of BSM can also be enhanced through the addition of BSM training. Gravina et al. (2008) examined the effects of BSM on safe posture and observed only modest improvements. In a follow-up study, the authors added BSM training, which resulted in a substantial improvement from the previous study (Gravina et al., 2013).

Although BSM may promote inclusive behavior when an individual is motivated to change, no studies have confirmed this. Furthermore, research is needed to understand how behavioral techniques such as BSM can be applied to increase inclusive behavior. The benefits of identifying an intervention that promotes trans-inclusive behaviors are undeniable. As ABA is a science that prides itself on socially significant outcomes, extending the literature in this area would seem, at the very least, a worthwhile venture, if not a responsibility. As such, the purpose of the present study was to assess the effects of a behavioral intervention package on promoting a trans-inclusive behavior. Specifically, researchers applied BSM to increase the percentage of proper pronouns used by two university students during a simulated work task, which emulated the role and expectations of an academic advisor.

Method

Participants

Participants were graduate students at a southeastern university who received extra credit in a course. To be included, they must have regularly used names or pronouns during interactions and scored 0% correct pronoun use during baseline probes. Given the nature of the dependent variable, individuals performed at either 0% or 100%. Those who were labeled as sensitive to pronouns used the correct pronoun all the time. Alternatively, those who were labeled as not sensitive never used the correct pronouns. A total of seven potential participants were recruited. Five did not meet inclusion criteria. Of those five who were excluded, four failed to meet inclusion criteria by using the correct pronoun 100% of the time without a cue or BSM. The final potential participant failed to regularly use names or pronouns during interactions (this will be discussed in more detail in what follows). Two of the seven met inclusion criteria. Both participants identified as women, were in their early 20s, and indicated that English was their first language. Both also reported having friends or past experiences with individuals who were TGNC and indicated being “somewhat familiar” with TGNC topics.

Setting and Materials

The study was conducted and recorded on Zoom. Materials included access to Microsoft Word, an “academic advisor” email account, a list of commonly gendered and gender-neutral names, a demographic information form for each hypothetical student advisee, and a data sheet with questions to ask about hypothetical student advisees. Further discussion of these materials will be provided in what follows.

Concerning the list of commonly gendered and gender-neutral names, this list was developed by the first author based on running a Google search of “gender-neutral names” and reviewing websites. Once the final list was constructed, it was reviewed by the second author, and they both agreed that these names were gender neutral. Many of the names selected also tended to align with anecdotal experiences such as knowing a person who identified as male who used the name “Jamie,” as well as an individual who identified as female.

Experimental Task

Memorization Component

The experimental task was a simulated work task in which the participant acted as an “academic advisor” at a university and reviewed emails from hypothetical student advisees. These emails were constructed by the researcher prior to the experiment. During the simulation, the participant reviewed an email and an attached demographic information form. They were told the study was a memory study and to memorize as much information on the form as possible in 1 min.

Importantly, this study contained deception. Whereas participants were told the focus was on their ability to memorize information, the researcher assessed their use of the correct name or pronoun. Deception was used to ensure the participants focused on distracting information to avoid a high level of correct pronoun use due to their awareness of the purpose of the study. This was also intended to be more representative of a typical academic advisor’s position. Faculty and advisors may be told to attend to pronouns but frequently become busy, which could increase errors.

Correct name or pronoun use was assessed when participants were questioned about each piece of information on the hypothetical student’s demographic information form. Pronouns were found in the signature block of the email, which is becoming an increasingly common location to indicate one’s pronouns (University of California San Francisco, 2021). For instance, after the participant reviewed the form, the researcher might have asked what the student’s major was, and the participant could respond with “His major is philosophy” or “Her major is psychology.” Each question provided an opportunity to identify the hypothetical student using the correct pronoun.

