Background
An encounter with a physician who struggled to ask me if I engaged in oral sex made me realize that physician discomfort around the topic of sex may lead to unnecessary awkwardness in the clinic.
“I-I-I...I’m not saying you do this...or that your condition is because of this, but sometimes we see this condition with people who do this. Do you, you know, uhm...do oral?”
A conversation with medical educators and a dive into the literature on this topic confirmed that healthcare professionals are generally uncomfortable with discussing sexual health with their patients
Tools
Our Team
Our Team
- Qualtrics
- Zoom
- Google Sheets
- SPSS
- R
- Microsoft Office
Our Team
Our Team
Our Team
- 1 social psychologist
- 1 clinical psychologist
- 2 OBGYN practitioners
- 1 sex medicine specialist
- 1 medical educator
- 3 research assistants
- 10 behavioral observers
My roles
Our Team
My roles
- Team lead
- Project management
- Study design
- Workshop design
- Workshop facilitation
- Behavioral observation training
- Data analysis & reporting
Insights from brainstorming session
What is (dis)comfort in sexual health communication?
What do students learn in medical school about sexual health communication?
What do students learn in medical school about sexual health communication?
- Discomfort can manifest as anxiety-soothing behaviors such as licking dry lips, which may look weird during sexuality discussions.
- Students who are uncomfortable may either avoid proper terminology or over-rely on medical jargon.
What do students learn in medical school about sexual health communication?
What do students learn in medical school about sexual health communication?
What do students learn in medical school about sexual health communication?
- They learn the technical skills to help them take a sexual history.
- They don't learn how to regulate feelings of discomfort or anxiety during sexuality discussions.
- The curriculum is packed, and there is not enough time for sexual medicine.
What would be helpful to include in our intervention/study?
What do students learn in medical school about sexual health communication?
What would be helpful to include in our intervention/study?
- Define sexuality and sexual health.
- To raise awareness of personal biases and their impact on comfort.
- In addition to behavioral observations and attitudinal measures, we could observe their performance in the year-end clinical exam.
Participants & Procedure
Participants
Participants were students who were enrolled in years 1,2, and 4 of their undergraduate medical program at a private university in Malaysia. Our sampling strategy and study design were informed by user personas that were created based on insights from our preliminary research.
Procedure
- Participants first completed their first baseline questionnaire, which included measures of self-reported pre-intervention knowledge, comfort, demographics, and personality.
- Next, they completed their first role-play assessment, which was videotaped and later coded to obtain pre-intervention observed comfort.
- They then attended their first workshop. Half were randomly allocated to the sexual health workshop (intervention group) while the other half were allocated to the cultural competence workshop (control group).
- Immediately after completing the workshops, participants completed the workshop evaluation questionnaire.
- Six weeks later, participants completed the second baseline questionnaire, which measured self-reported post-intervention knowledge and comfort. They completed the second role-play assessment, which was coded to obtain post-intervention observed comfort.
- They also attended a second workshop and completed a workshop evaluation questionnaire. However, these were not analyzed and were solely included to complete the cover story. Those who have attended the sexual health workshop attended the cultural competence workshop and vice versa.
Measures | Sample items from baseline questionnaire
Self-rated knowledge
Self-rated knowledge
Self-rated knowledge
A single-item measure of self-perceived sexual knowledge
Self-rated comfort
Self-rated knowledge
Self-rated knowledge
One of the three items used to capture attitudinal comfort
Extraversion
Social anxiety
Social anxiety
A sample item from the Extraversion subscale of the BFI-10 (John & Srivastava, 1999), which we used to capture individual differences in sociability and sexuality
Social anxiety
Social anxiety
Social anxiety
A sample item from the short form of the Social Interaction Anxiety Scale (Peters et al., 2012), which we used to capture individual differences in anxiety during social interactions
Measures | Role-play assessment
After completing the baseline questionnaire, participants engaged in a role-play, where their comfort behaviors were observed
Participants were presented with the following case scenario:
“Sarah is a 20-year-old undergraduate at a local university. She presents to the clinic with a problem of per vaginal spotting after intercourse.”
The goal of the role-play assessment was to get participants to ask questions about sexual health in a clinical setting. Their performance was video-recorded and later coded for verbal and non-verbal comfort behaviors.
Some of the questions asked by our participants include:
“When was the last time you had sex? Did you use a condom?”
“When you were doing it, did you feel any pain down there?”
Intervention | Control
Cultural competence
Sexual health
Once all participants completed the role-play assessment, they attended either the sexual health or cultural competence workshops.
Both workshops followed the same structure, used the same tasks, and were facilitated by the same people over Zoom.
Sexual health
Cultural competence
Sexual health
- 30-minute lecture on the complexity of sexual health, its relevance to healthcare, and the importance of comfort when talking about sex.
- 2 hours of guided, interactive activities that involved reflection and discussion on topics related to sexuality and sexual communication.
Cultural competence
Cultural competence
Cultural competence
- 30-minute lecture on the complexity of culture, its relevance to healthcare, and the importance of comfort when talking to someone of a different culture.
- 2 hours of guided, interactive activities that involved reflection and discussion on topics related to cross-cultural communication.
Measures | Sample from workshop evaluation questionnaire
Open-ended question
Qualitative responses were used to determine general workshop usability and also coded for recognition of workshop topic as a measure of successful manipulation (e.g. sexual health workshop attendee mentioned "sex" in their response).
Net promoter and satisfaction score
We measured how satisfied participants were with the workshop using ratings of satisfaction and likelihood of recommendations.
Perceived effectiveness
We also included some measures of the perceived effectiveness of the workshop.
Results & Insights
Workshop usability
Participants found the workshops usable and highly satisfactory, and were highly likely to recommend them to their peers.
Workshop effectiveness
Both workshops improved self-rated preparedness and comfort. However, two metrics suggest the superiority of the sexual health workshop:
- Participants showed less verbal avoidance after the sexual health workshop.
- The sexual health workshop was rated as more effective in promoting awareness related to effective sexual health communication.
Experiment success
Randomization of participants into groups was successful as evidenced by similarity in personality variables across groups. The average levels of social anxiety and extraversion were similar among attendees of the sexual health and cultural competence workshops. Participants also correctly identified the topics of the workshops, indicating manipulation success.