Indiana University-Purdue University Indianapolis (IUPUI) / Sexual behaviors in adolescence establish the initial resources an individual carries into sexual relationships in adulthood. Current definitions of sexual resilience in adolescence are defined from a negative, risk-based lens. Resilience theory, more generally defined, considers both internal and external factors that promote adaptation to challenging situations. A direct, capital-based approach to studying adolescent sexual resilience has not been found in the extant literature and I propose that a new, more inclusive definition of sexual resilience in adolescence will be more strongly correlated with sexual health in young adults than the risk-based definition. This study creates mutually exclusive risk-based and capital-based measures of adolescent sexual resilience and examines their associations with sexual health outcomes in young adulthood. The data did not produce significant findings, yet descriptive results provide direction for future research. Research in this area is of critical importance as adolescence and young adulthood are unique life stages that involve significant development in areas that influence health, both short and long term. This research, through a proper resilience lens, will better guide adolescent sexual education to develop internal resources as well as provide adequate external resources for adolescents that promote better sexual health and agency outcomes in adulthood.

Tennesseans have been experiencing increasing rates of sexually transmitted diseases since the year 2000. Those rates are highest among those 15- to 24-year-olds. At the same time, Tennessee policy requires the teaching of abstinence as the primary form of sexual health education and emphasized the use of abstinence-only curriculum. The school nurse represents an available resource in the Tennessee public schools. The purpose of the qualitative study was to explore, describe, and interpret the perceptions and experiences of public-school nurses from rural, suburban, and urban areas of Tennessee related to the sexual health and sexual health education of students. School nurses were recruited from across the state and from a variety of communities to complete an electronic survey and to participate in individual interviews. Critical Discourse Analysis was used to analyze results in the context of the existing sociocultural and power structures. The research plan included a comparison of results from participants in rural, suburban, and urban areas that could not be done because of the limited responses obtained from potential participants. Emerging themes in light of the limited participant responses created a view of power structures within the context of existing conditions that may be impacting the sexual health of students.

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Background: On behalf of the National Board of Health, WHO and ICN code of ethics for nurses; are nurses responsible to provide holistic care to their patients. This includes sexual health. Previous studies have revealed serious shortcomings at this point both out in clinical practice but also in nursing training. Therefore, it is of interest to see which recommendations that is available for the nurse to work with sexual health. Aim: To describe recommendations for the nurse's work on sexual health – based on personcentered care. Method: A general literature review with inductive approach of data collection has been used from the databases Cinahl and PubMed. A total of 13 science articles were elected. Results: Three maincathegories was identified for the work of the nurse: basic recommendations, specific recommendations linked to the disease state and models for assessment and intervention. Conclusion: Sexual health is central to human well-being and quality of life. It is important that the work of nurse with sexual health is based on well-functioning principles and models, such as described in this literature review. / Bakgrund: På uppdrag av Socialstyrelsen, WHO och ICN:s etiska kod för sjuksköterskor ansvarar sjuksköterskan för att ge holistisk omvårdnad till sina patienter. Detta inbegriper den sexuella hälsan. Tidigare studier visar på allvarliga brister på denna punkt både i den kliniska verkligheten men även i sjuksköterskeutbildningen. Därför är det av intresse att se vilka rekommendationer som finns tillgängliga för sjuksköterskan att använda i omvårdnadsarbetet med sexuell hälsa. Syfte: Att beskriva rekommendationer för sjuksköterskans arbete med sexuell hälsa - utifrån personcentrerad omvårdnad. Metod: En allmän litteraturöversikt med induktiv ansats har använts. Datainsamlingen har gjorts från databaserna Cinahl och PubMed. Sammanlagt valdes 13 vetenskapliga artiklar ut. Resultat: Tre övergripande huvudkategorier identifierades för sjuksköterskans arbete med sexuell hälsa: grundläggande rekommendationer, specifika rekommendationer kopplat till sjukdomstillstånd samt modeller för bedömning och intervention. Slutsats: Då den sexuella hälsan är central för människans välbefinnande och livskvalitet är det viktigt att sjuksköterskans arbete med sexuell hälsa bygger på vedertagna välfungerande rekommendationer och modeller.