Presentation of Proper Name and Pronouns

Each email contained a generic message from the hypothetical student with a greeting, a message about meeting later, and a sign-off with a signature block. The signature block included the student’s proper name, pronouns, institution, and status as a student (see Appendix A). The attached demographic information form included demographic information and other important information for the hypothetical student. Examples include legal first and last name and chosen/proper name, the student’s sex (i.e., sex assigned at birth), student ID, degree program, major, GPA, and so on. As mentioned, this was information the participant was instructed to memorize for the experimental task.

For hypothetical TGNC students, the gendered legal name and sex (i.e., sex assigned at birth) on the demographic form did not match the proper name (which was gender neutral) and pronouns in the signature block of the email. The pronouns were either gender neutral if the student identified as nonbinary (e.g., they/them) or the opposite of the sex assigned at birth. For instance, a student’s gendered legal name may have been “Frank Hope” and the student’s sex (i.e., sex assigned at birth) on the demographic information form may have been male (see Appendix B). However (as seen in Appendix A), the student would have signed off with a gender-neutral name such as “Frankie” and the proper pronouns provided in the signature block of the email may have been she/her for a transgender student who identified as female or they/them for a nonbinary student.

We arranged the experimental task in this manner to highlight the effects of the intervention, as we theorized errors would likely occur due to one’s learning history, as discussed previously. Thus, a gendered legal name and information including sex (i.e., sex assigned at birth) may evoke the use of gendered pronouns that aligned with each, given one’s learning history and the gendered name and sex acting as discriminative stimuli. This would only occur if the participant failed to attend to the proper pronouns in the signature block of the email.

One may argue that it would be unrealistic for an academic advisor to be provided with a student information form that contained a gendered legal name that did not align with a student’s chosen name or proper pronouns. However, this was intended to be representative of a typical student encounter given that it is often difficult for TGNC students to change their legal name. Thus, they may need to provide it on documentation, which can lead to additional confusion and may increase the likelihood of incorrect pronoun use if one fails to attend to proper pronouns. Additionally, the sex (i.e., sex assigned at birth) is frequently provided on demographic information forms, which also may cause confusion.

Dependent Variable and Measurement

The dependent variable was proper pronoun or name use. For the purposes of this study, proper pronoun use was defined as using the pronoun specified in the email signature block (she/her, they/them, he/him). An example of proper pronoun use is the statement “His middle initial is M” or “He is an international student” when the signature block indicated a hypothetical student’s pronouns were he/him. An incorrect instance of proper pronoun use for the same hypothetical student is stating “Her middle initial is M” or “She is an international student.” Additionally, although they/them pronouns are appropriate for instances in which a person’s pronouns are not known, because the pronouns were indicated, use of they/them pronouns when the pronouns in the email were she/her or he/him were marked as incorrect. Responses in which a participant used the hypothetical student’s legal name rather than their chosen name or pronoun were also considered incorrect.

To increase external validity, both hypothetical TGNC and cisgender students were included. However, data were only collected for hypothetical TGNC students given the increased likelihood of errors associated with learning history. Measurement was based on percentage and was calculated according to the number of times the participant used the correct name or pronoun out of the 10 demographic questions they were asked for each hypothetical TGNC student.

Questions were one or two words (such as “Name?”) to avoid potential confounds associated with the researcher modeling proper or improper pronoun use through the question. To promote full-sentence responses, the researcher instructed the participant to use full sentences, as this may be expected of an academic advisor who was discussing student information. On questions that could not be scored (such as when the participant did not use a pronoun or name), the researcher reminded them to use full sentences and asked another question to provide another opportunity; up to five additional opportunities were provided per hypothetical student.

Neglecting to use names or pronouns was rare. Participant 1 completed 16 sessions with hypothetical TGNC students, which consisted of a total of 162 questions. Participant 1 did not use a pronoun or name for 2 of the 162 questions (1%), requiring a reminder to use complete sentences. Participant 2 completed 14 sessions with hypothetical TGNC students, which consisted of a total of 143 questions. Participant 2 did not use a pronoun or name for 3 of the 143 questions (2%), requiring a reminder to use complete sentences. Neither participant had to be reminded more than one time within a single session.

