Table 2 Characteristics of the educational intervention curricula, presented by types: one–time intervention, workshop, semester course
Authors | Intervention Objectives | Instruments | Intervention components | Key findings |
One-time intervention (only lecture/ practice session only) | ||||
Wiskin C, [53] | Attitudes Comfort level | 25 items questionnaire included personal, perceived stigma, and social distance items | Role play with sexual health history-taking scenarios | No changes in a general attitude |
Kennedy KM, [58] | Knowledge | No data about the questionnaire | One lecture | Knowledge improved after the intervention |
McBain L, [54] | Skills Confidence Comfort levels | A questionnaire with closed and open questions No additional data about the instrument | Practical simulation session on male & female genital examinations | Skills, Confidence, and Comfort levels were improved after the intervention (p < .01*) |
Cooper MB, [30] | Knowledge | The retrospective pre-post survey, 10-point rating scale | Didactic lecture | Knowledge increased in all domains, especially in the following: Knowledge about LGBTQ challenges health risks (pre: M = 5.8, CI: 5.4 -6.2) vs. (post: M = 8.1, CI: 7.8 – 8.4), (p < .01*) Knowledge about community resources for providing support to LGBTQ patients (pre: M = 3.7; CI: 3.1 – 4.3) vs (post: M = 8.1, CI: 7.5 – 8.7), (p < 0.4) |
Stumbar SE, [33] | Comfort level | The online survey, eight items (1–5-point Likert scale) | Didactic lecture with three cases about: ✓ introduction to the social determinants of sexual and reproductive health of LGBTQ ✓ health disparities ✓ sexually transmitted diseases Interactive panel session with patients | All Comfort levels improved after the session. (p < .01*) with the most significant changes regarding: Discussing a patient sexual history (pre-mean rank = 14.5 vs post – mean rank = 18.9) Discussing sexual issues with patients > 60 y.old (pre- mean rank = 16.5 vs post mean rank (26.0) Treating patients with different sexual orientation (pre mean rank = 12.6 vs post mean rank = 14.6) Knowledge about the LGBTQ health concerns (pre mean rank = 15.1 vs post mean rank = 21.2) |
Micheal MW, [59] | Knowledge | No data about the tool | The online material included the following topics: ✓ gender and sexual identity ✓ gender-based epidemiology ✓ gender as a social determinant of Health ✓ addressing health in a healthcare setting The interactive session consists of 5 stations (small group) with video clips and discussions on the following topics: ✓ Man’s/women’s/transgender health ✓ contact tracing for sexually transmitted infections ✓ gender and sexuality stereotypes | The average score for knowledge improved after the session in the following domains: gender and sexual health issues (6.3 to 8.2); women’s health services (5.7 to 7.6); men’s health services (4.4 – 6.9); sexual health services (5.8 – 7.6) (p < .01*) |
Grova MM, [35] | Knowledge and skills Openness and Support Awareness of Oppression in the LGBTQ | AIM inventory, 19 items (1–5 Likert scale) | Training consists of five parts: ✓ Purpose of the training and educational objectives ✓ Allyship and Invitational Theory ✓ Strategies for Allyship and Intentionally Inclusive Care ✓ Case scenarios | Significant following effects were found: Knowledge: (F (1,7) = 8.30, p = .0024, ω2p = .02 Openness: (F (1,7) = 6.14, p = .0042, ω2p = .04 Awareness- NS |
Ojo A, [40] | Knowledge Comfort levels toward reproductive justice (RJ) | No data about the questionnaire | 4 cases on the following content: ✓ RJ & Indigenous health ✓ RJ & LGBTQ ✓ RJ & Maternal mortality ✓ RL & Family planning 25 min. recorded lecture | n = 28 (41%) – completed pre-test n = 31 (46%) -completed post-test n = 15 (22%) – completed both pre-and-post tests Following the intervention, participants reported enhanced levels of comfort and knowledge in certain subjects, though not across all areas No noticeable improvement in skills was observed after the intervention |
