The Effects of a Culture-Based Sexual Health Training Course on Knowledge, Attitude, Performance, and Self-Efficacy of Midwives in Providing Sexual Health Services


  • Maryam Mohseni PhD Candidate in Reproductive Health, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Hedyeh Riazi PhD Candidate in Reproductive Health, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Maliheh Nasiri Assistant Professor, Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Zahra Karimian Assistant Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran


Background: Sexual health is one of the major aspects of health that is formed under the influence of various biological, social, psychological, and cultural factors. This study was conducted with the aim to determine the effects of a culture-based sexual health training course on the knowledge, attitude, performance, and self-efficacy of midwives in providing sexual health services.

Methods: The present study was performed with a pretest-posttest design and follow-up. In total, 32 midwives were included in the online sexual health training course via the census sampling method. Accordingly, the knowledge, attitude, performance, and self-efficacy of the midwives were assessed using a researcher-made questionnaire before, immediately after, and 4 weeks after the intervention. Moreover, repeated measures ANOVA was used to determine the effects of the intervention.

Results: Comparing the results of pretest and posttest indicated that the training course significantly increased the midwives’ mean scores of knowledge (from 17.12 to 23.87), attitude (from 39.40 to 50.18), performance (from 36.18 to 46.15), and self-efficacy (from 27.31 to 39.28)..

Conclusion: This study indicated that running a culture-based training course on sexual health would be likely to improve professional capacity building in providing sexual health services. Given the importance of cultural and social issues in sexual health education, this course could play an effective role in helping midwives face and solve their clients’ problems.


Arab, R. K. , Jannati, Y. (2016 Nov 24-25). Explain the axes of sexual and reproductive health counseling based on the societi's needs. Proceedings of the Conference on Health Promotion Strategies and Challenges; Sari, Iran.

Baker-Green, R. (2017). Nurses experiences discussing sexuality with urinary catheter patients. Int. J. Urol. Nurs., 11(1), 6-12.

Bal, M. D., & Sahiner, N. C. (2015). Turkish Nursing StudentsÇÖ Attitudes and Beliefs Regarding Sexual Health. Sex Disabil, 33(2), 223-231.

Çuhadaroðlu, A. (2017). The effects of sex education on psychological counselling students in Turkey. Sex Edu., 17(2), 209-219.

Dyer, K., & das Nair, R. (2013). Why don't healthcare professionals talk about sex? A systematic review of recent qualitative studies conducted in the United kingdom. J Sex Med, 10(11), 2658-2670. doi:10.1111/j.1743-6109.2012.02856.x [doi];S1743-6095(15)30171-5 [pii]. Retrieved from PM:22846467

Evangelista, A. D. R., Moreira, A. C. A., Freitas, C. A. S. L., Val, D. R. D., Diniz, J. L., & Azevedo, S. G. V. (2019). Sexuality in old age: knowledge/attitude of nurses of Family Health Strategy. Rev.Esc.Enferm.USP., 53, e03482. doi:S0080-62342019000100454 [pii];10.1590/S1980-220X2018018103482 [doi]. Retrieved from PM:31365728

Evcili, F., & Demirel, G. (2018). Sexual myths of midwifery and nursing students and their attitude regarding the assessment of sexual health. J. Hum. Sci., 15(4), 2280-2288.

Farnam, F., Janghorbani, M., Raisi, F., & Merghati-Khoei, E. (2014). Compare the effectiveness of PLISSIT and sexual health models on women's sexual problems in Tehran, Iran: a randomized controlled trial. J Sex Med, 11(11), 2679-2689. doi:10.1111/jsm.12659 [doi];S1743-6095(15)30614-7 [pii]. Retrieved from PM:25091932

Ford, J. V., Barnes, R., Rompalo, A., & Hook, E. W., 3rd. (2013). Sexual health training and education in the U.S. Public.Health Rep, 128 Suppl 1, 96-101. doi:10.1177/00333549131282S111 [doi]. Retrieved from PM:23450890

Goossens, E., Norekval, T. M., Faerch, J., Hody, L., Olsen, S. S., Darmer, M. R. et al. (2011). Sexual counselling of cardiac patients in Europe: culture matters. Int J Clin.Pract., 65(10), 1092-1099. doi:10.1111/j.1742-1241.2011.02756.x [doi]. Retrieved from PM:21923848