If a potential participant regularly failed to use a name or pronoun, the study ended and they were debriefed and dismissed. As mentioned, one potential participant was excluded due to regularly failing to use a name or pronoun. Anecdotally, this individual typically answered with statements such as “The state of origin is . . .” rather than a statement that included a pronoun (e.g., “Her/His/Their state of origin is . . .”). The few instances they did use pronouns were incorrect.

Interobserver Agreement (IOA)

IOA was collected using a trial-by-trial method. The formula was the number of agreements divided by the number of agreements plus disagreements, multiplied by 100. A secondary observer reviewed the video recordings and independently scored a random sample of 33% of sessions. An agreement occurred when the observers agreed that a single opportunity counted as proper or improper pronoun use. The IOA calculated for the study was 99.02%.

Independent Variables

Subtle Cue

To counter the argument that the participants used the proper pronoun simply due to increased awareness alone, a subtle cue condition was included. Prior to having the participant review the email, the researcher provided a cue that instructed participants to “attend to and be sensitive to various cultural and other background information as any academic advisor would be expected to.” This was intended to simulate a real-world task in which a typical academic advisor must remember a lot of information about each student. However, they are frequently also prompted (often subtly) at the start of a semester to be sensitive to students’ background information and social and cultural differences.

BSM Training and BSM

The independent variable assessed was BSM. Intervention sessions began with all participants being told to attend to and self-monitor their correct use of the proper pronouns for all hypothetical students (i.e., both TGNC and cisgender). Prior to beginning the trial, a brief BSM training session occurred during which the researcher instructed and modeled which behavior specifically they should be recording and when to tally themselves. The participant was also able to practice after the modeling session. BSM occurred immediately following each interview and involved marking a tally on a Microsoft Word document if the participant believed they used the proper name or pronoun 100% of the time during the interview. The response was saved, and the same form was used after each session so they could see their progress. When the participant was finished self-monitoring, the researcher began the next session.

The accuracy of the recording was also reviewed. Correct implementation of the treatment was considered to have occurred each time the participant either correctly marked a tally or did not mark a tally based on pronoun or name usage.

Research Design

A multiple-probe across-participants design was used to assess the effects of BSM on correct pronoun and name use. Baseline data were collected for each participant. When the data showed stability for three consecutive data points, the subtle cue was introduced for the first participant while the second participant remained in baseline. After one data point of subtle cue data was collected for the first participant, BSM was introduced. Once the first participant reached the criterion, a probe baseline data point was collected for the second participant, and the subtle cue was provided. After one data point of subtle cue data was collected, Participant 2 received the BSM intervention. Once in the intervention phase, data were collected continuously for each participant.

Procedures

Baseline

The researchers told an incoming participant they were participating in a memory study and would have 1 min to memorize as much information from a demographic form as they could. They were also informed that the timer would start once the attachment was opened. Immediately afterward, participants were given time to review the body of the email. Recall that the body of the email contained the signature block with the hypothetical student’s pronouns and chosen name.

Once the participant confirmed they were ready, the researcher opened the attachment and participants were given 1 min to learn as much information on the demographic form as they could. Once the minute had elapsed, the researcher stopped sharing the screen. Immediately afterward, each participant engaged in a brief interview session during which they were questioned about items on the demographic information form.

During this interview, the researcher asked the participant at least 10 questions about the hypothetical student. Additional questions were asked if the 10-pronoun-usage requirement was not met. After the interview, the researcher shared their screen for the next hypothetical student, allowing the participant time to read the email. Once the participant stated they were done, the researcher opened the attachment and the participant again was given 1 min to review the information before being asked questions.

Subtle Cue

A subtle cue condition was implemented to mimic a prompt that an academic advisor may receive to encourage inclusivity. After the subtle cue script was read, the session proceeded similar to baseline with participants accessing the email and having 1 min to review the demographic information form. Participants were then asked questions until the 10-pronoun criterion was met.