Bear MD, [43] | Attitude Knowledge toward LGBTQ | ATLPS 5 point – Likert scale | Educational content was: ✓ Health disparities & terminology ✓ The basics of pharmacological endocrine treatment ✓ Gender identity assessment ✓ | Year 1: n = 24 (8.5%) completed all survey Year 2: n = 141 (51.6%) completed both pre-and post-test Year 1: online module shows significant improvement in 1/9 survey items regarding the concerns of the LGBTQ population (p = .002*) Year 2: in-class materials: there was an improvement in 3/9 items after the intervention: The perceived competence to provide care (p = .02*) Competence to talk to LGBTQ patients (p < .001**) The belief that the curriculum addressed the PLBTQ population concerns (p < .001**) |
Workshops | ||||
Authors (Country) | Intervention Objectives | Instruments | Intervention components | Key findings |
Athanasiadis L, [57] | Attitude toward patient-centered care Overall evaluation: new knowledge acquisition, quality of presentation, usefulness for clinical practice (5 = point Likert scale) | Patient–Practitioner Orientation Scale (PPOS), 18-item Cross Cultural Attitude Scale (CCAS), 29-item | Didactic components: ✓ Human sexuality, ✓ Principles of taking sexual history for ED patients, ✓ ED treatment and follow-up Workshops component: ✓ Role-play scenarios | Physicians’ Attitude (53.6% response rate) A significant difference in Attitudes after the intervention (PROS: p < .05*; CCAS: p < .01 *) Overall evaluation (62.3% response rate) Tutorial sessions for “medical treatment of ED” (p < .001) ** and role–play on sexual history taking (p < .05) * received higher evaluation scores |
Rosen R, [25] | Communication skills Changing in clinical practice | The questionnaire constructed by the authors consisted of the following: 19 items (5-point Likert scale) for pre-intervention evaluation Six items (5-point Likert score) for post-intervention evaluation Six multi-choice questions for Follow-up | Faculty and patient-physician panel presentations about male and female sexual dysfunctions Patients and physician panels live interviewing | Pre-intervention evaluation: 88% of participants sometimes or rarely discussed sexual health issues with patients 48% reported low confidence in managing sexual problems in a clinical situation Post-intervention evaluation: 93% of participants reported that after the workshop, they could better identify common sexual problems 92% improved their communication skill in sexual history-taking Follow-up evaluation: (9/34; 28.2% response rate) 90% of participants ranked their comfort level in sexual health history taking greatly improved |
Gianotenn WL, [56] | Communication skills | A Dutch version of KCAAS (knowledge, comfort, approach, and attitude toward sexuality) | The workshop content: ✓ Introduction ✓ Definition and theoretical framework ✓ Sexuality in the context of the Rehabilitation ✓ Staff’s attitudes and beliefs toward sexuality ✓ Sexual health history taking practice module ✓ Rehabilitation approach and treatment ✓ Review learning objectives for clinical practice. Conclusion and closing session (four months after the course) | Discipline-specific training: Documented improvements in knowledge and communication skills after the intervention (p < .001**), with no differences in follow-up evaluation Team-specific training: No results from pre-post evaluation Follow-up evaluation reveals improvement in knowledge (F = 16.00, p = .00), comfort (F = 8.8; p = .01*), and approach (F = 3.7; p = .05*) |
Cushing A, [55] | Attitudes, behavioral intentions, and changes in actual behavior | Instruments constructed by Authors: Attitude scale (12 items, 5-item Likert scale), with face validity Behavioral Intentions – no data Actual behavior – no data | Didactic session based on the introduction of Sexual response Phases, and the PLISSIT model A practical session based on scenario analysis focused on identifying reasons for taking a sexual history, barriers, and strategies for improving the skills | Attitude change (87.6% response rate) Were significantly favorable changes in all 12 items after the intervention Behavioral Intentions (43.8% response rate) 34.7% of participants believed that they would ask about sexual health in their routine practice Actual behavior (one-year follow-up) with an 80.3% response rate; 92% asked patients about sexual health |
