Exploring Sexual Attitudes of Students in Health Professions

"Ripping Off the Band-Aid": uncovering future health care Professionals' "Fractured Knowledge" about sexual and reproductive health

Background

Research has shown the role of identity on future health professionals' confidence and competence in addressing the sexual and reproductive health (SRH) needs of their patients. While there has been some work in increasing the sexual health literacy of future providers via various curricular approaches and comprehensive clinical-based training, there are research gaps on how social differences around identity impact future healthcare professionals' knowledge and practices around SRH.

Objectives

This article presents research findings on the experiences of US undergraduate students attending a campus that provides training in the health sciences and health professions. Our study aims to understand the perspectives of these students as they pertain to their future career choices in healthcare, with a focus on how their past experiences learning about sex, sexuality, and reproduction impact their current and future professional trajectories.

Methods

We present a qualitative analysis from 40 in-depth interviews with U.S. undergraduates. The interview questions were designed in collaboration with undergraduate researchers interested in sexual health education. These student researchers collected all the interview data and worked with senior researchers to analyze some of these data.

Results

The themes that emerged from the interviews were around experiences with what students perceived as "fractured" sexual and reproductive health (SRH) knowledge they received as children and adolescents. This knowledge shaped essential aspects of their identity as young adults and future healers. Data indicated unique processes implicated in how past as well as present socialization experiences learning about sex, sexuality, and reproduction positions undergraduates in health professions to see young adulthood as a journey of "catching up" on sexual knowledge but also as an ongoing experience of anticipation and planning influencing their career-building journey.

Conclusions

The importance of sexual health literacy among healthcare professionals cannot be overstated, as it is vital in providing patient-centered and non-judgmental sexual and reproductive health (SRH) care and services. To date, there is a shortage of studies looking at the impact of sexual health knowledge on healthcare professionals. More research is needed on educational strategies that could be implemented at the intra-personal level to assist college-aged young adults in healthcare career tracks to "catch up" or "fill in the gaps" in their sexual education journey.

A scoping review to identify and organize literature trends of bias research within medical student and resident education

BACKGROUND

Physician bias refers to the unconscious negative perceptions that physicians have of patients or their conditions. Medical schools and residency programs often incorporate training to reduce biases among their trainees. In order to assess trends and organize available literature, we conducted a scoping review with a goal to categorize different biases that are studied within medical student (MS), resident (Res) and mixed populations (MS and Res). We also characterized these studies based on their research goal as either documenting evidence of bias (EOB), bias intervention (BI) or both. These findings will provide data which can be used to identify gaps and inform future work across these criteria.

METHODS

Online databases (PubMed, PsycINFO, WebofScience) were searched for articles published between 1980 and 2021. All references were imported into Covidence for independent screening against inclusion criteria. Conflicts were resolved by deliberation. Studies were sorted by goal: 'evidence of bias' and/or 'bias intervention', and by population (MS or Res or mixed) andinto descriptive categories of bias.

RESULTS

Of the initial 806 unique papers identified, a total of 139 articles fit the inclusion criteria for data extraction. The included studies were sorted into 11 categories of bias and showed that bias against race/ethnicity, specific diseases/conditions, and weight were the most researched topics. Of the studies included, there was a higher ratio of EOB:BI studies at the MS level. While at the Res level, a lower ratio of EOB:BI was found.

CONCLUSIONS

This study will be of interest to institutions, program directors and medical educators who wish to specifically address a category of bias and identify where there is a dearth of research. This study also underscores the need to introduce bias interventions at the MS level.

Nursing students' attitudes and beliefs regarding sexual healthcare in Ethiopia: An online cross-sectional study

BACKGROUND

Unresolved sexual issues can have an impact on a person's wellbeing, social interactions, or even medication compliance. Given the enormous global demand to enhance and preserve sexual health, faculty members have a specific goal of developing nursing workforce who are truly prepared to work with clients who have sexual health issues. Hence, the study's purpose has been to evaluate the current state of attitude and belief of nursing students toward sexual healthcare and the factors that influence it in Southwest Ethiopia.

