Multidimensional Intelligences Model as a predictor for coming out acceptance and growth among LGB non-migrant Hispanics: A pilot study

The coming out process has biopsychosocial components that occur whenever a lesbian, gay or bisexual (LGB) person shares their sexual orientation with another person. It is a complex and difficult process, but it has been described as an essential component for identity formation and integration. The purpose of this pilot study was to assess a Multidimensional Intelligences Model (MIM) (Body, Emotional, Social, and Ecological Intelligences) as predictor of the coming out acceptance (COA) and growth (COG).The objectives of this study were to 1) examine if MIM can predict COA and COG among LGB individuals; and 2) determine differences in the MIM between the four stratified groups (lesbian women, bisexual women, gay men, bisexual men). This pilot study had a quantitative method with an exploratory cross-sectional design. A total of 67 LGB participants completed an online survey. The results shows that the MIM could not predict the COA. However, the MIM could predict the COG and explained 20.6% of the variance. We believe this can be explained because in the COA people do not have control of how other people can feel and react. However, in the COG the person could have full self-control of their own growth.


Introduction
Scienti c evidence sustains that in the coming out process, a more Coming Out Acceptance and Coming Out Growth are related to better mental health and wellbeing [1,2,3]The coming out process, also known as the disclosure of the sexual orientation, is a life process that sexual minorities such as Lesbian, Gay, or Bisexual (LGB) persons face, and it is faced differently according to the sex, gender, sexual orientation, and other identities of the person [4].
The coming out process has biopsychosocial components (e.g., chronic stress, anxiety, family rejection) that occur whenever an LGB person shares their sexual orientation with another person. It is a complex and di cult process, but it has been described as an essential component for identity formation and integration [1,5]. The successful coming out to others can lead to mental health bene ts, contrarily negative consequences can lead to stressors like family, friends and acquaintances' rejection, discrimination, prejudices, victimization, violence, and harassment [6,7,8]. Literature suggests that those stressors can be doubled in individuals who do not have social support [9,10].
Most individuals experience disproportionate sensations of fear, guilt, confusion, doubt, denial, and religious/spiritual internal con icts during this process which is not only once in life but can be extended throughout the lifespan [4,11,12]. The positive effects of coming out are linked to better mental health, wellbeing, higher self-esteem, lower anxiety, emotional relief, work satisfaction, increased coping resources, and resilience [1,13,14]. The negative consequences of the coming out can positively change with the development of programs and psychoeducational interventions to plan, prepare, and support the coming out process [15,16] On the other hand, uid intelligences are those that we learn on the path of our life and help us solve more effectively our di culties and evaluate various solutions [17]. Therefore, uid intelligences can be integrated into biological, psychological, social, and ecological dimensions. Therefore, we created the Multidimensional Intelligences Model (MIM) that can help conceptualize and promote healthier coming out process. Based on a biopsychosocial-ecological approach, we connected the following intelligences instrument to address all four dimensions: Body Intelligence (Biological Level) [18] Emotional Intelligence (Psychological Level) [19] Social Intelligence (Social Level) [20], and Ecological Intelligence (Ecological Level]) [21].
Body Intelligence assesses forms of body awareness that support overall wellness. It is the awareness and use of bodily sensations that we use to support health and well-being, supply information about environmental safety and comfort, and enhance personal and spiritual development to support overall health and well-being [18]. On the other hand, emotional intelligence assesses a form of relational intelligence that involves the ability to monitor the self, our own feelings and emotions, discriminate between them, and use the information to guide thoughts and actions [19]. Furthermore, social intelligence assesses social understanding and interest, as well as the ability to interpret social information leading to accurate social inferences. This construct includes cognitive and behavioral sociocultural competencies such as social information processing, social skills, and social awareness [20]. Finally, ecological intelligence assesses the systemic thinking, ecophilosophy, holistic perspective, collective lifestyle, and cultural commons. Ecological intelligence is the capacity to learn from experiences and deal effectively with our environment, understanding of organisms and their ecosystems [21].
In the Hispanic culture, a collectivist culture, there is particular importance on close family relationships titled familism. Hispanics place greater emphasis on family relationships as their priority to obtain social support, making the acceptance of the coming out process extremely important in the Hispanic culture [22,23]. When Hispanics experience coming out rejection from their family, it can be perceived as discrimination, prejudice, victimization, and/or harassment among others. Studies of young, gay Hispanics in Puerto Rico reports that only 23% of their mothers and 20% of their fathers accepted them during their coming out process, while their parents were also the people that most frequently rejected them because of their sexual orientation [24].
Emotional intelligence has showed a positive association related with coping with stressing situations [25,26,27], however, there seems to be a gap in literature regarding the association of emotional intelligence and the other discussed intelligences with the coming out process. The aim of this study was to examine if MIM can predict Coming Out Acceptance and Coming Out Growth among LGB Hispanic individuals living in Puerto Rico. The hypothesis of this pilot study was that the MIM will signi cantly predict the Coming Out Acceptance and Coming Out Growth with more than 10% of the variance.
Validating this hypothesis provided us evidence to develop prevention and intervention programs to reduce health disparities associated with the coming out process among the LGB Hispanics Adults.