Loeb DF, [26] | Practical skills in sexual health history taking | Chart review on the following domains: The rates of sexual history documentation The rates of specific components of the sexual history The effect of an intervention | Short (30 min) lecture about: ✓ The importance of sexual health history, ✓ The general principles of sexual health history taking Practical session (role-play scenario) | pre-intervention:369 charts reviewed post-intervention: 260 charts There were changes regarding the documented sexual health history component and the mean number of components A modest effect of the intervention was found |
Zabar S, [27] | Skills and knowledge Clinical performance Patients satisfaction | OSCE (6 domains evaluation form) Chart review (5 items evaluation form) Survey (10 items). No additional data | The workshops focused on acquiring and practicing communication skills in the following areas: ✓ managing a different patient encounter ✓ screening and assessment for depression and alcohol use ✓ taking a sexual history; behavior change counseling | Skills and knowledge (N = 15) A significant change between pre-post intervention was found in the following domains in the overall communication (p = .004*) Knowledge = NS Clinical performance The screening rate improved depending on the clinical setting Patients’ satisfaction – NS |
Kim JH, [52] | Primary outcomes measures: Evaluating SHC competencies (knowledge, attitudes, practice) Second outcome: nurses’ satisfaction | Sexual Health Care Knowledge Scale (33 items on a 2-point scale) Sexual Health Care Attitudes Scale (17 items on a 3-point Likert scale) Sexual Health Practice Scale (21 items on a 2-point scale) | The web-based interactive program consisted of short videos (3–5 min) on five cases: ✓ breast cancer ✓ endometrial cancer ✓ prostate cancer ✓ testicular cancer ✓ colorectal cancer | Knowledge level was significantly higher in the intervention group (U = 68.50, p = .041), 3 months after the intervention No difference in the attitude score (U = 68.50, p = .021) and the practice score (U = 155.50, p = .06) 52.9% of participants were satisfied with e-PBL intervention |
Wang LY, [28] | comfort level and self-reported frequency of addressing cancer-relating sexual issues | Online survey Pre-test: 8 items on a 5-point Likert scale Post-test survey: seven items on a 5-point Likert scale | The theoretical part consists of: ✓ Introduction to the bio-psycho-social aspect of sexuality ✓ breast cancer-specific issues relating to sexuality and quality of life Practice part: a sexual health assessment technique “Did you CARD her?” | Significant improvement in the comfort level (p < .001**) and in the frequency of addressing sexual health (p < .001**) after the intervention |
Kim M, [45] | Sex-role perception Sexual knowledge Sexual attitude | Gender–role perception scale 15 items (1–5 points Likert scale) Knowledge scale, 40 items in seven domains (2-point scale) Sexual attitude scale with 16 items (1–5 point Likert scale) | The first session included five lectures on the following topics: ✓ Human sexuality ✓ Social, Cultural, and Historical aspects of sexuality ✓ Human & Sexual subjects ✓ Health risk & unprotective sexual behavior ✓ Contraceptive methods The second session included S-PBL | Sexual knowledge significant improved in the experimental group (M = 0.83; SD = 0.08 preintervention vs. M = 0.92; SD = 0.06 postintervention) compare to control group (M = 0.83; SD = 0.09 pre-intervention vs. M = 0.84; SD = 0.08, postintervention), (p < .05*) Sexual attitudes changes were found in the intervention group (M = 3.66; SD = 0.26, pre vs. M = 3.79; SD = 0.26 post) compare to control group (M = 3.63; SD = 0.28, pre vs. M = 3.54; SD = 0.20 post), (p < .05*) Gender and Role Perception—NS |