METHODS

An online cross-sectional survey was conducted in Mizan-Tepi University involving 134 undergraduate nursing students from February 1 to March 10, 2022. The Sexual Attitude and Beliefs Scale (SABS) were used to assess the level of attitudes and beliefs regarding sexual care. Statistical Package for Social Science (SPSS) Version 26 was employed for data analysis. Multivariable linear regression analyses was conducted to identify predictors of attitudes and beliefs regarding sexual healthcare. The significance level was set at p<0.05.

RESULTS

The mean age of the nursing students participating in this study was 28.47±5.2. In our study, mean SABS score of the nursing students was found as 42.3 ± 2.1. The mean score of the SABS items ranged from 1.68±0.93 to 4.37±1.48. Having receiving sexual health education (p<0.001) was significantly associated with attitude and beliefs regarding sexual healthcare.

CONCLUSIONS

Ethiopian nursing students have been found to have a negative attitude and beliefs about sexual health care. Because comprehensive sex education is sorely lacking in nursing schools, this scrutiny prevents student nurses from receiving an adequate education. As there is a lack of appropriate sexual health subject matter, it is critical to standardize sexual health education in nursing programs so that nursing students can learn to provide comprehensive care to clients.

Assessment of the psychometrics of the Students' Attitudes towards Addressing Sexual Health Extended (SA-SH-Ext) questionnaire for social educator students

Background

Social educators have an important role in promoting and rehabilitating sexual health as they provide information, discuss, and support sexual health in daily life for persons living with impairments, intellectual disabilities, and complex needs.

Aim

The study aimed to assess the psychometrics of the Students´ Attitudes towards addressing Sexual Health Extended (SA-SH-Ext) questionnaire for social educator students.

Methods

A sample of 213 Norwegian social educator students was used to test internal consistency reliability and construct validity with explorative factor analysis.

Outcomes

Internal consistency reliability showed a Cronbach's alpha of 0.906 and construct validity measured with explorative factor analysis showed good results with the Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) being high (0.929) and Bartlett´s test of sphericity being significant (P = .000).

Results

The SA-SH-Ext is reliable and valid for social educator students, however the psychometric assessment revealed that the domains of the SA-SH-Ext should be revised compared to the original SA-SH questionnaire.

Clinical implications

Measuring the effectiveness of sexual health education interventions is important and to have a valid and reliable questionnaire to assess future professionals’ attitudes towards addressing sexual health increases the ability to target specific client needs or knowledge gaps, such as addressing sexual health for persons with intellectual disabilities.

Strengths

and limitations: In comparison with previous studies of the original SA-SH, SA-SH-Ext has high reliability and validity. The current study was performed with classical test theory. Performing Rasch analysis may detect other psychometric issues, by improving precision and thereby providing a deeper understanding of both how to optimise a questionnaire and understand the results of a used questionnaire. Despite the response rate of 34%, the results are seen as valid considering the low correlation between response rate and validity and that the sample size was sufficient for the chosen psychometric tests.

Conclusion

The SA-SH-Ext is a valuable questionnaire for assessing the level of perceived preparedness among social educator students in addressing sexual health, a field often neglected in health and care.

Lunde GH, Blaalid L, Gerbild H, et al. Assessment of the psychometrics of the Students' Attitudes towards Addressing Sexual Health Extended (SA-SH-Ext) questionnaire for social educator students. Sex Med 2022;10:100507.

Attitudes and Beliefs of Portuguese and American Nursing Students about Patients’ Sexuality

Nursing school graduates must be prepared to interact comfortably and effectively with patients about their sexual health. This study analyses the attitudes and beliefs about patient sexuality held by Portuguese and American nursing students. Objective: In Portuguese and American nursing students, (1) we analyzed students’ attitudes and beliefs towards sexuality using the Sexuality Attitudes and Beliefs Survey (SABS); (2) we identified nationality, socio-demographic information, and affective-sexual beliefs and attitudes. Method: Quantitative, cross-sectional study; convenience sample of 296 students (63.2% Portuguese; 36.8% American); mean age: 21.9 years (SD = 3.12); two-way ANOVA and multiple correspondence analyses were performed. Results: Attitudes and beliefs toward sexuality: Portuguese women are more liberal than men, contrary to American students. Among both nationalities, participants with multiple sexual partners held more conservative attitudes. Sexual orientation: bisexual American students and homosexual Portuguese students are conservative. Multiple correspondence analysis revealed two profiles: (1) Portuguese students: liberal-tolerant in attitudes towards patient sexuality, live with family/roommate, 18 to 21 years old, no or one sexual partner; (2) US students: traditionalist attitudes towards patient sexuality, share house, 22 and 23 years old, multiple partners. Conclusion: Human sexuality must be addressed in nursing education curricula.