BSM Training and BSM

Following the subtle cue condition, BSM was implemented for the remainder of the study. As mentioned, before the trial began, a brief BSM training session occurred. After BSM training, similar to baseline, participants were given time to review the email and then 1 min to review the attachment. During each session in the BSM phase, the researcher asked the participants questions (to meet the 10-pronoun-use criterion). Upon meeting the criterion, the participant was instructed to mark a tally or not mark a tally based on the aforementioned criterion.

Maintenance

A maintenance probe was collected 8 weeks after the last intervention session. Participants were instructed to recall information about the student. Again, they were to self-monitor and tally whether they used the proper pronoun 100% of the time. One maintenance data point was collected for each participant.

Treatment Integrity

Treatment integrity data were collected for half of the sessions of the subtle cue condition. This was done to ensure the researcher was using the correct script for the subtle cue condition. Phrases such as “be respectful” and “various cultural factors” were pinpointed from the script as important to state to the participant. A total of eight phrases were targeted. Treatment integrity was conducted by a secondary researcher who reviewed the recording and indicated whether a given phrase was vocally stated exactly as written. The treatment integrity check determined that all eight target phrases were stated exactly as written in the script, resulting in 100% treatment integrity for the subtle cue condition.

Social Validity

Upon completion of the study, participants completed a social validity questionnaire electronically. The researcher was not present when they completed this questionnaire. Once data collection was complete, the participants were debriefed and informed that the primary purpose of the study was to increase trans-inclusive behaviors, specifically related to pronoun use.

Results

Behavioral Data

Figure 1 shows the percentage of correct pronouns used by each participant during the baseline, subtle cue, BSM, and maintenance phases. Both participants consistently made errors across all three sessions in baseline, with 0% correct pronoun and name usage. They each remained at 0% in the subtle cue condition. Upon the introduction of BSM, there was an immediate increase in level with Participant 1 using proper pronouns and names 100% of the time, and this pattern maintained. A probe data point demonstrates that Participant 2 remained at 0% correct pronoun and name use in baseline after Participant 1 had reached 100% during the intervention. Immediately upon entering the BSM phase, a similar pattern was observed for Participant 2. Correct pronoun use was seen in 100% of remaining sessions. Maintenance probes indicate the data maintained at 100% correct pronoun use 8 weeks after the last BSM data point was collected.

Fig. 1.

Multiple-probe across-participants design for percentage of correct pronouns used. Note. This figure demonstrates the percentage of correct pronouns used by Participant 1 and Participant 2 across the baseline, subtle cue, behavioral self-monitoring (BSM), and maintenance phases

Accuracy of BSM Data

Participant 1 was not 100% accurate, marking that they did not use the proper pronoun 100% of the time with one of the hypothetical TGNC students. Regardless, Participant 1 still used the proper pronoun 100% of the time across all sessions in which BSM was applied. However, Participant 2 was 100% accurate. Thus, accuracy in the current study had little impact on performance, though more complex behaviors may still benefit from accurate BSM.

Social Validity

Participant 1 reported that the BSM technique was helpful and easy to use. They also indicated that they would use the strategy all or most of the time in the future. Participant 2, although agreeing the technique was easy to use, reported that it was somewhat helpful and indicated that they may use it in the future sometimes. Participants also differed on how often they would have liked to record. Participant 1 stated that recording after each student was sufficient, whereas Participant 2 would have preferred to record more frequently.

Discussion

The purpose of the study was to evaluate the effects of BSM on trans-inclusive behaviors exhibited by graduate students during a simulated work task, which emulated the responsibilities of an academic advisor. Trans-inclusive behavior was operationalized as the percentage of correct pronouns used when referring to a hypothetical TGNC student during an interview. Few studies have targeted inclusive behavior, and no studies to date have implemented a behavioral intervention to increase trans-inclusive behavior specifically. BSM proved effective for increasing proper pronoun use in graduate students when BSM followed BSM training. The introduction of BSM resulted in an immediate and sustained change from 0% proper pronoun use in baseline to 100% in intervention.

