Views and Experiences of People with Intellectual Disabilities Regarding Intimate Relationships: A Qualitative Metasynthesis

Sexual support and education for adults with mild intellectual disabilities: a Delphi study on multiple perspectives

BACKGROUND

Providing appropriate sexual support and education for adults with mild intellectual disabilities (IDs) is a source of considerable debate, resulting in diverse, non-funded and potentially adverse practices. This study aims to identify a consensus among experts regarding what conditions are conducive to successful sexual support and education for adults with mild IDs.

METHODS

A Delphi study was conducted with 13 experts, including experts-by-experience, relatives, support staff, psychologists and sexologists. Qualitative data on the conditions for sexual support and education were gathered in the first round and thematically analysed. In the following three quantitative rounds, consensus was achieved using Likert-type response scales and participants' feedback.

RESULTS

Round 1 resulted in 82 conditions on six themes: 'the necessary attitude', 'requirements', 'approach to delivering sexual support and education', 'appropriate providers', 'settings and timing' and 'effective collaboration with the network'. In the following three quantitative rounds, the experts reached consensus on 68 conditions distributed across the six themes.

CONCLUSIONS

The six themes highlight conducive conditions for successful sexual support and education for adults with mild IDs, emphasising the significance of a safe and supportive environment, comprehensive educational programmes, and the promotion of autonomy and protection. The consensus-based findings have distinct implications for practice and future research.

How do people with intellectual disabilities understand friendship? A systematic meta-synthesis

BACKGROUND

Previous systematic reviews of the relationships of people with intellectual disabilities have included consideration of intimate relationships. In this paper, we report a systematic review of papers describing friendship only.

METHOD

A systematic qualitative meta-synthesis of the research exploring experiences of friendship as reported by people with intellectual disabilities.

RESULTS

Seven papers met the inclusion criteria for analysis. Three superordinate themes were identified. (1) Reciprocity, 'Someone who helps me, and I help them'. (2) The building blocks of friendships, 'I can tell her some secrets'. (3) Managing friendship difficulties, 'In real life it's much harder'.

CONCLUSION

People with intellectual disabilities value friendship and actively engage in reciprocal exchanges. We explore the strengths and limitations of current research, clinical implications, and directions for future research.

People with intellectual disabilities' sexuality from three different perspectives: Parents, professionals, and themselves

BACKGROUND

A positive conception of sexuality among people with intellectual disabilities is crucial and relies on several social and interpersonal contexts. The goal of this study is to analyse the interaction and impact of three different contextual groups: individuals with intellectual disabilities, their parents, and professionals working with them.

METHODS

Survey data were collected from 330 people with intellectual disabilities attending occupational centres in eastern Spain, 330 parents, and 100 professionals.

RESULTS

Correlation and variance analyses of dyad-level data show significant differences among the three groups in all variables. Professionals perceived people with intellectual disabilities to have higher knowledge of socio-sexual norms than people with intellectual disabilities actually appear to be, but they are also more concerned about aspects related to this area of people with intellectual disabilities. Compared to people with intellectual disabilities and professionals, parents perceived people with intellectual disabilities to have lower sexual knowledge.

CONCLUSIONS

Our study demonstrates inconsistent perceived knowledge of people with intellectual disabilities' socio-sexual norms and sexual knowledge among the three groups, leading to disparate levels of concern regarding people with intellectual disabilities sexuality. Thus, the need to collect information from different perspectives for more accurate reporting and the critical need for sex education programs that involve the target population, but also parents and professionals who frequently interact with people with intellectual disabilities are highlighted.

Using to

People with mild to borderline intellectual disabilities face many barriers toward their sexual health. To promote sexual health and overcome these barriers, they need individualized forms of sexuality support and education. To align sexuality support and education insight is needed on their understanding of sexual health. The current paper aims to provide greater insight in what sexual health consists of according to people with mild to borderline intellectual disabilities. Nine people with a mild to borderline intellectual disability participated in a concept mapping procedure, consisting of brainstorming, sorting, and ranking the statements. The resulting clusters and concept map were interpreted by an expert group. Analysis resulted in five clusters which participants considered important for their sexual health. According to people with mild to borderline intellectual disability cluster pertaining to romantic relationships and sexual socialization were the most important. These were followed by clusters on sexual health and lastly sexual selfhood. These results have implications for the development of sexuality support and education, as well as further research.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11195-023-09796-w.