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.

Let us integrate sexual health-do psychiatrists integrate sexual health in patient management?

The high prevalence of sexual dysfunction and the importance of sexual health issues in general stress the need for a physician to integrate sexual health issues in patient management. In this study, we evaluate the frequency of psychiatrists addressing sexual health issues as well as their attitude towards sexual health. Plus, we want to evaluate the multi-professional network for patient treatment that is needed by physicians for collaboration with other medical specialists and health care professionals. At total 100 psychiatrists (age range 30-60 years), participating at the annual meeting of the Austrian Society of Psychiatry, Psychotherapy, and Psychosomatics, were invited to self-assess their caring for patients' sexual health issues and answer a self-report questionnaire. The return rate was 74%. A third of the participating psychiatrists and psychotherapists stated to address sexual health in patients in daily routine. Twenty-five percent of the physicians suspected sexual health problems in 60-100% of their patients but did not ask the patients about this topic. Mentioned reasons why patients would not actively address sexual problems were rated by the survey participants "a different problem was more important", "lack of time", and "embarrassment". Only few of the participating psychiatrists stated to offer a consultation in sexual health to the patients, none to offer sexual therapy. A mentioned reason was "lack of competence regarding sexual health". Twelve percent referred the patients with sexual issues to a physician with another medical specialization, especially to experts in gynaecology and obstetrics, to experts in urology, or to andrologists. However, a need for a network in the field of sexual medicine was stated and an unawareness of a sexual health care network: where to refer the patients in need. Our data showed an increased need in the routine treatment and management of sexual health care in psychiatrists and psychotherapists. Plus, the data stresses the need for professional sexual medicine qualification and for extended cooperation between different medical fields and health care professionals in order to integrate sexual health topics professionally in daily routine.

Occupational therapy students' views on addressing sexual health

BACKGROUND

Sexual health is an important issue in daily life, but little is known about occupational therapy (OT) students' views on these matters.

AIM

To explore occupational therapy students' views on addressing sexual health in their future professional role.

MATERIAL AND METHODS

A descriptive qualitative study involving 37 OT students in 5 focus groups was performed and analyzed using content analysis.

RESULTS

Three categories: 'Sexual health is part of occupational therapy and but not of the OT educational program'; 'Need for knowledge to identify and intervene related to sexual health problems'; and finally, 'Communication about sexual health-unknown, untried, but necessary', formed the theme, 'Willing to try, wanting to know more, and recognizing not only the difficulties and challenges but also the importance of sexual health in OT practice'.

CONCLUSIONS

OT-students consider sexual health as part of OT-practice, but experience lack of knowledge of sexual health related to disease/disability, cultural diversity, and age and sexual orientation. Educational programs need to cover these matters, including how to address sexual health in OT-practice, to enhance OT's future competence related to promotion of sexual health for clients.

SIGNIFICANCE

Knowledge on students' views are vital to guide education on this important, rather neglected, area.

Nursing Students' Attitudes Toward Lesbian, Gay, Bisexual, and Transgender Persons: An Integrative Review

AIM

The aim of this study was to critically appraise and synthesize findings from studies on the attitudes of nursing students toward lesbian, gay, bisexual, and transgender (LGBT) persons.

BACKGROUND

There is paucity of research to assess the attitudes of nursing students toward LGBT persons.

METHOD

An electronic search was conducted using PubMed, Medline, Web of Science, EbscoHost, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature using medical subject headings terminologies. Search terms used included gay, lesbian, transgender, bisexual, LGBT, nursing students, baccalaureate nursing, undergraduate nursing, homophobia, homosexuality, sexual minority, attitudes, discrimination, and prejudice.