Bakgrund: Vid gynekologisk cancer involveras organ som är relaterade till kvinnlighet och sexualliv. Sjukdomen och behandlingen kan innebära en negativ inverkan på kvinnans sexuella hälsa vilket är en viktig del av livet och kan ha en stor påverkan på livskvalitén. I sjuksköterskans profession ingår att främja och bevara patientens hälsa och därmed sexuell hälsa. Syfte: Syftet var att belysa kvinnors upplevelser av sexuell hälsa vid gynekologisk cancer. Metod: En litteraturstudie med en kvalitativ ansats baserad på en analys av 10 artiklar genomfördes. Resultat: Kvinnor drabbade av gynekologisk cancer upplevde att sjukdomen och dess behandlingar hade påverkan på den sexuella hälsa. Sex teman identifierades, varav brist på information var det mest framträdande. Slutsats: Kvinnor drabbade av gynekologisk cancer upplevde flera hinder för att uppnå en tillfredsställande sexuell hälsa. Det främsta hindret och den gemensamma nämnaren, var bristen på information om hur behandlingar och dess biverkningar påverkade den sexuella hälsan, vilket medförde onödigt lidande och försämrad livskvalité. Klinisk betydelse: En ökad förståelse av kvinnornas upplevelser kan hjälpa sjuksköterskor att tillgodose en omvårdnad innefattande flera aspekter av sjukdomen, såsom sexuell hälsa. På grund av ämnets känsliga natur behöver det lyftas i grundutbildningen för sjuksköterskor, så att studenterna skall bli bekanta med och känna sig bekväma med ämnet så att det ska bli en naturlig del i den kliniska omvårdnaden. PLISSIT-modellen bör implementeras som ett verktyg för sjuksköterskor att använda vid samtal med patienter om sexuell hälsa. / Background: Gynecological cancer involves organs related to femininity and sexual life. The disease and treatment can have a negative impact on the woman's sexual health, which is an important part of life and can have a major impact on quality of life. The nurse´s profession includes promoting and preserving the health of the patient and thus the sexual health. Aim: The aim of this study was to highlight women's experiences of sexual health in gynecological cancer. Method: A literature review was conducted with a qualitative approach based on an analysis of 10 articles. Results: Women suffering from gynecological cancer experienced that the disease and its treatments had an impact on their sexual health. Six themes were identified of which, lack of information was the most prominent. Conclusion: Women with gynecological cancer experienced several obstacles to achieve satisfactory sexual health. The main obstacle and the common denominator was the lack of information on which impact treatments and their side effects had on sexual health, causing unnecessary suffering and impaired quality of life. Clinical suggestions: An increased understanding of women´s experiences can help nurses to meet the care, such as sexual health. Because of the sensitive nature of the topic, the authors consider that it needs to be emphasized in the nursing education, for students to become familiar with and feel comfortable with the topic to become an integrated part of clinical care. The PLISSIT-model should be implemented as an instrument for nurses to use in conversations with patients about sexual health.

Bakgrund: Sexualiteten är en del av varje människa och den sexuella hälsan är en del i den övergripande hälsan. Bröstcancer och behandling av bröstcancer påverkar de sexuella funktionerna. Dessa förändringar kan ha stor inverkan på kvinnans sexuella hälsa.Syfte: Att belysa hur kvinnor med bröstcancer upplever sin sexuella hälsa. Metod: Studien är kvalitativ och data har samlats in från bloggar som sedan analyserats induktivt.Resultat: Under analysen bildades de tre kategorierna Upplevelsen av kroppslig attraktivitet, Påverkad känsla av kvinnlighet och Inverkan på sexuella funktioner. Kvinnorna upplevde att deras förändrade utseende och de påverkade sexuella funktionerna förändrade deras psykiska välmående och sättet att se på sig själva. Både fysiska, psykiska och emotionella förändringar hade stor inverkan på den sexuella hälsan.Slutsatser: Sexuell hälsa ses som en kombination av fysiskt, socialt och emotionellt välbefinnande i samband med sexualitet. Den sexuella hälsan hotas vid en cancerdiagnos och det är viktigt att inte enbart fokusera på en av dessa faktorer utan se den drabbade kvinnan som en helhet. Kvinnorna ger uttryck för en maktobalans inom vården då vårdpersonal inte diskuterar ämnet. Det finns ett behov av ytterligare kunskap om fenomenet som kan genereras genom vidare forskning. / Background: Sexuality is a part of every human and sexual health is part of the overall health. Breast cancer and treatment of breast cancer affect sexual function . These changes can have major impact on women's sexual health.Purpose: To illustrate how women with breast cancer experience their sexual health.Method: The study is qualitative and data were gathered from blogs and then analyzed inductively.Results: During the analysis three categories were formed The perception of bodily attractiveness, Affected sense of femininity and Impact on sexual function. The altered appearance and the affected sexual function changed the womens mental well-being and way of looking at themselves. Both physical, mental and emotional changes had  impact on the sexual health.Conclusions: Sexual health is a combination of physical, social and emotional well-being related to sexuality. The sexual health is threatened by cancer diagnosis and it is important not to focus exclusively on one of these factors but see the woman as entirety. The women reflect an imbalance in health care when healthcare professionals do not discuss this topic. Further understanding of the phenomenon is needed and may be generated by further research.