Method
We implemented a quantitative pilot study with a cross-sectional approach and exploratory design. The study was approved by the Institutional Review Board (#2006039528) of the Ponce Health Sciences University.

Participants
We used G*Power to compute the estimated minimum standardized effect size for the linear multiple regression. Assuming one tail, 0.30 effect size (medium), alpha error probability of .05, and a power of .95, a minimum sample size was 53. We employed a strati ed sample procedure to ensure maximal variation in our sample, increase internal validity, and obtain the greatest comparison across the sexual orientations. A total of 67 participants (14 participants more than expected) completed the online study (13 lesbian women, 26 gay men, 15 bisexual women, and 13 bisexual men). Selection of these participants was based on convenient sampling following inclusion criteria: 1) being an adult between 21 to 39 years old, 2) identify as lesbian, gay, or bisexual, 3) identify as cisgender, 4) identify as Hispanic-Puerto Rican, 5) live in Puerto Rico, and 6) being out to at least one person. Since most of the population in the islands of Puerto Rico identify as Hispanic, and they are naturally born as United States of America (USA) citizens, Puerto Rico is an ideal place to conduct research about non-migrant Hispanics individuals.
This condition allows researchers reduce additional associated with minority stressors due to the intersectionality of ethnic/race stigma and migratory status, that usually go along with Hispanics living in the continental USA [9].
The sample had an average of 28 years old. Also, 62.7% reported to have at least one partner, 71.6% were from an urban area, 4.5% informed a functional diversity, and 31.3% identi ed a religion or spiritual a liation. Area of residence in the Island were also informed being 50.7% from the metropolitan area.

Recruitment And Procedure
We used a community outreach approach to recruit participants across the Island which gave us access to a diverse pool of possible participants. We also used Facebook ads to promote the study yer. SurveyMonkey platform was used to access the anonymous survey. After accepting the platform informed consent, participants were able to complete sociodemographic and instrument data. Once they completed the survey, they were redirected to another REDCap platform page (to maintain con dentiality) where they gave their email information to receive a $25 gift card incentive for their participation. The gift cards were given to each participant who provided their email address.

Results
Data were analyzed in the IBM SPSS Statistics Program (25.0v). First, we calculated the internal consistency indices (Cronbach's Alpha), obtained the means and standard deviations of the measurements. Correlation analyses were performed between all study variables using Pearson's Product-Moment Coe cient (r). To verify internal consistency, values were supposed to be greater than .70 [29]. To interpret the correlations, the classi cation suggested by Taylor [30] was used: correlations from .01 to .35 are considered low, between .36 and .67 moderate, between .68 and .89 high and, nally, .90 henceforth are considered very high. To identify the types of intelligence that could predict the scores of the dependent variables Coming Out Acceptance and Coming Out Growth, a series of multiple regressions were performed using the stepwise method. The effect size of the predictor on the predicted variable was established through the standardized regression coe cient (β). Values of β lower than .09 were interpreted as a trivial effect size, between .10 and .29 small, between .30 and .49 medium, between .50 and .69 large, and greater than .70 very large [31]. All results were considered signi cant for p values <.05. Linear regression analyses were performed considering the entire sample and then by four strati ed groups.
Analysis revealed that all the scales obtained acceptable values of internal consistency higher than .70. The results of the correlations show that the variable Coming Out Acceptance was not associated with any type of intelligence. However, the variable Coming Out Growth correlated between low and moderate with most types of intelligence, except for ecological intelligence. Table 2 shows the descriptions and correlations in detail.  Table 3).  Table 3). Note. ** = p < .01; * = p < .05. (n = 67).