Program evaluation of an adapted PEERS® social skills program in young adults with autism spectrum disorder and/or mild intellectual impairment and social skills difficulties

RATIONALE, AIMS AND OBJECTIVES

Social challenges are common for young adults with autism spectrum disorder (ASD) and/or mild intellectual impairment, yet few evidence-based interventions exist to address these challenges. PEERS®, the Program for the Education and Enrichment of Relational Skills, has been shown to be effective in improving the social skills of young adults with ASD; however, it requires a significant time commitment for parents of young adults. As such, this mixed-methods study aimed to investigate the experiences of young adults, parents and PEERS® social coaches participating in an adapted PEERS® program, and to evaluate its acceptability and efficacy.

METHOD

Young adults with ASD and/or mild intellectual impairment participated in a 16-week PEERS® program. Parents and PEERS® social coaches attended fewer, condensed sessions, where they learnt program content to support the young adults' social skill development at home and in the community. Focus groups were conducted post intervention. Quantitative pre-post assessment using the Social and Emotional Loneliness Scale for Adults, the Test of Young Adult Social Skills Knowledge, and Quality of Socialization Questionnaire-Young Adults was completed by young adults. The Social Responsiveness Scale Second Edition was completed by young adults and their parents.

RESULT

Qualitative results revealed that, taken together, young adults, parents and PEERS® social coaches all felt that the adapted PEERS® program was 'challenging, but worth it'. The program was acceptable with a 93% attendance rate across all sessions. Whilst young adults' perceptions of their own social functioning did not change post-intervention, their knowledge of social skills content improved significantly (p < 0.05). Parent perceptions of young adults' social responsiveness also improved (p < 0.05).

CONCLUSIONS

Social skill knowledge, social responsiveness, and social engagement improved significantly following the completion of the adapted PEERS® program. It was deemed acceptable and worthwhile by young adults, their parents and PEERS® social coaches.

Mothers of Adults with Intellectual Disabilities: Experiences, Perceptions and Influences on Their Sons’ and Daughters’ Romantic and Sexual Lives

Individuals with Intellectual Disability (ID) value romantic and sexual expression, however often face barriers to developing relationships. Family caregivers play a significant role in supporting them with such matters throughout adulthood. In order to understand how to best support individuals with ID in this sphere of their lives, it is therefore essential to investigate family caregivers’ perceptions, influences and experiences. This study explored the views and experiences of nine mothers of adult individuals with mild and moderate ID in relation to their children’s romantic and sexual lives. Data was collected using semi-structured interviews and analyzed using Interpretative Phenomenological Analysis. Findings suggested that mothers held positive, but sometimes ambivalent, attitudes towards their children’s romantic and sexual lives. They assumed the dual role of a facilitator and a protector, and although they generally expressed a commitment to supporting romantic experiences, they viewed sexual experiences with caution due to fears relating to vulnerability and risk. In the context of vulnerability, although most participants described their children’s sexual knowledge as poor, they reported lack of preventative sexual or contraceptive education delivered at home. Participants hoped that their children would manage a long-term relationship, however also experienced a sense of loss related to the realization that this might not be possible. The findings of this study highlight the need to help mothers to proactively support their adult children in building sexual knowledge. This, in turn, can reduce individuals’ vulnerability and improve their ability to make informed choices. Suggestions for future research are also discussed.

“It Gives Me, as her Caregiver, a Sense of Security.” Young People with Intellectual Disability and Their Experiences with Sexuality, Menstruation, Gynecological Treatment and Contraception: A Follow-up Analysis of Parents’ and Caregivers’ Perspectives

Background

Research shows that caregivers support but also impede people with intellectual disabilities from developing intimate relationships. People with intellectual disability experience coital sex later and less often compared to adolescents without disabilities. Caregivers often request hormonal contraception from gynecologists on their behalf. Their main motives are pregnancy avoidance (either as a result of consensual sex or sexual abuse) and menstrual suppression.

Method

The sample included 42 primary caregivers of young people with intellectual disability aged 14 to 25. Interviews were evaluated with qualitative content analysis.

Results

Nine of the main caregivers assumed that sexual intercourse had taken place. Half of the carers evaluated the importance of sexuality for the young people with intellectual disability as high. The main reason for seeing a gynecologist was the prescription of hormonal contraceptives; the outcome of which was arbitrary and dependent on the individual gynecologist. The majority of young women took general hormonal contraceptives as a preventive measure or due to heavy bleeding, regardless of sexual activity. One-fifth took hormone depots as a form of long-term contraception.