RESULTS

Less than 50 percent of the studies (5 out of 12) suggested positively leaning attitudes of nursing students toward LGBT persons; six studies reported negative attitudes, and one study reported neutral attitudes.

CONCLUSION

There are some indications that student attitudes may be moving toward positively leaning. Studies published before 2000 reported a preponderance of negative attitudes.

Knowledge and attitude on sex among medical students of a Malaysian university: a comparison study

INTRODUCTION

The objective of this study was to determine the relationship between clinical/socio-demographic factors with knowledge and attitude on sex among medical students of the National University of Malaysia (UKM).

METHODS

A cross-sectional study assessing 452 students using a self-administered questionnaire of knowledge and attitude was performed and had a response rate of 80%.

RESULTS

The majority of respondents were Malays (56%), females (57.5%), lived in urban areas (66.4%), had a median family income of RM3000 and perceived themselves as moderately religious (60%). The overall score on knowledge about sex was 21.7 of 35 (a higher score indicates better knowledge about sex). It was noted that 73.2% of students felt that they did not receive adequate training in medical school to deal with patients' sexuality and sexual problems, while 51.5% felt uncomfortable talking to patients about these issues. Students in the clinical year were more knowledgeable than those in pre-clinical years (22.67 versus 20.71, P < 0.001). No significant differences were found in terms of their backgrounds, such as being from urban or rural areas (P = 0.349) and between genders (P = 0.286). Only 54.9% of students had a satisfactory level of knowledge on sex (>22 marks [median score]).

DISCUSSION

The students' attitude on sex was considered conservative as the majority of them disagreed on premarital sex, masturbation, abortion, homosexuality and oral sex. Gender and religiosity have a large influence on attitudes on controversial sexual issues, whereas clinical status plays a small role. Knowledge on sex among UKM medical students is inadequate and their attitudes on sex are considered conservative. Integration of sexual medicine and health modules in the medical curriculum is crucial for students to more effectively address patients' sexual problems and promote non-judgmental attitudes towards patients.

Motivations and sexual attitudes, experiences, and behavior of sexuality professionals

This study examined the motivations for entering the field and sexual attitudes, experiences, and behavior of an international group of sexuality professionals. Participants were 252 individuals attending the XVII World Congress of Sexology who completed a questionnaire in English, Spanish or French. Most participants' reported professional rather than personal motivations for entering the field in addition to interest. On average, participants reported little sexual communication with their parents as children. About one-third had experienced unwanted sexual activity as a child. Participants were mostly accepting of a range of sexual activities, although they were less accepting of some behaviors than of others. Twelve of the participants who had engaged in sexual activity with a casual or anonymous partner in the previous 2 years had not used a condom consistently. Participants reported high sexual satisfaction and good sexual communication with their partner. Nevertheless, 45% of the women and 35% of the men reported regularly experiencing one or more sexual problems. Few participants reported that their profession affected their sexual functioning negatively; in contrast most reported that it had positive effects on their sexual functioning. These results suggest that there are few differences between sexuality professionals and the general public.

Associations of desire for change in sexual life amongst female medical students in North America

We analyzed associations of dissatisfaction with sexual life and desire for change in female medical students. Students enrolled in medical schools in North America between February and July 2008 were invited to participate in an internet based survey of sexual function. The principle outcome measure was a single item question on sexual life satisfaction and desire for change. Women who reported dissatisfaction and desire for change were classified as “sexually bothered”. The survey also assessed ethnodemographic factors, student status, sexual history, and depressive symptoms. Respondents completed the Female Sexual Function Index (FSFI) and the Index of Sex Life (ISL). Descriptive statistics, ANOVA, and multivariable logistic regression were utilized to analyze responses. There were 661 non-virgin female subjects with data adequate for analysis. Whereas 281 (43%) of these met criteria for High Risk of Female Sexual Dysfunction (HRFSD) based on FSFI scoring, just 173 (26%) reported sexual bother. Among women with HRFSD, 126 (45%) reported sexual bother; in women without HRFSD, 362 (95%) were not sexually bothered. Interference in sexual life from tiredness and stress were associated with sexual bother. Progressively better scores on the FSFI-desire, orgasm, and satisfaction domains were significantly associated with lower odds of sexual bother. Few women in this cohort with FSFI score >26.55 reported sexual bother. Women with FSFI less than 26.55 had greater odds of sexual bother but this criterion alone was not pathognomonic for sexual concerns. Issues of sexual desire and orgasm appear to play a more important role than lubrication, arousal, and sexual pain issues in this population.