One potential reason for the lack of research on trans-inclusive behaviors could be that it may be difficult to observe discriminatory behaviors due to reactivity. Additionally, errors in proper pronoun use may occur in isolated instances, which can make them challenging to observe. The present study contrived a scenario (with a deception component) that made it possible to avoid reactivity and enabled one to observe repeated instances of pronoun use in a single meeting. The distractor memorization task was meant to mimic any task an academic advisor may encounter that may reduce attentiveness to pronouns. Furthermore, the subtle cue represented any general message that may be provided at the beginning of the semester regarding attending to cultural factors.

The findings of the current study suggest that general instructions for promoting cultural inclusion (similar to those presented in the subtle cue condition) may be ineffective for promoting TGNC-inclusive behaviors. Although one goal of these messages may be to encompass a wide range of inclusive behaviors, they may lack the specificity needed to promote particular behaviors such as pronoun use. One may argue that only one data point was collected in the subtle cue condition and it may have been possible to eventually observe behavior change if more than one cue was provided. However, offering one cue may be more representative of the conditions encountered in an academic setting. Typically, one message may be delivered at the beginning of the semester. Another message may not be sent until an incident occurs or a new semester begins.

The participants both reported having friends or experiences with individuals who were TGNC and indicated being “somewhat familiar” with TGNC topics. Thus, it is possible they were aware that pronouns could frequently be listed in the signature block of emails. However, despite potential awareness, they still failed to attend to the pronouns considering the distractions (i.e., memorization task). This could occur with many individuals such as academic advisors or professors who, despite their efforts to use proper pronouns, may become distracted with responsibilities that can increase errors. Engaging in frequent self-reflection through BSM appeared to help promote attending to proper pronouns in the presence of distractions. It would be interesting to evaluate if this increase in attentiveness would generalize to other settings outside of the laboratory. It is possible that through engaging in BSM, these participants learned to attend more closely to, and self-reflect on, their proper pronoun use, and this may extend to other circumstances.

Recall the two primary reasons individuals perform inadequately on a task. The first is a lack of proficiency, whereas the second concerns motivation (Mager & Pipe, 1997). Regarding pronouns, it was theorized that individuals may make errors due to a lack of awareness or proficiency, which could perhaps be explained through learning history. These errors were anticipated to occur in the presence of certain stimuli such as a gendered name or sex that did not correspond with the proper pronouns. Evidence from the study supports this theory. For example, Participant 1 referred to “Ash,” whose pronouns were he/him but whose legal name was “Ashley,” with she/her pronouns. This error was consistent across sessions whether the pronoun indicated was she/her, he/him, or they/them. Like Participant 1, Participant 2 emitted pronouns that tended to align with the gendered legal name rather than those specified in the signature block.

Although this study provides evidence to suggest that BSM is effective for promoting correct pronoun use when it follows BSM training, there are limitations. Perhaps BSM was effective primarily through bringing one’s attention to the pronouns. The subtle cue condition was intended to overcome this concern by offering a subtle method for drawing attention to pronouns. However, it is still possible that the primary function of BSM was to increase awareness. Through BSM, participants were instructed to attend to their correct pronoun use for the purposes of monitoring it. Before beginning the trial, a brief BSM training took place. This should be noted as a limitation given that the effects of BSM alone were not isolated. Thus, the results indicate that BSM is effective when it follows BSM training. Future research should examine the effects of BSM alone. Additionally, it is possible that a simpler method, such as instruction alone, may have been sufficient, and this should be examined through future research. If instruction alone is sufficient for behavior change, it would be more efficient to incorporate it into existing training. However, recall that one concern was reactivity. It is possible that in a controlled environment with few distractions, a participant may effectively attend to pronouns, and this was one reason for the deception component. In a natural setting, there may be many distractions, and instruction alone may be insufficient over time. Through BSM, one is continuously attending to and recording behavior that may be critical in a natural setting with frequent distractions. Future research is needed to confirm this theory.

