Relationship Between the Knowledge, Attitude, and Self-Efficacy on Sexual Health Care for Nursing Students

doi:10.1016/j.profnurs.2014.11.001

Journal of Professional Nursing

Volume 31, Issue 3, May–June 2015, Pages 254-261

https://doi.org/10.1016/j.profnurs.2014.11.001 Get rights and content

Highlights

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We assess the factors impacting nursing students on sexual health care practice.
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Structural equation modeling is used for assessment.
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Knowledge, attitude, and self-efficacy to sexual health care are correlated.
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Providing nursing students knowledge of sexual health care is not sufficient.
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Improving nursing students' positive attitudes on sexual health care is needed.

Promoting patients' sexual health for better quality of life is an important task for nurses. Little is known about the factors impacting nursing students to better prepare for the future nursing practice on sexual health care. The purpose of the study is to address the need for nursing education on sexuality by exploring the relationship between nursing students' knowledge, attitude, and self-efficacy for patients' sexual health care. A total of 190 senior nursing students were purposely enrolled to the study by answering a self-report questionnaire, and the data were analyzed using structural equation modeling (SEM). The results demonstrated positive correlation of the relationship between knowledge of sexual health care (KSH) and attitude to sexual health care (ASH; γ = .35, t = 3.31, P < .001), the relationship between KSH and self-efficacy for sexual health care (SESH; γ = .29, t = 2.98, P < .01), and relationship between ASH and SESH (γ = .34, t = 4.30, P < .001). Therefore, nursing educators need not only provide students the knowledge and skills on sexual health care but also educate them about positive attitudes on sexuality to enhance their efficacy to deal with the patients' sexuality matters in the future nursing practice.

Section snippets

Design, Participants, and Procedure

This was a cross-sectional study. A total of 190 senior nursing students were recruited from a nursing college in Taiwan via the recruitment seminar at campus, which explained the study objectives, procedure, and program contents. The participants were purposely selected from senior grade because they all had nursing clinical practice experience. The study was approved by the ethics committee. All participants were required to sign a consent form after explaining the study objectives,

Characteristics of Participants

All nursing students were female and single with average age of 21.12 years old (SD = 0.52; age range = 20–23 years), and the statistics of their other demographic data was as follows: 46% having no specific religious belief, 66% from nuclear family, 43% having received sex/gender education course before, 44% perceiving good parent–child relationship, 85% having dating experience before, 82% having experience of falling in love, 39% having sexual experience, 56% having experience committed boy

Discussion

It has been generally perceived that additional education on sexuality for nursing clinical practice is significantly related to nurses' being more comfortable attitude in sexual health care (Jaarsma et al., 2010, Sung et al., 2010) and can lead to improvement of self-efficacy (Sung and Lin, 2013, Tsai et al., 2005). This study demonstrates that, for nursing students, KSH, ASH, and SESH are positively correlated with each other. In other words, nursing students with more KSH would have a more

Conclusion

The structural model derived in this study reveals that knowledge, attitude, and self-efficacy have positive association to sexual health care on nursing students. The results allow nursing educators to scrutinize the relationship among knowledge, attitude, and self-efficacy to sexual health care for nursing students. Nursing educators need not only provide students the knowledge and skills on sexual health care, but also educate students' appropriate attitudes exploring their own values and

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Cited by (44)