Grewal, G. S., Gill, J. S., Sidi, H., Gurpreet, K., Jambunathan, S. T., Suffee, N. J. et al. (2014). Prevalence and risk factors of female sexual dysfunction among healthcare personnel in Malaysia. Compr.Psychiatry, 55 Suppl 1, S17-S22. doi:S0010-440X(13)00036-9 [pii];10.1016/j.comppsych.2013.01.009 [doi]. Retrieved from PM:23452905

Helland, Y., Garratt, A., Kjeken, I., Kvien, T. K., & Dagfinrud, H. (2013). Current practice and barriers to the management of sexual issues in rheumatology: results of a survey of health professionals. Scand J Rheumatol., 42(1), 20-26. doi:10.3109/03009742.2012.709274 [doi]. Retrieved from PM:22994142

Jaarsma, T., Stromberg, A., Fridlund, B., De, G. S., Martensson, J., Moons, P. et al. (2010). Sexual counselling of cardiac patients: nurses' perception of practice, responsibility and confidence. Eur.J Cardiovasc.Nurs, 9(1), 24-29. doi:S1474-5151(09)00151-0 [pii];10.1016/j.ejcnurse.2009.11.003 [doi]. Retrieved from PM:20005178

Karimian, Z. (2016). Designing and evaluation of the community-based modules in sexual health assessment and counceling to promote midviews' professional practices. Shahroud, Iran: Shahroud University of Medical Sciences.

Karimian, Z., Azin, S. A., Javid, N., Araban, M., Maasoumi, R., Aghayan, S. et al. (2018). Reaching consensus: a review on sexual health training modules for professional capacity building. Health Promot Perspect., 8(1), 1-14. doi:10.15171/hpp.2018.01 [doi]. Retrieved from PM:29423357

Khadivzadeh, T., Ghazanfarpour, M., & Latifnejad, R. R. (2018). Cultural Barriers Influencing Midwives' Sexual Conversation with Menopausal Women. J Menopausal.Med, 24(3), 210-216. doi:10.6118/jmm.2018.24.3.210 [doi]. Retrieved from PM:30671415

Khadivzadeh, T., Ardaghi, M., Mirzaii, K., & Mazloum, S. R. (2016). The Effect of Interactive Educational Workshops with or Without Standardized Patients on the Self-Efficacy of Midwifery Students in Sexual Health Counseling. Journal of Midwifery and Reproductive Health, 4(2), 562-570.

Magnan, M. A., Reynolds, K. E., & Galvin, E. A. (2005). Barriers to addressing patient sexuality in nursing practice. Medsurg.Nurs, 14(5), 282-289. Retrieved from PM:16318107

McIntosh, T., Fraser, D. M., Stephen, N., & Avis, M. (2013). Final year students' perceptions of learning to be a midwife in six British universities. Nurse.Educ Today., 33(10), 1179-1183. doi:S0260-6917(12)00172-4 [pii];10.1016/j.nedt.2012.05.020 [doi]. Retrieved from PM:22703835

Nakopoulou, E., Papaharitou, S., & Hatzichristou, D. (2009). Patients' sexual health: a qualitative research approach on Greek nurses' perceptions. J Sex Med, 6(8), 2124-2132. doi:S1743-6095(15)32615-1 [pii];10.1111/j.1743-6109.2009.01334.x [doi]. Retrieved from PM:19493279

Nicolai, M. P., Both, S., Liem, S. S., Pelger, R. C., Putter, H., Schalij, M. J. et al. (2013). Discussing sexual function in the cardiology practice. Clin.Res Cardiol., 102(5), 329-336. doi:10.1007/s00392-013-0549-2 [doi]. Retrieved from PM:23392531

Oren, B., Zengin, N., Yazici, S., & Akinci, A. C. (2018). Attitudes, beliefs and comfort levels of midwifery students regarding sexual counselling in Turkey. Midwifery., 56, 152-157. doi:S0266-6138(17)30126-2 [pii];10.1016/j.midw.2017.10.014 [doi]. Retrieved from PM:29121550

