The Effectiveness of Safe Sex Education on Promoting Healthy Sexual Behavior, Self-Efficacy and

Knowledge in Older Adults

Natalie Beal, B.S., Elise Martinez, B.S., Sarah Roberts, B.S., Charity Smith, B.A.
Azusa Pacific University, School of Nursing
Abstract

Introduction
As health care improves, the older population has the opportunity to
live longer and have more active sexual lives. Research shows a
concurrent increase in the incidence of sexually transmitted
infections (STIs), with the CDC reporting in 2013 that 19% (217,000)
of older Americans (55+) are living with STIs. However, research and
education regarding prevention, awareness, and reduction of STIs is
typically directed towards younger adults. With these growing trends,
STIs in older adults remains an overlooked discourse.
Purpose
To improve self-efficacy of the older adult (55+) through the
promotion of healthy sexual behaviors and safe sex practice
education.
Methods
Quasi-experimental, pre/post-test prospective design with a
convenience sample of 110 participants ages 55+ in senior living
community will be recruited. Nurses will provide a 45-minute sex
education workshop regarding awareness and behaviors. The
independent variable is the workshop and the dependent variables
are the positive and negative elements of sexual health and will be
measured using a modified version of the Canadian Sexual Health
Indicators Survey.
Discussion
It is important to equip nurses with effective strategies and
educational programs tailored to the needs of older adults sexuality
and the involved risk for STIs.

Aim
The studys aim is to create a valid and reliable research study
which consistently measures the effectiveness of a safe sex
intervention in this overlooked population. The purpose of this
proposal is to recommend a theory-based educational program
that will improve self-efficacy, STI knowledge and promote healthy
behaviors of older adults, aged 55 and over, that may ultimately
improve commitment to healthy sexual practices.
Research Hypothesis
We hypothesize that there will be a significant improvement in
self-efficacy and safe sex practices following a safe sex education
program versus a comparison group receiving only an
informational pamphlet.

Theory
This theory-driven study will utilize the Health Promotion Model
(Pender, 2001) to potentially increase the health-promoting
behaviors in older adults.
Figure 1 below: Penders Health Promotion Model, with the
proposed intervention point and specified variables.

Background
Improvements in healthcare and the availability of various
medications are allowing the older population to live longer and
remain sexually active (CDC, 2013). However, with sexual activity
comes the potential for acquiring and spreading sexually transmitted
infections (STIs). Of the people with HIV/AIDS in the US, nearly a
quarter are age 55 and older (CDC, 2013). While HIV is the most
reported and studied, it is not the only STI causing morbidity in older
adults (WHO, 2013). There is a lack of quantitative research
regarding sexual behaviors and the older population.
Proposed Methodology
A prospective quasi-experimental pre-test/post-test design with a
convenience sample of 110 participants, aged 55+, in a senior living
community, randomly assigned to either the intervention group or
comparison group. The Canadian Sexual Health Indicators Survey
(Smylie et al. 2013) will be used to measure the effects of a sex safe
education program (independent variable) on knowledge and
healthy sexual behaviors (dependent variables) in older adults.

Literature Review
The literature revealed safe sex education to currently be
predominately directed at young adults and a rarely discussed topic
in the older population. There appeared to be a gap in the literature
describing current health needs and practices of the older
population and even fewer studies describing effectiveness of safesex interventions for this population.
Understanding Sexual Behavior in Other Populations
Shipitsyna et al. (2013) conducted a study to ascertain sexual
behaviors, knowledge and attitudes about safe sex in correlation
with STIs in youth clinics. Findings demonstrated males displayed
riskier sexual behaviors and poorer attitudes regarding safe sex. In
another study, Haley et al., (2013) aimed to examine the predictive
value of selected personal, environmental and behavioral factors for
condom use among rural adolescents. The findings indicated that
condom users had a significantly higher levels of knowledge, selfesteem, personal standards, self-efficacy and higher levels of
perceived support from their family.
Understanding Sexual Behavior in Older Adults
In a Brazilian study analyzing behavior, knowledge and risk
perception of STIs in a random sample of people 50 years of age and
older, Olivi et al. (2008) found a statistically significant association
between risk perception and frequency of condom use. In an action
research study, Balsdissera et al. (2012) found sexual problems may
reflective of loneliness and consequent lack of affection by partners.
Jena et. al. (2010) examined rates of STD prevalence among men, 40
years and older who use erectile dysfunction (ED) drugs and those
who do not use ED drugs. The researchers concluded that there
were higher rates of STIs and HIV among men that used ED drugs
compared to men that do not use ED drugs.
Sexual Education Interventions in Other Populations
Jemmott et al. (2010) conducted a study that implemented a
modified version of Focus on the Future regarding condom use
among adolescents. Findings showed consistent condom use
among the intervention group. A randomized control trial in Hong
Kong found a statistically significant improvement in condom use
in the intervention group after a three-week safe-sex education
program (Lau, et al, 2014). The intervention group reported higher
levels of sexual self-efficacy and knowledge of STIs, and felt more
confident in their ability to use condoms.
Sexual Education Interventions in Older Adults
Gedin and Resnick (2014) implemented a qualitative study utilizing
a focus group approach to determine the practicability of using
group-based educational program on improving STI risk knowledge
and prevention techniques among older adults in senior living
facilities. Findings supported the use of a self-efficacy based
educational program to teach older adults sexual health behaviors,
and advocated for further research using similar interventions on
this population.

Nursing Implications
Nurses play an integral role in bridging the generational gap that
often fails to address the sexual health needs of the older adult.
This nursing intervention of safe-sex education presents the
opportunity to neutralize the sense of taboo associated with the
older adult's sexual activities through the promotion of selfefficacy and healthy behaviors, and may lead to a healthy behavior
change that will support older adults during this life transition.

Discussion/Conclusion
With reliable and valid assessment tools, nurses may be better
equipped to address the overlooked needs of older adults sexuality
and the involved risk for STIs. Through education and reinforcing selfefficacy, older adults may be more likely to engage in healthy sexual
behaviors that may reduce the incidence of STIs. Future research
needs to be directed toward older adults and can utilize this tool to
explore effective educational interventions among the older
population.

IRB Approval
This study seeks approval from the Azusa Pacific Universitys
Institutional Review Board. All recruited participants will be
educated on the purpose of the study and informed of their rights to
confidentiality and voluntary status. Verbal and written consent will
be obtained by all participants at the time of enrollment. The safe sex
education program, being low risk in nature, allows the attainment of
maximum benefits with no perceived harm.

References
Center for Disease Control and Prevention (2013). HIV Among Older
Americans. Retrieved from: http://www.cdc.gov/hiv/risk/
Pender, Nola, J. (2011). Health Promotion Model Manual. Deep Blue.
University of Michigan. Retrieved from:
http://deepblue.lib.umich.edu/bitstream/handle/2027.42/85350_h
ealth_promotion_manual_Rev_5-2011.pdf
Smylie, L., Clarke, B., Doherty, M., Gahagan, J., Numer, M., Otis, J., & ... Soon, C.
(2013). The development and validation of sexual health indicators
of canadians aged 16-24 years. Public Health Reports, 128(Supp 1),
53-61.
World Health Organization (2013). Sexually transmitted infections (STIs)
Factsheet. Retrieved from http://www.who.int/mediacentre/factsheet
**Complete Reference List available upon request**
Acknowledgements: Dr. Najood Azar, Dr. Karen Nielsen-Menicucci