Healthcare students’ attitudes toward addressing sexual health: validation of the European Portuguese version
2024, Teaching and Learning in Nursing
To tailor curriculum and training programs on sexual health for undergraduate health students, assessing students' attitudes toward working with sexual health is necessary. The Students’ Attitudes Toward Addressing Sexual Health Questionnaire (SA-SH) provides adequate measurement proprieties to assess health students' attitudes toward sexual health. This questionnaire has yet to be available for use in European Portuguese-speaking countries.
Translate, culturally adapt, and validate the European Portuguese version of the SA-SH.
Cross-sectional, observational study. The translation was performed according to international guidelines; a panel of four sexuality experts was invited for content validity purposes; construct validity was obtained with the results of 122 questionnaires submitted online to health students and correlation with the Sexuality Attitudes and Beliefs Survey. Internal consistency reliability was also calculated.
The European Portuguese version showed a Cronbach's alpha between 0.669 and 0.770, and four items were removed after factorial analysis. A significant correlation was found with the results of the Sexuality Attitudes and Beliefs Survey.
The SA-SH European Portuguese version is a valid and reliable instrument to use among the Portuguese population and institutions.
Psychometric Properties of the Danish Version of the Questionnaire Professionals’ Attitudes towards Addressing Sexual Health (PA-SH-D)
2022, Sexual Medicine
Citation Excerpt :
Danish health professionals lack competences and education within the field of sexual health.11 Discussing sexual problems with patients can be limited due to barriers such as lack of education,12,15–18 knowledge,12,15,16,19,20 training,16,17,20 communication skills,15,17 feelings of embarrassment among health professionals12,15,21 and health professionals questioning whether sexual health is part of their professional responsibility.12,16 Thus, health professionals’ attitudes influences their competences to address sexual health in their professional interventions.12
Health professionals’ attitudes towards addressing sexual health are important to promote patients’ sexual health. Therefore, measurement of health professionals’ attitudes towards addressing sexual health is essential.
This study aimed to adapt the questionnaire Students’ Attitudes towards Addressing Sexual Health (SA-SH-D) to health professionals working with rehabilitation in Danish municipalities and evaluated psychometric properties of the adapted questionnaire: The Danish Version of the Professionals’ Attitudes towards Addressing Sexual Health (PA-SH-D).
The SA-SH-D was adapted to PA-SH-D and a face validity evaluation focusing on phrasing, functionality, perception and relevance was done. In a pilot study, the PA-SH-D was answered by health professionals and internal consistency reliability and floor and ceiling effects were evaluated.
Face validity included phrasing, functionality, perception and relevance of the items in PA-SH-D, internal consistency with Cronbach's alpha in the total scale and floor and ceiling effects.
Face validity of the PA-SH-D was acceptable. The sample size was 52 health professionals working with rehabilitation, the internal consistency reliability (Cronbach's alpha: 0.89 [lower confidence interval {CI}: 0.85]) and floor and ceiling effects (0.0%–13.7%) of the PA-SH-D were acceptable.
As sexual health is important in human quality of life, the validation of the PA-SH-D is highly valuable as it evaluates health professionals’ attitudes towards addressing sexual health, and thereby is able to measure the need for education and training in sexual health and detect changes in attitudes following an educational intervention.
Strengths were that the PA-SH-D measures both attitudes and competences and covered a need in clinical practice. The recruitment was broad and we used the work of others to orient this work. Limitations were that this study covered a preliminary psychometric evaluation and a thorough evaluation covering other aspects of psychometry should be done. We used both paper-based and online-based survey which possibly could cause bias. The study had a relatively small sample size. Comparing health professionals to students can be seen as both a limitation and a strength.
The results in face validity and internal consistency reliability indicate usefulness of the PA-SH-D to measure health professionals’ attitudes towards addressing sexual health. Further evaluation of psychometric properties of the PA-SH-D is recommended.
Elnegaard CM, Christensen J, Thuesen J, et al. Psychometric Properties of the Danish Version of the Questionnaire Professionals’ Attitudes towards Addressing Sexual Health (PA-SH-D). Sex Med 2022;10:100527.
Assessment of the psychometrics of the Students' Attitudes towards Addressing Sexual Health Extended (SA-SH-Ext) questionnaire for social educator students
2022, Sexual Medicine
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.
The study aimed to assess the psychometrics of the Students´ Attitudes towards addressing Sexual Health Extended (SA-SH-Ext) questionnaire for social educator students.
A sample of 213 Norwegian social educator students was used to test internal consistency reliability and construct validity with explorative factor analysis.
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).
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.
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.
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.
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.
Danish Health Professional Students' Attitudes Toward Addressing Sexual Health: A Cross-Sectional Survey
2021, Sexual Medicine
Citation Excerpt :
This result confirms the sexual “two-way taboo” in health care, which has been found earlier.15,35,37 A few of the students felt that they have been educated about sexual health in their educational program and that they have sufficient competences to talk about sexual health with their future patients, which is comparable to previous studies.8,11–13,20 As the hesitation of HPs to discuss sexual concerns may be due to feelings of inadequacy in responding to patients' questions in this field,38 competences in how to communicate about sensitive issues are important in HP students' education.10,12