Discussion
Preliminary ndings of this pilot seem to indicate that the MIM initially predict the Coming Out Growth. On the contrary, preliminary ndings showed no prediction for the Coming Out Acceptance. We believe this can be explained because in the Coming Out Acceptance process people may not have control of how other people can feel and react to the disclosure of their sexual orientation. On the other hand, in the Coming Out Growth process the person could have particular in uence of their own growth [2]. This means that creating an intervention based on the model could help increasing the Coming Out Growth (e.g., developing a positive personal and social identity that is healthily shared with others), especially taken into consideration factors that interact with Hispanic LGB individuals such as familism, and machismo [9]. Moreover, social intelligence seems to be the more predictive factor in the model of the Coming Out Growth. However, the model requires further steps, including a larger sample to continue establishing its validating and to reduce the possibility of statistical errors.
It is too early to conclude on the ndings of this model due to its pilot nature. However, preliminary ndings suggest early evidence to continue working with the validation of this predictive model. The coming out is a diverse and ongoing process, and its results can vary each time. Thus, it is crucial and bene cial to provide LGB individuals preparation and coping skills such as uid intelligences to better manage this process and prevent any potential effects on their physical, psychological, social, and environmental health consequences. Specially, when this process is followed by rejection or tolerance. Body intelligence can help the individual to be aware of their physical symptoms (e.g., sweating, elevated palpitations, tremors) when planning or conducting the coming out, preventing and/or handling subsequent physical health consequences (e.g., fainting, dizziness, chest pain). Similarly, emotional intelligence can help the individual to be aware of their psychological symptoms (e.g., anxiety, stress, depression) and improve their ability to manage and organize their feelings and emotions, before and after the coming out process, in order to better oversee their thoughts and actions.
Moreover, social intelligence can increase the ability of social and interpersonal awareness before, during, and after the coming out process by increasing the ability to understand information like safety, importance, and the context of the potential reaction. At the same time, being prepare for possible unhealthy, adverse, or dangerous scenarios (e.g., rejection, violence, homelessness). Finally, ecological intelligence helps the individual dealing more effectively with the cultural, systematic, and environmental components of the coming out process.
Strengths and limitations were also present in this study. Some of the strengths of the study are: 1) the proposed sample was achieved, 2) sex and sexual orientation was strati ed following the guidelines of the National Institutes of Health, and 3) internal consistency of the instruments were adequate. On the other hand, some limitations are also present: 1) the Coming Out Acceptance Scale was constructed and preliminarily validated for this study, despite, acceptable values of internal consistency were obtained, 2) all the other instruments were translated, culturally adapted, and preliminarily acceptable values of internal consistency were obtained for this study, but a larger sample is needed for a formal internal consistency validation, and 3) a medium effect size sample was used for this study which affects the statistical power.
With the successful validation of this model our team can develop prevention and intervention programs to reduce health disparities among the LGB Hispanic community due to the coming out process. This innovative model created by and for Hispanics, can also be adapted in future studies from different disciplines to reduce psychosocial disparities in other vulnerable minority groups. Future research directions can include the use of the model for other concerns inside and outside sexual minorities, the use of the model with other developmental stages (e.g., adolescents, older adults), and the use of the model with other ethnic/race groups. The coming out instruments can also be adapted to be used with gender minorities. Furthermore, other types of uid intelligences can be integrated in the model (e.g., spiritual intelligence).

Declarations
Ethics approval and consent to participate This study was approved by the Institutional Review Board (IRB) of the Ponce Health Sciences University (#2006039528). All methods were carried out in accordance with relevant guidelines and regulations. Informed consent was obtained from all the participants.

Consent for publication
Not applicable.

Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests
The authors declare that they have no competing interests. Authors' contributions CE: conceptualization, research design, collection of the data, preparation of the data, drafting manuscript, editing manuscript; ARP: conceptualization, research design, drafting manuscript, editing manuscript; JAGR: preparation of the data, statistical analyses, drafting manuscript.; EMT: literature search, collection of the data, preparation of the data, editing manuscript; EHL: drafting manuscript, editing manuscript. All authors read and approved the nal manuscript.