Discussion

A trusting relationship with the gynecologist favored the compliance and well-being of the young women. The administration of hormonal contraceptives seems to be controlled by third parties. Caregivers used hormonal contraceptives to simplify the regulation of menstruation and felt relieved by it. Carers view the sexual activities of the young women more critically because they fear a pregnancy and the responsibility for a potential grandchild. The use of hormonal contraceptives made carers clearly more tolerant of sexual activity.

Exploring Definitions of Consent and Healthy Relationships Among College Students with Disabilities: "I think it's fuzzy"

Purpose

College students with disabilities (SWDs) experience elevated rates of sexual violence and intimate partner violence compared with their non-disabled peers. While tailored interventions for these pressing health issues are needed, current research lacks investigation into how SWDs conceptualize relevant key concepts, such as consent and healthy relationships.

Method

This descriptive qualitative study explored these concepts through semi-structured interviews with college SWDs (n=49), 18-24 years old, in Pennsylvania and West Virginia.

Results

The results culminated in six rich, descriptive themes addressing: 1) interpersonal and intrapersonal skills necessary for relationship health; 2) normalization of unhealthy treatment by a partner due to manipulation, denial, and love for the partner; 3) how dichotomous definitions of consent interfere with practical application in lived experiences; 4) how active consent can be both facilitated and hindered within the context of a romantic relationship; 5) perceptions that healthcare providers aim to elicit disclosures of abuse rather than initiate a discussion about relationship health; and 6) students' reticence to disclose abuse to healthcare providers due to mistrust and fear over loss of agency.

Conclusions

These results contradict historic narratives that SWDs do not have the same sexual and relationship beliefs and experiences as other students and highlight the perspectives of this marginalized population. Implications for campus prevention programming and healthcare practices include incorporating intersections of disability and violence, discussing the nuances of consent and substance use, and creating conversations about relationship health that are transparent, non-judgmental, and include a broad range of types of abuse.

The Sexual Rights of Others: Majoritized Women's Support for Marginalized Women's Sexual Rights

Advocates argue that sexual safety, access to sexuality-related services, sexual health and well-being, sexual privacy, and sexual autonomy are universal and inalienable rights of all people. However, for those relegated to the social, economic, and political margins, their sexual rights can only be secured with the support of others. In the current study, we examined whether a sample of 307 majoritized women (i.e., white, cisgender, and heterosexual) would endorse the sexual rights of four theoretical groups of marginalized women: those who identify as lesbian; those with low incomes; those who are adolescents; and those labeled with an intellectual disability (ID). Whereas results indicated broad and equivalent support for the sexual rights of lesbians and low-income women, participants were somewhat equivocal about the sexual rights of ID-labeled women and least supportive of the sexual rights of adolescent women. We consider how protectionist attitudes toward adolescent and ID-labeled women may explain these findings and ultimately undercut their sexual rights. Rather than restrict the rights of marginalized women, even in the interests of protection, we advocate committing energy and resources to reducing their vulnerability so that all women may exercise a full complement of sexual rights.

Approaches to Determine and Manage Sexual Consent Abilities for People With Cognitive Disabilities: Systematic Review

BACKGROUND

This review focused on how sexual consent ability was determined, managed, and enhanced in people with cognitive disabilities, with the aim of better understanding the recurring themes influencing the design and implementation of these approaches. If a person's consensual ability becomes compromised, owing to either an early or late-onset cognitive disability, the formal systems involved must establish plans to balance the individual's rights and restrictions on sexual expression. This review identified these plans, focusing on how they promoted the intimacy rights of the individual.

OBJECTIVE

This study aims to identify approaches that determine sexual consent ability in people with cognitive disabilities, identify the means of managing and enhancing sexual consent ability in people with cognitive disabilities, and note the recurring themes that influence how these approaches and management systems are designed and implemented.

METHODS

A systematic literature review was performed using EBSCOhost (Social Gerontology, CINAHL Plus, MEDLINE, and SocINDEX), Embase, PsyInfo, and Scopus to locate reports on terms expanded on sexual consent and cognitive disability.

RESULTS

In all, 47 articles were identified, featuring assessment practices, legal case studies, and clinical standards for managing sexual consent capacity in people with cognitive disabilities. A total of 8 studies (5/8, 63% qualitative and 3/8, 38% quantitative) were included out of the 47 articles identified. Approaches for determining sexual consent included functional capacity and person-centered, integrated, and contextual approaches. Management of sexual consent ability included education, attitude, and advanced directives and support networks. The recurring themes that influenced these approaches included the 3 legal criteria of consent, American Bar Association and American Psychological Association Model, Lichtenberg and Strzepek Instrument, Ames and Samowitz Instrument, Lyden approach, Mental Capacity Act of 2005, and Vancouver Coastal Health Authority of 2009.