To prevent unwanted pregnancies and sexually transmitted infections, sexually active individuals should practice safer sex (World Health Organisation 2008). This is important across the lifespan (Nusbaum and Rosenfeld 2004). But older and heterosexual populations are typically overlooked in safer sex interventions (Bodley-Tickell et al. 2008; Bowleg 2011). The Theory of Planned Behaviour (TPB) has been used to predict behaviour, and develop safer sex interventions (Fishbein and Ajzen 2010). But a criticism of the TPB is that it fails to recognise the emotional aspect of safer sex (Norton et al., 2005). Extending the TPB to include affective attitudes has enhanced the effectiveness of safer sex interventions (Ferrer et al. 2011). Furthermore, safer sex typically involves a series of five condom-related behaviours; accessing, carrying, negotiating, using and disposing (Moore et al. 2006). Yet most interventions promote only one condom-related behaviour. In addition, the internet is now being used more as a platform for delivering interventions (Kraft and Yardley 2009). For safer sex interventions, online delivery may help reduce the embarrassment individuals often report when discussing sexual health (Qulliam 2011). Therefore, the aim of this thesis was to develop and evaluate an online safer sex intervention to promote performance of multiple condom-related behaviours in a broad population. A series of studies were conducted in order to develop the intervention. Study 1, an online elicitation study with 26 individuals, used an extended TPB framework to explore attitudinal, normative and control beliefs toward performing five condom-related behaviours. Findings suggested that individuals hold a range of attitudinal, normative and control beliefs toward performing these condom-related behaviours. Study 2, an online questionnaire study with 363 individuals identified beliefs and behaviours for intervention target. Findings suggested that three condom-related behaviours should be promoted; carrying, negotiating and using. In addition, analysis showed that affective and moral norm beliefs were most predictive of intention to perform these three condom-related behaviours, and should be the intervention targets. Study 3 was an online intervention with 439 individuals. Individuals were randomised to one of three conditions; control message, positively- or negatively-framed persuasive message. TPB and self-report behaviour measures were taken pre-, immediately post-intervention and three months later. Findings demonstrated that performance of condom-related behaviours did not significantly increase from participation in the intervention. However, intention to carry and use condoms increased over time regardless of intervention condition in all populations sampled. Overall, findings from this thesis support the development of safer sex interventions that promote multiple condom-related behaviours in a broad population. However, findings suggested that persuasive messages targeting psychological constructs of the TPB do not change intentions better than a control message in a broad population. From a public health perspective, these findings suggest that highlighting the benefits of performing condom-related behaviours may be sufficient to strengthen intentions. These strengthened intentions may be protective in the future if the situation arises for an individual which requires the performance of these behaviours. Recommendations for future safer sex research are considered.

Sexualiteten och den sexuella hälsan är en grundpelare i att varje människas individualitet. Det finns ett fördomsfullt synsätt angående äldre och deras sexualitet där gruppen blir betraktade som asexuell. Ämnet är tabubelagt och det föreligger relativt lite kunskap kring det. Livskvalitet är en subjektiv upplevelse som förändras över tid. Åldrandet bidrar till flera riskfaktorer som kan leda till nedsatt livskvalitet. Denna litteraturstudies syfte var att undersöka hur sexualitet och sexuella hälsa bland äldre individer ≥ 50 år är kopplade till deras livskvalitet. En litteratursökning gjordes med hjälp av identifierade sökord som var relevanta för studiens syfte i databaserna PubMed och Google Scholar. Tretton artiklar användes i litteraturstudiens resultat. Resultatet visade att sexualiteten och den sexuella hälsan har betydelse för majoriteten av den äldre befolkningens livskvalitet då den bland annat främjar självförtroendet, självbilden och självkänslan. Sexuell aktivitet och sexuell tillfredsställelse har oftast en koppling till en bättre upplevd livskvalitet. Äldre med god sexuell hälsa har oftast ett gott psykiskt välbefinnande. Det finns också en del äldre som med åldern omprioriterar sexualiteten på grund av att andra behov anses som viktigare. En del äldre anser att deras sexualitet är i det förflutna. Vissa utvecklar en inre acceptans medan andra får en negativ påverkan på livskvaliteten. Kopplingen mellan sexualitet, sexuell hälsa och livskvalitet skiljer sig mellan äldre individer men för majoriteten har den en betydelse för deras fysiska och psykiska välbefinnande. / Sexuality and sexual health is a keystone of every person's individuality. There is a prejudiced view about the elderly and their sexuality that perceive the group as asexual. The subject is taboo and there is relatively little knowledge about it. Quality of life is a subjective experience that changes over time. Aging contributes to more risk factors that can lead to impaired quality of life. This study aimed to examine how older people; ≥50 years, sexuality and sexual health are linked to their quality of life. A systematic review was conducted using identified keywords relevant for the purpose of the study to search the databases PubMed and Google Scholar. Thirteen articles where selected and used in the systematic review. The results showed that sexuality and sexual health is important for the majority of the older population’s quality of life as it promotes self-esteem, self-image and self-reliance. Sexual activity and sexual satisfaction is often related to a better quality of life. Older people with a good sexual health usually experience a good mental well-being. In addition, there are older people from for whom the meaning of sexuality changes because other basics needs are considered more important. Some older people view their sexual activity is behind them. Some develop an inner acceptance towards this while others become adversely affected. The link between sexuality, sexual health and quality of life differ among older individuals but for the majority, it has an impact on their physical and mental well-being.