Papaharitou, S., Nakopoulou, E., Moraitou, M., Tsimtsiou, Z., Konstantinidou, E., & Hatzichristou, D. (2008). Exploring sexual attitudes of students in health professions. J Sex Med, 5(6), 1308-1316. doi:S1743-6095(15)32070-1 [pii];10.1111/j.1743-6109.2008.00826.x [doi]. Retrieved from PM:18410302

Penwell-Waines, L., Wilson, C. K., Macapagal, K. R., Valvano, A. K., Waller, J. L., West, L. M. et al. (2014). Student perspectives on sexual health: implications for interprofessional education. J Interprof.Care, 28(4), 317-322. doi:10.3109/13561820.2014.884553 [doi]. Retrieved from PM:24547937

Percat, A., & Elmerstig, E. (2017). "We should be experts, but we're not": Sexual counselling at the antenatal care clinic. Sex Reprod Healthc., 14, 85-90. doi:S1877-5756(17)30150-7 [pii];10.1016/j.srhc.2017.10.001 [doi]. Retrieved from PM:29195640

Pieters, R., Kedde, H., & Bender, J. (2018). Training rehabilitation teams in sexual health care: A description and evaluation of a multidisciplinary intervention. Disabil.Rehabil., 40(6), 732-739. doi:10.1080/09638288.2016.1271026 [doi]. Retrieved from PM:28068867

Quinn, C., & Happell, B. (2013). Talking about sexuality with consumers of mental health services. Perspect.Psychiatr.Care, 49(1), 13-20. doi:10.1111/j.1744-6163.2012.00334.x [doi]. Retrieved from PM:23293993

Rostamkhani, F., Jafari, F., Ozgoli, G., & Shakeri, M. (2015). Addressing the sexual problems of Iranian women in a primary health care setting: A quasi-experimental study. Iran J Nurs Midwifery.Res, 20(1), 139-146. Retrieved from PM:25709703

Russell, E. B. (2012). Sexual Health Attitudes, Knowledge, and Clinical Behaviors: Implications for Counseling. Fam. J., 20(1), 94-101.

Sung, S. C., & Lin, Y. C. (2013). Effectiveness of the sexual healthcare education in nursing students' knowledge, attitude, and self-efficacy on sexual healthcare. Nurse.Educ Today., 33(5), 498-503. doi:S0260-6917(12)00208-0 [pii];10.1016/j.nedt.2012.06.019 [doi]. Retrieved from PM:22789872

Sung, S. C., Huang, H. C., & Lin, M. H. (2015). Relationship between the knowledge, attitude, and self-efficacy on sexual health care for nursing students. J Prof.Nurs, 31(3), 254-261. doi:S8755-7223(14)00191-4 [pii];10.1016/j.profnurs.2014.11.001 [doi]. Retrieved from PM:25999199

Sung, S. C., Jiang, H. H., Chen, R. R., & Chao, J. K. (2016). Bridging the gap in sexual healthcare in nursing practice: implementing a sexual healthcare training programme to improve outcomes. J Clin.Nurs, 25(19-20), 2989-3000. doi:10.1111/jocn.13441 [doi]. Retrieved from PM:27324599

Tabatabaie, A. (2015). Constructing the ideal Muslim sexual subject: problematics of school-based sex education in Iran. Sex Education, 15(2), 204-216.

Tugut, N., & Golbasi, Z. (2017). Sexuality Assessment Knowledge, Attitude, and Skill of Nursing Students: An Experimental Study with Control Group. Int J Nurs Knowl., 28(3), 123-130. doi:10.1111/2047-3095.12127 [doi]. Retrieved from PM:26667096

Walker, S. H., & Davis, G. (2014). Knowledge and reported confidence of final year midwifery students regarding giving advice on contraception and sexual health. Midwifery, 30(5), e169-e176. doi:S0266-6138(14)00041-2 [pii];10.1016/j.midw.2014.02.002 [doi]. Retrieved from PM:24661469

World Health Organization. (2010). Developing sexual health programmes: A framework for action. Geneva, Switzerlands: WHO.




How to Cite

Mohseni, M. ., Riazi, H. ., Nasiri, M., & Karimian, Z. . (2022). The Effects of a Culture-Based Sexual Health Training Course on Knowledge, Attitude, Performance, and Self-Efficacy of Midwives in Providing Sexual Health Services. International Journal of Body, Mind and Culture, 9(2). Retrieved from



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