Neff A, [29] | Knowledge Attitudes Skills | Multiple choice questionnaire | Introduction lecture Patient panel and discussion | The posttest score was 20% higher compared to the pretest (range of 90%—99% correct answer vs. 29%—94% in the pretest) |
Taylor LE, [31] | Knowledge | Multiple choice test (7 items) | Video materials and discussion | The mean score after training improved (91.9%) vs. the mean score before the training (45.5%) (p < .01*) |
Cummins AM, [46] | Knowledge Confident | 13-item survey (1–5 point Likert scale) | The first workshop focused on the sensitive issues in midwifery practice and included interactive games The second workshop is equipped with mindfulness techniques and the PERMA model | Confidence level and knowledge improved after the workshop (p < .05*) |
Ross MW, [47] | Knowledge Communication skills Attitudes | Sexual health education professional scale (SHEP) (1–7-point Likert scale) | Sexual health workshop with sexual history taking practicing session | Improvement in all domains of knowledge and communication skills (p < .01*) Change in Attitude was not for all domains |
Shroff S, [32] | Knowledge Attitudes | Case-based questions Likert scale questions No specific data about the tools | The curriculum included three introductory components: ✓ Flipped classroom ✓ Introductory communication skills ✓ Practice session of taking a sexual history | Mean knowledge score improved from 59% to 76T% (pre-post test) (p = .004) Median Comfort score for sexual history taking improved from 3.8 [QR v3.0, 4.0] to 3.8 [QR 3.6, 4.6] and 3.8 [QR 3.6, 4.0] to 4.1 [QR 3.9, 4.1] for male patients (p = .05) and female patients (p = .008) respectively Median frequency score for taking sexual history improved from 2.9 [QR 2.7, 3.0] to 3.1 [QR 2.8, 3.4] and 3.2 [QR 2.8, 3.7] to 3.4 [QR 3.2, 4.0] for male (p = .16) and female patients (p = .008) respectively |
Frasca K, [34] | Comfort level | Self-assessment questions constructed by authors | Curriculum components: ✓ LGBTQ terminology ✓ Inclusive sexual history taking ✓ LCBTQ and HIV- related health disparities ✓ HIV risk assessment and prevention counseling ✓ PrEP candidacy and care delivery | Comfort levels increased after the training in all HIV prevention topics (p < .05*) |
Salkind J, [60] | Confidence | self-assessment questionnaire constructed by authors | Training topics included: ✓ introduction to LGBTQ patients (lecture) ✓ interactive panel with LGBTQ patient ✓ seminar work with clinical–based cases | Confidence using appropriate terminology to describe sexual orientation increased from 62% (58 – 67%, pre) to 93% (91 – 95%, post), (p < .001**) and gender identity from 41% (36 – 46%, pre) to 91% (88 – 93%, post) (p < .001**) Confidence in the clinical assessment increased from 75% (71 – 79%, pre) to 93% (90 – 95%, post) (p < .001**) |
Natan S, [36] | Knowledge Awareness Attitude | Self-assessment questionnaire constructed by authors (1–5-point Likert scale) | The didactic lecture included following topics: ✓ Trauma-informed care overview ✓ Sex trafficking ✓ Evidence-based practice for STI prophylaxis in sexual assault care ✓ Relationship-Centered Communication ✓ Strangulation ✓ Trauma-informed pelvic examination ✓ Consent and confidentiality Simulation in two clinical cases | Self – reported Knowledge, Awareness, and Attitudes were improved after the course (p = .01, 95% CI) |
Ng AH, [48] | Knowledge and attitude | Aging sexuality knowledge and Attitudes Scale (ASKAS) consisted of a knowledge subscale (35 items) with a 3-point scale and an attitude subscale (26 items), with a 7-point Likert scale | Educational topics: ✓ Perspectives of love ✓ Sexuality of older adults ✓ Sexual dysfunction of older adults ✓ Chronic illness and sexuality of older adults ✓ Sexual coping of older adults ✓ Meaning of sexuality older adults ✓ | the intervention significantly enhanced students’ knowledge (F (1,28) = 257.10, p < .001**), with Cohen ď of 3.7, and positive attitudes (F (1,128) = 51.17, p < .001**) with Cohen ď of 1.2 |