The aim of this project is to examine the relationships between two approaches to the measurement of life history strategies. The traditional method, termed here the biodemographic approach, measures developmental characteristics like birthweight, gestation length, inter-birth intervals, pubertal timing, and sexual debut. The alternative method under exploration, termed here the psychological approach, measures a suite of cognitive and behavioral traits such as altruism, sociosexual orientation, personality, mutualism, familial relationships, and religiosity. Although both approaches are supported by a large body of literature, they remain relatively segregated. This study draws inspiration from both views, integrating measures that assess developmental milestones, including birthweight, prematurity, pubertal timing, and onset of sexual behavior, as well as psychological life history measures such as the Mini-K and a personality inventory. Drawing on previous theoretical work on the fundamental dimensions of environmental risk, these measures are tested in conjunction with several scales assessing the stability of early environmental conditions, including both "event-based" measures that are defined with an external referent, and measures of internal schemata, or the predicted psychological sequelae of early events. The data are tested in a three-part sequence, beginning with the measurement models under investigation, proceeding to an exploratory analysis of the causal network, and finishing with a cross-validation of the structural model on a new sample. The findings point to exciting new directions for future researchers who seek to integrate the two perspectives.

Thesis (MBA)--Stellenbosch University, 2012. / Providing quality primary healthcare services in a scarce resource environment in South Africa is a challenge. This is exacerbated by segments of the population experiencing high unemployment and extreme poverty leading to a prevalence of diseases such as HIV/Aids and Tuberculosis. Long queues and staff shortages have led to the Department of Health decentralising the primary healthcare system into district facilities, with the intention of offering greater access to equitable healthcare for all South Africans. Sexual reproductive health falls under the category of primary healthcare and is a specialised function, often carried out by inadequately trained providers using quota systems, who consider this essential service to be a low priority. The area of sexual reproductive health includes termination of pregnancy, contraception, treatment of sexually transmitted infections and cancer screening. Although termination of pregnancy is legal in South Africa, reluctance on the part of service providers to offer this service, due to conscientious objection has created a shortage of safe, legal healthcare facilities. In an effort to provide these life-saving services, non-governmental organisations are attempting to fill the service delivery shortfall. With the assistance of international donor funding, Marie Stopes South Africa has established a number of sexual reproductive healthcare facilities in townships in Gauteng and KwaZulu Natal. These services take place from basic structures located within communities most in need of healthcare, and offer a range of sexual reproductive health services at low cost to men and women of reproductive age. As the operational focus is on provision of services otherwise not available, the organisation has not measured the levels of customer satisfaction adequately to date. Due to the preventative and potentially life-saving nature of these services, improved customer satisfaction levels could, through word of mouth advertising and customer retention, increase the use of these facilities by community members, reduce numbers of unplanned pregnancies, and ultimately contribute to a decrease in the incidence of maternal mortality due to unsafe abortions. In this study, the SERVQUAL instrument will measure the gap between customer expectations prior to services received, and perceptions of the services post-delivery, in order to establish the current service quality gaps in township healthcare facilities. Management of the organisation will use this information to implement actions to improve customer satisfaction and monitor the impact of these actions, with the aim of increasing positive word-of-mouth advertising, leading to greater use of services and ultimately the long-term sustainability of the facilities.