CONCLUSIONS

Determining sexual consent takes a holistic approach, with individuals judged in terms of their adaptive abilities, capacities, and human rights. The attitudes of those using this holistic approach need to be balanced; otherwise, the sexual rights of assessed people could be moved either in favor or against them. The ideal outcome, after person-centered considerations of those living with cognitive disabilities includes the people themselves being involved in the process of personalizing these approaches used to facilitate healthy intimate relationships.

Young People with Intellectual Disability and Their Experiences with Intimate Relationships: a Follow-up Analysis of Parents’ and Caregivers’ Perspectives

Background

Research shows that people with intellectual disability both want and benefit from relationships. Caregivers play an important role in the development and maintenance of these relationships. Barriers to relationships include lack of privacy, inadequate sex education, and lack of public transportation.

Method

The sample included 42 primary caregivers of young people with intellectual disability aged 14 to 25. Interviews were evaluated with the qualitative content analysis.

Results

Two-thirds of the caregivers reported the young people having had at least one relationship. The caregivers tended to minimize the importance of the young people’s relationships and reported, in equal measure, both positive and negative relationship skills. Caregivers described limited choice in terms of partner selection, lack of social opportunities, and low quality couple time. Parents face the detachment process with ambivalence and wish for a stable partnership for their children in the future.

Discussion

Young people with intellectual disability face barriers and limitations regarding intimate relationships. Some young people may keep their partnerships secret to avoid possible restrictions from their caregivers. Their time together is quantitatively high, but qualitatively poor due to a lack of transportation and inclusive services. Caregivers need to support the young people’s autonomy and take their relationships more seriously.

Attitudes towards sexuality and related caregiver support of people with intellectual disabilities: A systematic review on the perspectives of people with intellectual disabilities

BACKGROUND

Sexual health remains at risk for people with an intellectual disability. Attitudes towards sexuality, its support and education have an important role in promoting sexual health. The current review aims to provide an overview of the current research on supportive and restrictive attitudes towards sexuality and its support of people with intellectual disabilities themselves.

METHOD

A systematic review was conducted, searching across eight databases. The quality of the studies was assessed with the Mixed-Method Appraisal Tool.

RESULTS

Six themes emerged from the data: sexual behaviour, sexual identity, intimate relationships, barriers to sexual expression, sex education and support by caregivers. Supportive and restrictive attitudes were reported throughout.

CONCLUSIONS

Attitudes regarding sexuality of people with intellectual disabilities are heterogeneous and people with intellectual disabilities seem to be able to express their sexual desires, needs and attitudes. Findings allow for improved individual support and in-depth research questions.

Social educator students' readiness to address sexual health in their future profession

BACKGROUND

Norwegian social educator students' attitudes towards addressing sexual health are unknown, even if their future clients often have needs related to sexual issues.

PURPOSE

To investigate social educator students' readiness to address sexual health in their future profession.

METHODS

In 2019, 213 social educator students (response rate 34%) responded to the Students' Attitudes towards addressing Sexual Health Extended online questionnaire.

RESULTS

Most of the social educator students felt comfortable and ready to address sexual health in their future profession, but thought they had insufficient competence and education concerning sexual health. There were gender and age differences when discussing sexual health among persons with intellectual disabilities.

CONCLUSION

Despite most Norwegian social educator students feeling ready to address sexual health, they needed additional competences and education. Further research is needed concerning the effectiveness of educational interventions targeting competence in sexual health, to ensure sufficient support for clients in this field.

'Love makes me feel good inside and my heart is fixed': What adults with intellectual disabilities have to say about love and relationships

BACKGROUND

Adults with intellectual disabilities have historically been hindered, rather than supported, in their desire to form loving relationships. This paper sought to explore with them what kinds of support they wanted in the 21st Century.

METHOD

Semi-structured in-depth interviews were conducted with 40 adults with intellectual disabilities in the United Kingdom.

RESULTS

Participants placed a high value on having a partner and being supported to maintain and develop a loving relationship. The factors which constrained them in achieving this included a lack of social opportunities, barriers created by social care services and limits on them exercising autonomy. Facilitating factors included access to specialist dating agencies, strong family and staff support and opportunities to learn about relationships.