Another limitation concerns sample size. Of the seven potential participants recruited, only two met the inclusion criteria. The small sample size limited the number of intersubject replications, potentially reducing the generality of the findings. Although this was unfortunate, these findings are encouraging overall. The mastery in baseline for the majority of participants may reflect a growing change in the larger cultural awareness and acceptance toward TGNC-related topics. Furthermore, the number of potential participants who attended to the pronouns in the signature block may provide indirect support for the initial claim that including one’s pronouns in this location is becoming more common (University of California San Francisco, 2021).

In addition to sample size, other factors could also limit the generality of the findings. The participants consisted of university graduate students, both of whom identified as women, and each was in their early 20s. These results may not generalize to older populations or those less familiar with TGNC topics. University students may be more likely to encounter TGNC-related topics, either by identifying as TGNC, meeting other individuals who are TGNC, or taking coursework that addresses these topics. Furthermore, research indicates that women are more likely to have positive attitudes toward LGBTQ+ people (Copp & Koehler, 2017).

Recall that the second reason individuals perform inadequately is due to motivation. It was postulated that BSM would be most appropriate for an individual who was motivated to be inclusive toward TGNC individuals but needed to increase their proficiency or awareness. It was not believed that it would be effective for those who lacked the motivation to use proper pronouns. Given the participant characteristics and the results of the study, it is likely that the initial low performance was due to a lack of awareness rather than motivation. These results would likely fail to generalize to a person who was not motivated to use the proper pronouns.

Future research should explore behavioral interventions that address a failure to use proper pronouns for reasons based on motivation rather than understanding. To do this, one should consider addressing populations with limited experience with TGNC-related topics, such as older adults or participants outside of a university setting. However, caution is necessary given that some individuals may react negatively toward TGNC topics. Further research is needed to identify interventions directed toward increasing willingness to engage in TGNC-related topics. Such interventions could include educating individuals on certain topics and providing reinforcement (e.g., social praise) for engaging in trans-inclusive behaviors.

It would also be valuable to assess the effects of BSM on proper pronoun use in a natural context. Recall that participants reported the technique was easy to use and that they would be likely to use the technique at least some of the time in future email correspondences. The ease and reported use of the technique beyond the scope of the study provide evidence to corroborate the social validity of BSM to address proper pronoun use. This could increase the likelihood that it would be consistently used in a natural setting.

Future research should also examine the effects of different interventions on proper pronoun use and other inclusive behaviors. As mentioned, one benefit of BSM is that it can be done privately. This may be ideal for addressing behaviors that are more sensitive such as proper pronoun use. However, future research is needed to confirm this. A study that directly compares the effects of BSM and another intervention such as feedback would help explore this question further. Such research could inform the selection of behavioral interventions for addressing inclusive behavior such as proper pronoun use.

Conclusion

This study was the first to assess the effects of a behavioral intervention to increase trans-inclusive behavior. Whereas there are many types of trans-inclusive behavior, for this initial investigation, we selected correct name and pronoun use, as proper pronoun and name use has been correlated with improved outcomes that contribute to the health and survival of TGNC people (Russell et al., 2018). To some, proper name and pronoun use may seem simple. However, for an individual who identifies as TGNC, proper pronoun or name use can help validate and support their identity, which can be critical to that individual. Receiving consistent support and validation could impact mental health and wellness. With an emphasis on social significance, behavior analysts should continue to extend research in this area. Doing so could promote the inclusion of TGNC people and may ultimately help save lives.

Appendix A

Advisee Email

Appendix B

Demographic Information Form

Funding

No funding was received to assist with the preparation of this article.

Data availability

All data generated or analyzed during this study are included in this published article (and its supplementary information files).

Declarations

Competing interests

The authors have no relevant financial or nonfinancial interests to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

An element of deception was necessary for this study to prevent reactivity. Due to this requirement for deception, the institutional review board waived full informed consent at the beginning of the study. A consent form for audio and video recording was administered at the beginning. Each participant was also informed of their right to withdraw at any time and both provided consent to participate. Additionally, at the conclusion of the study, participants were debriefed on the true nature of the study, and the authors affirm that the human research participants provided informed consent for publication of the data in Figure 1.