Sexual health of Dutch medical students: nothing to worry about

INTRODUCTION

Little is known about the sexual lives and development of medical students because of relatively small sample sizes and, in particular, low response rates in research. Enhancing medical students' awareness and understanding of sexual behavior is imperative, as gaps in knowledge might impede effective sexual health consultations in their later professional practice.

AIM

The aim of this study was to provide insight into the sexual lives and development of medical students.

MAIN OUTCOME MEASURES

The main outcome measures of this study are demographic, contextual, and sexual data based on validated surveys.

METHODS

Preclinical medical students aged under 26 years were approached during scheduled classes and by e-mail to complete a web-based questionnaire. Our results were compared with international and Dutch normative data. Ordinal regression analysis and Pearson's correlation analysis were used to assess relationships between variables.

RESULTS

A total of 1,598 questionnaires were returned (response rate 52%: 1,198 by women, 400 by men). There were 719 first-year students (mean age 19.17 years) and 879 third-year students (mean age 21.5 years). Gender distribution differences were seen in all the cohorts and were corrected for. Compared with international and Dutch (88%) normative data, our first- (62.7%; P<0.001) and third-year (79.9%; P=0.018) medical students had less sexual experience and showed different advancements in sexual behavior. However, these differences decreased, which suggests that medical students "catch-up" as their age increases. Sexual behavior in our sample did not differ from international data, except for a strikingly high sexual satisfaction (80%). We also confirmed that social and environmental characteristics change with alterations in sexual behavior. Although contraceptive measures were used more frequently (98%; P=0.006), sexually transmitted diseases were more common (4.6%; P=0.008), which suggests inappropriate use of protective measures. Independent predictive determinants for protective sexual behavior were the form of relationship (P<0.001; OR=1.97) and sexual orientation (P=0.009; odds ratio=2.26).

CONCLUSION

These data provide insight into the sexuality of medical students. The results of this study reliably clarify previous findings and form a solid basis for further research.

Medical student sexuality: how sexual experience and sexuality training impact U.S. and Canadian medical students' comfort in dealing with patients' sexuality in clinical practice

PURPOSE

To determine factors associated with students' comfort in addressing patients' sexuality in the clinical context.

METHOD

The authors invited students enrolled in MD-degree-granting and osteopathic medical schools in the United States and Canada to participate in an anonymous Internet survey between February and July 2008. The survey assessed ethnodemographic factors and sexual history. Respondents also completed the Center for Epidemiologic Studies Depression Scale. Male respondents completed the International Index of Erectile Function and the Premature Ejaculation Diagnostic Tool. Female respondents completed the Female Sexual Function Index and the Index of Sex Life. The authors used descriptive statistics, ANOVA, and multivariable logistic regression to analyze responses.

RESULTS

The authors' analyses included 2,261 completed survey responses: 910 from men, 1,343 from women, and 8 from individuals who self-identified as "other" gendered. Over 53% of respondents (n = 1,206) stated that they felt they had not received sufficient training in medical school to address sexual concerns clinically. Despite this, 81% of students (n = 1,827) reported feeling comfortable dealing with their patients' sexuality issues. Students with limited sexual experience, students at risk for sexual problems, and students who felt that they had not been trained adequately were less likely to report being comfortable talking to patients about sexual health issues.

CONCLUSIONS

Perception of inadequate sexuality training in medical school and personal issues pertaining to sex may be associated with students' difficulty in addressing patients' sexuality. Adequate training is preeminently associated with feeling comfortable addressing patients' sexuality and should be a priority for medical education.