CONCLUSIONS

The importance of a loving relationship as a source of pleasure and meaning in the lives of adults with intellectual disabilities who are often disadvantaged in many other spheres of life is emphasised.

Securing sexual justice for people with intellectual disability: A systematic review and critical appraisal of research recommendations

BACKGROUND

People with intellectual disability contend with significant restrictions to their sexual expression and partnered relationships. This review examines the types of recommendations scholars offer in their qualitative research involving participants with intellectual disability discussing sexuality and intimate relationships.

METHOD

A systematic review of peer-reviewed studies published between 1972 and July 2018 yielded a sample of 26 studies. Thematic analysis was used to taxonomize scholars' recommendations.

RESULTS

Six distinct forms of recommendations were identified. The most frequently offered and most strongly emphasized recommendation across studies aimed to change individuals with intellectual disability. In contrast, a minority of studies prioritized engaging individuals as informants, eliciting individuals' wishes, enabling relationships and fostering ideological change. No studies placed the greatest weight on promoting systems change.

CONCLUSIONS

Recommendations in the literature have predominantly emphasized individual as opposed to environmental changes. I consider the ramifications of this and argue for a reorientation towards systems change.

The Design, Content and Delivery of Relationship and Sexuality Education Programmes for People with Intellectual Disabilities: A Systematic Review of the International Evidence

There is growing empirical evidence regarding the relationship and sexuality experiences and needs of children, young people and adults with intellectual disabilities. A total of twelve papers met the inclusion criteria regarding relationship and sexuality education (RSE) programmes specific to the needs of this population. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed and quality appraisal undertaken. The four themes identified were principles informing RSE programme development, design and content of RSE programmes, delivery of RSE programmes and evaluation of RSE programmes. The discussion presents areas that need to be addressed to ensure that people with intellectual disabilities, their families, carers and professionals are fully involved in the design and delivery of RSE programmes. Further research is required to identify the impact of the programmes and the sustained outcomes achieved. Recommendations are made regarding the activities required to enable the development of evidence-based and person-centred approaches to relationship and sexuality programmes.

Supporting Adults with Intellectual Disabilities with Relationships and Sex: A Systematic Review and Thematic Synthesis of Qualitative Research with Staff

Staff working with individuals with Intellectual Disabilities (ID) play an important role in enabling them to fulfill their sexual and romantic needs. Given the lack of recent reviews providing a synthesis of qualitative research in this population, the present review explored how staff working with individuals with ID in a variety of capacities (e.g. support workers, service managers, nurses, educators, psychologists, social workers) perceived their role in relation to supporting sexuality and relationships. A systematic search of EMBASE, PsychINFO, MEDLINE, CINAHL, ASSIA and SCOPUS was carried out and identified articles were rated against inclusion and exclusion criteria, as well as quality criteria. Findings were analyzed using thematic synthesis. The application of criteria resulted in the inclusion of 15 articles. Four themes were identified: (a) “Attitudes towards sexuality and relationships: A right and a challenge”, (b) “Responding to sexuality and relationships: A conflicted discourse”, (c) “Uncertainty and lack of systemic support”, and (d) “Influences on decision-making”. Findings suggest that staff hold ambivalent attitudes and often respond inconsistently to issues relating to service users’ sexuality. Role uncertainty, fear of accountability, lack of training and policy, as well as factors related to employing organizations and family caregivers were identified as barriers. The findings highlight the importance of providing training and supervision for staff in order to address ambivalent attitudes and anxieties, further developing national and local policy in relation to sexuality and relationships, and supporting family caregivers to meaningfully work alongside staff on issues relating to service users’ sexuality.

An Examination of Social Skills, Friendship Quality, and Loneliness for Adults with Williams Syndrome

Individuals with Williams Syndrome (WS) are hypersocial, overfriendly, and experience social skills deficits that may adversely impact their social outcomes. This study examined the relation between social skills, friendship quality, and feelings of loneliness for adults with WS as reported by 114 parent-adult with WS dyads. Results indicate that although most friends do not live close-by, adults with WS have good quality friendships and do not report high feelings of loneliness. Positive friendship qualities were found to partially mediate the relationship between social skills impairments and social feelings of loneliness. Findings indicate that although adults with WS experience social skills deficits and struggle to maintain friendships in their immediate community, they still report positive friendship qualities and low feelings of loneliness.

