Gender and sexual minorities (GSM) experience considerably worse health outcomes than heterosexual and cisgender people, yet no comprehensive understanding of GSM health exists due to a dearth of research. GSM leaders in Dallas expressed need for a community needs assessment of GSM health. In response to this call, the Center for Psychosocial Health Research conducted a needs assessment of gender and sexual minority health in Dallas (35 interviews, 6 focus groups). Competency was one area highlighted and shared across existing research. Thus, the current study explored how competency impacts gender and sexual minorities' experience of health care in Dallas. We utilized a consensual qualitative research approach to analyze competency-related contents. The meaning and implications of emerging core ideas were explored. These findings were also used to develop a survey instrument.

Guided by attachment theory and principles of positive psychology, a conceptual model was developed depicting the direct and indirect effects of attachment insecurity, state hope, belongingness, and meaning in life on wellness indicators (i.e., life satisfaction, physical health, and depression) of first generation Latino immigrants in the U.S. Specifically, the present study proposed that the effects of attachment insecurity on Latino immigrants' wellness would be mediated by two tiers of factors. The first tier consisted of state hope (i.e., general state hope, spiritual state hope, mastery state hope) and sense of belonging (i.e., general belongingness; connectedness with mainstream/ethnic community), which represented individual-level and relational factors, respectively, salient in Latino culture. Greater attachment insecurity was hypothesized to contribute to a compromised MIL and poorer wellness by decreasing state hope and sense of belongingness. A total of 352 first-generation Latino immigrants from Texas participated in this study. The exploratory factor analysis on the Experiences in Close Relationships Scale revealed a two-factor factor structure that is different from the two factors of adult attachment typically found with American samples (i.e., anxiety and avoidance). The emerged two factors represent anxious-distancing attachment and comfort-seeking attachment. Results from structural equation modeling analysis showed adequate model fit …