Friedlander R, [38] | Knowledge Comfort Attitude | Online, 4-point Likert scale survey designed by authors | SRH topics included: ✓ Diversity of sexuality and sex practices ✓ Sexual complaints across various populations ✓ Diversity in reproductive choice ✓ Options for unintended pregnancy ✓ Disparities in the peripartum period | Knowledge score improved from 54% (pre) to 60% (post) Comfort with taking a sexual history and discussion SRH increased: 0.92 for the classroom format and 0.50 for the online Attitude – NS |
Mert – Karadas M, [51] | The attitude scale toward LGBTI consisted of 28 items, a 5-point Likert scale The Reproductive health history skills checklist has 38 questions (3-point scale) The effective communication skills evaluation form has 33 questions (3-point scale) Knowledge test, 16 multiple choices with 3 open-ended questions | Educational content consisted of: The theoretical part of Five modules: Basics concept, sexual orientation, the status of LGBT in the world and Turkey, reproductive health, and nursing care Practical part: simulations | the study found a significant increase in the median student’s knowledge (p < .001**), positive attitudes (p < .001**) and effective communication scores, and recording sexual health history (p < .001**) after the intervention | |
Semester course | ||||
Authors (Country) | Objectives | Instruments | Intervention components | Key findings |
Sung SC, [44] | Knowledge Attitude Self-efficacy | Knowledge of sexual healthcare Scale (31 items, 2-point scale) Attitude to sexual healthcare Scale (18 items, 5-point Likert scale) Self-efficacy for sexual healthcare Scale (22 items, 5-point Likert scale) | The educational program covered three main subjects: ✓ Bio-psycho-social aspect of sexuality ✓ the bio-psycho-social effect of illness, disability, and medical treatment on sexual problems ✓ communication skills and principles of sexual health history-taking | Significant differences were found in the intervention group relating to knowledge increased (β = -0.27; P < .001); attitude (β =—0.38, p < .001**), and self-efficacy (β =—0.90, p < .001**) |
Unal Toprak F, [49] | Sexual health knowledge and Myths | The Sexual knowledge about reproductive sexual health (40 questions), 1/0 scale The sexual myths form – 46 expressions, True/False scale | Course content: ✓ Concepts related to sexual health & sexuality ✓ Physiological, Psychological, and Sociological factors affecting sexual health ✓ Reproductive health & sexual rights ✓ Physiology of sexual activity ✓ Sexual function disorders ✓ Sexual development across the lifespan ✓ Abnormal behaviors toward sexuality ✓ Sexual abuse & Sexual violence ✓ Sexual Health education & nursing approaches ✓ STIs & protection methods ✓ Sexual health problems in the LGBTQ community Sexual health problems in cancer patients | There was a statistically significant difference (p < .05*) between the intervention and control groups in terms of reproduction sub-dimensions of Sexual Knowledge Test There was no statistically significant difference (p < .05) * between the intervention and control group pre-post test mean scores regarding Knowledge and Myths |
White LY, [28] | Knowledge Overall preparedness Comfort Confidence | 36 items questionnaire based on TPB theory | Course content: ✓ Values reflection and provider self–inventory ✓ Health policy ✓ Clinical care of sexual minorities ✓ Clinical care of gender minorities ✓ Overview of global care ✓ HIV/AIDS, STIs including prevention, testing, and treatment ✓ HPV-associated diseases ✓ Comprehensive sexual history–taking, Risk Reduction ✓ Aging, mental health, human trafficking ✓ Emerging and re-emerging infectious diseases | Knowledge – NS Overall preparedness – improved in the intervention group after the intervention (MD = 1.50, 95% CI -1.03 – 1.97], p < .05*) Comfort – increased after the intervention regarding discussing sexual health with transgender persons (MD = 1.43, p < .05*), sexual trauma (MD = 1.10, p < .05*), older adults (MD = 1.17, p < .05*), and different sexual orientation persons (MD = 1.10, p < 0.5*) Confidence – confidence improved in the intervention group regarding describing sexual health disparities associated with sex workers (MD = 1.73, p < .05*), racial minorities (MD = 1.63, p < 0.5*), and in performing sexual health assessment for transgender patients (MD = 1.63, p < .05*) |