Danish health professional (HP) students' attitudes toward addressing sexual health are unknown.
To investigate Danish HP students' attitudes toward addressing sexual health in their future professions, and to assess differences in perceived competences and preparedness between professional programs.
A Danish national survey of nursing, occupational therapy, and physiotherapy students was conducted. Totally, 1,212 students were invited to respond to an online questionnaire “The Students' Attitudes toward Addressing Sexual Health.”
The main outcome measures investigated were Danish HP students' attitudes toward addressing sexual health in their future professions, and differences in perceived competences and preparedness depending on the professional program.
A total of 584 students (48%; nursing 44%, occupational therapy 70%, physiotherapy 43%) responded. Mean total score ranged between 63.7 and 66.3 (±8.3–8.8) classifying students in the low-end of the class: “comfortable and prepared in some situations.” No clinically relevant differences were determined between the professional programs with respect to perceived competences and preparedness to address sexual health.
In the field of addressing sexual health, most Danish HP students reported positive attitudes and a need for basic knowledge, competences, communication training, and education.
H Gerbild, C M Larsen, T. Junge, B. S. Laursen, K. Areskoug-Josefsson. Danish Health Professional Students' Attitudes Toward Addressing Sexual Health: A Cross-Sectional Survey. Sex Med 2021;9:100323.
Sexual health attitudes and beliefs among nursing faculty: A correlational study
2021, Nurse Education Today
Citation Excerpt :
Nursing faculty for baccalaureate programs expressed deficiencies in teaching sexual health topics (Echezona-Johnson, 2017; Lim et al., 2015). According to Bell and Bray (2014), Steinke et al. (2016), Sung et al. (2015), and Yingling et al. (2017), their level of education affected the learning and teaching of sexual health. These findings supported the need for more sexual health preparation in nursing faculty across the different programs and the value of a doctorate prepared nursing faculty.
Sexual health is an integral part of nursing care across the life span. Nurses internal and external factors influenced their knowledge, experiences, and competencies. These impact nursing education and professional practice. There was no known research regarding the nursing faculty's sexual health attitudes and beliefs and the relationship with predictive factors.
The purpose aims to identify any statistical relationships between nursing faculty age, nursing educational level, nursing specialty, years of work, and years of teaching in nursing to predict their sexual health attitudes and beliefs.
This is nonexperimental and quantitative research of predictive correlational design with multiple linear regression statistical analyses.
Data gathered from nursing faculty across the United States.
Nursing faculty teaching at the baccalaureate, master, and or advanced practice nursing programs.
Online survey of sexuality attitudes and beliefs (SABS).
A convenience sample of 371 nursing faculty. The results showed a statistically significant and a moderate correlation (R = 0.35, R² = 0.12, F(9, 361) = 5.68, p < 0.01) of their sexual health attitudes and beliefs and the predictors. This indicated nursing faculty with a doctorate, women's health specialty, and increased years for age, nursing practice, and teaching showed lower SABS scores or barriers to addressing sexual health. The social cognitive theory and Benner's novice to expert model explained the relationship between predictors and sexual health attitudes and beliefs.
The findings of this study showed personal, educational, and professional factors as predictors affecting positively or negatively the faculty's sexual health attitudes and beliefs.
Awareness of those findings should promote changes in nursing education, decrease sexual health barriers, and prepare faculty, students, and nurses to provide sexual health care across the life span.
Knowledge and attitude of nursing students regarding older adults' sexuality: A cross-sectional study
2021, Nurse Education Today
Although older adults are sexual, sexuality is infrequently discussed with them by health care professionals. Nursing students, as future professionals, can make an important contribution by developing competences in discussing intimacy and sexuality with older adults to increase quality of life and to prevent sexual problems. In order to improve these competences, current levels of knowledge and attitude need to be explored.
To investigate i) knowledge and attitudes of nursing students regarding intimacy and sexuality of older adults, ii) the difference in knowledge and attitudes of nursing students in different years of study and iii) frequency of discussing intimacy and sexuality with older adults.
Cross-sectional.
A University of Applied Sciences in the Netherlands.
Nursing students, ≥16 years who were able to read and write in Dutch.
The Ageing Sexual Knowledge and Attitudes Scale was used among nursing students. Furthermore, demographic information and frequencies were collected. Data was analyzed using SPSS.
In total, 732 students participated. The mean knowledge-score was 43.9 (SD = 8.9), the mean attitude-score 64.3 (SD = 16.0). Unlike attitude, the level of knowledge differed significantly per year of study: first year students had the lowest and third year students the highest knowledge. Most students stated they ‘never’ (54.1%) or ‘once’ (13.2%) discussed intimacy and sexuality with older adults. Reasons to avoid talking about intimacy and sexuality were feelings of ‘not being the right person’ (17.3%) and ‘incompetence’ (14.0%).
Nursing students had moderate knowledge and positive attitudes toward older adults' intimacy and sexuality. The knowledge-level differed per year of study, the attitude level did not. Only a minority discussed intimacy and sexuality with older adults. Moderate knowledge and positive attitudes do not mean that intimacy and sexuality is discussed. To ensure students feel responsible and competent, interventions should focus on continuous knowledge dissemination, role clarification and role modelling.