Challenges of having a loving partner: the views of adults with intellectual disabilities

BACKGROUND

Making decisions about feelings and relationships is a challenge for many people with intellectual disabilities (ID). The aim of this article is to explore their opinions regarding the difficulties they experience in relation to having a partner and living together.

METHOD

Nine advisers with ID with experience in inclusive research discussed issues about having a loving partner during 8 meetings. Discussions were recorded, and a thematic content analysis was conducted.

RESULTS

The results show that the network of social relationships, control over one's own intimate relationships, obtaining the right support and having training in couple relationships are key elements in people with ID having a satisfying couple relationship.

CONCLUSIONS

The research gives visibility to the difficulties that people with ID encounter in having intimate couple relationships and sheds light on the need to undertake actions that contribute to their right to intimate citizenship.

Consensus-based good practice guidelines for clinical psychologists to support care staff in enabling sexual expression in people with intellectual disabilities-A Delphi study

BACKGROUND

Care staff supporting people with intellectual disabilities (PWID) report accepting views on PWID's sexual expression, but people with intellectual disabilities report their sexual expression is restricted by care staff.

METHODS

We recruited a panel of 17 UK clinical psychologists experienced in helping care staff support PWID's sexual expression. We used the Delphi Method to develop consensus-based practice guidelines for UK clinical psychologists supporting care staff in this way.

RESULTS

Having proposed three guidelines each in Round One, panel members reached consensus (≥90% agreement) that 12 were important, falling under four themes: "Addressing staff attitudes," "Addressing uncertainty about rights and responsibilities of people with intellectual disabilities," "Locating the problem, being part of the solution," and "Supporting care staff to understand and reflect upon their role."

CONCLUSIONS

Clinical psychologists help care staff support PWID's sexual expression by normalizing care staff concerns, encouraging reflection, clarifying PWID's rights, and prompting those at managerial and service level to support care staff.

Restrictions, Power, Companionship, and Intimacy: A Metasynthesis of People With Intellectual Disability Speaking About Sex and Relationships

Examining literature that tells us what people with intellectual disability (PWID) think and feel about their sexual lives may enable families and professionals to offer a more person-centered approach to education and support. Examining the voices of many individuals across several studies may provide more convincing evidence about the experiences of these individuals-turning a solo into a chorus. Thus, the purpose of this article is to describe the results of a metasynthesis of qualitative studies highlighting the voices of PWID with respect to relationships and sexuality. Combining the results of 16 qualitative studies, 271 participants with intellectual disability were interviewed individually or in focus groups about their feelings and experiences regarding intimate relationships. Studies were conducted across Europe, in Australia, China, and in the United States. A little more than half of the participants were male; ages ranged from 13 to 89. Results revealed two competing themes of control and desire. Participants across studies desired friendships and close interpersonal relationships, yet were restricted from developing these relationships by policies, program staff, and family members.

A comprehensive sexual health care program for educable intellectually disabled adolescent girls: protocol for a mixed methods study

Background

Protection and promotion of sexual health is of great importance for educable intellectually disabled adolescent girls; since they are prone to high risk sexual vulnerabilities and consequences, such as unwanted pregnancy, sexually transmitted infections, and acquired immune deficiency syndrome. Although the rights of intellectually disabled adolescents have been emphasized through the recent years, their sexual health care is still a challenge for parents, teachers, caregivers, and service providers. This study aims to present a comprehensive sexual health care program for educable intellectually disabled adolescent girls.

Methods

This study is carried out by an exploratory sequential mixed qualitative-quantitative methods approach including three sequential phases. The researcher represents sexual health state of educable intellectually disabled adolescent girls using a qualitative approach. In the onset of the second phase, a comprehensive sexual health care program is designed for educable intellectually disabled adolescent girls. In this regard, in addition to qualitative studies, some related papers and texts are used. The suggested program of expert panel is approved based on prioritization guidelines. Then, in the third phase and after different stages of finalization of the program, its affectability is evaluated regarding improvement of sexual health state of educable intellectually disabled adolescent girls.

Discussion

It is expected that from the results of the present mixed methods study, by presenting a comprehensive sexual health program for educable intellectually disabled adolescent girls, lead to improvements in the sexual health of these girls. Moreover, it wants to reduce risky sexual behaviors, sexual abuse and harassment, and their consequences in adolescent girls in order to improve sexual health state of the society. If this program works, it can become one of the leading education and care guidelines for sexual health care of intellectually disabled adolescent girls.

Trial registration

IRCT20160224026756N5. Registered 22 June 2018.