Mahabamunug J [39], | Enhancing student comfort | based on a previous study, the anonymous questionnaire consisted of quantitative and qualitative questions No data was found about the reliability and validity | Seminar’s lectures content: Year 1: 2018 – 2019 ✓ Birth control & Family planning ✓ Geriatric & Palliative approach to the LGBTQ population ✓ Perspectives from intersex patients ✓ HIV prevention: PEP & PrEP ✓ Female genital cutting ✓ Care for the transgender adolescent ✓ Innovative practices for LGBTQ health center ✓ Elective termination of pregnancy & marriage management Year 2: 2019 – 2020 ✓ Birth control & Family planning ✓ Puberty suppression in transgender children ✓ Working with victims of domestic violence & human trafficking during COVID-19 ✓ Breast cancer and HIV stigma in immigrant populations ✓ STDs & stigma ✓ Trauma & PTSD | n = 152 (17.7%) – completed pre- test n = 105 (12.3%) – completed post-test The post-test result reveals improvements in student’s self -assessed comfort levels in following domains: Communicating with diverse patient population: Adult—(90% vs 59%) Adolescent- (83% vs 51%) Trans—(68% vs 29%) LGB—(84% vs 49%) Communicating about sexual health content: Termination of pregnancy—(73% vs 51%) Sexual violence – (65% vs 33%) Contraception options – (93% vs 78%) Medical transition – (57% vs 22%) Identifying female genital cutting—(44% vs 11%) Counseling patients on PrEP- (70% vs 27%) |
Roth LT, [42] | Knowledge Comfort Impact on clinical practice | Knowledge assessed by 8 multiple choice question Comfort level and impact on clinical practice assessed by tools constructed by authors (1–5 points Likert scale) | Course topics included: ✓ Community LGBTQ resources ✓ Pre-exposure prophylaxis ✓ Introduction to LGBTQ health; HIV ✓ LGBTQ health for outpatient pediatricians ✓ Gender-affirming care ✓ Evidence supporting gender translation ✓ Communication and cultural components of sexual health | Knowledge increased from 25.2% correct answers to 38.5% (p = .01*) Comfort level increased: asking about sexual orientation (3.5 – 3.8, p = .02), gender identity (3.5 = 3.8, p = .02*), and sexual practice (3.4 – 3.8, p < .01*) Impact on clinical practice score increased for the intention domain (4.5 of 5), importance (4.8 of 5), and satisfaction (4.5 of 5) domains |
Ross MW, [41] | Knowledge Attitudes Communication skills | SHEPS questionnaire with 26 items (1–7 Likert scale) | The theoretical part included the following topics: ✓ Sexual dysfunction and relationship ✓ Gender spectrum ✓ Sexual History Taking ✓ Female and Men sexual health and dysfunction ✓ Contraception ✓ Sex trafficking ✓ Abortion ✓ Child sexual abuse ✓ Chronic illness and Sexuality ✓ Sexuality and Disability The practical part consisted of 3 OSCE stations: ✓ female SP ✓ male SP ✓ transgender assigned male at birth SP | Knowledge and communication skills- a significant change was found with a high effect size. However, the differences between means scores in the pre-post-intervention were small, especially: Knowledge to discuss with young patients (from M = 3.59, SD = 2.19 to M = 1.93, SD = 1.17, dc = 0.95); with middle age patients (from M = 4.12, SD = 2.30 to M = 2.15, SD = 1.29, dc = 1.07); with older patients (from M = 4.96, SD = 2.16 to M = 2.63, SD = 1.43, dc = 1.27), and with patients with sexual problems related to medical or surgical treatment (from M = 5.42, SD = 1.99 to M = 2.85, SD = 1.51, dc = 1.46) Communication skills improved: with young patients (from M = 2.97, SD = 1.28 to M = 1.77, SD = 0.93, dc = 1.07); middle age patients (M = 3.74, SD = 1.66 to M = 2.00, SD = 0.92, dc = 1.30); with older patients (from M = 4.55, SD = 1.71 to M = 2.41, SD = 1.02, dc = 1.48) Attitude revealed minimum change The correlation of the OSCE total with the attitude scale was rs = -0.15, p = .21 |