View all citing articles on Scopus

^☆: Conflict of interest statement: No conflict of interest has been declared by the authors.

^☆☆: Funding statement: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

View full text

Original articleRelationship Between the Knowledge, Attitude, and Self-Efficacy on Sexual Health Care for Nursing Students☆,☆☆

Highlights

Section snippets

Design, Participants, and Procedure

Characteristics of Participants

Discussion

Conclusion

The Journal of Sexual Medicine

Nurse Education Today

The Journal of Sexual Medicine

The Journal of Sexual Medicine

Heart & Lung

Nurse Education Today

Nurse Education Today

Culticate self-efficacy for personal and organizational effectiveness

Social cognitive theory: An agentive perspective

Annual Review of Psychology

Sexuality education: Theory and practice

Sexual dysfunction in men with COPD: Impact on quality of life and survival

Lung

Introducing LISREL: A guide for the uninitiated

Improving sexual health of HIV patients by providing a combination of integrated public health and hospital care services; A one-group pre- and post test intervention comparison

BMC Public Health

Moving beyond the therapeutic relationship: A selective review of intimacy in the sexual health encounter in nursing practice

Journal of Clinical Nursing

Multivariate data analysis

Current practice and barriers to the management of sexual issues in rheumatology: Results of a survey of health professionals

Scandinavian Journal of Rheumatology

Using social learning theory to explain individual differences in human sexuality

The Journal of Sex Research

Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives

Structural Equation Modeling: A Multidisciplinary Journal

Nursing students' attitudes towards provision of sexual health care in clinical practice

Journal of Clinical Nursing

Sexual counseling of cardiac patients: Nurses' perception of practice, responsibility and confidence

European Journal of Cardiovascular Nursing

Original article
Relationship Between the Knowledge, Attitude, and Self-Efficacy on Sexual Health Care for Nursing Students☆,☆☆