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Journal of Sex & Marital Therapy Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/usmt20
The Effect of Face-to-Face With Telephone-Based Counseling on Sexual Satisfaction Among Reproductive Aged Women in Iran a
a
a
Shirin Zargar Shoushtari , Poorandokht Afshari , Parvin Abedi & b
Hamed Tabesh a
Midwifery Department, Reproductive Health Promotion Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran b
Health Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Accepted author version posted online: 25 Apr 2014.Published online: 19 May 2014.
To cite this article: Shirin Zargar Shoushtari, Poorandokht Afshari, Parvin Abedi & Hamed Tabesh (2014): The Effect of Face-to-Face With Telephone-Based Counseling on Sexual Satisfaction Among Reproductive Aged Women in Iran, Journal of Sex & Marital Therapy, DOI: 10.1080/0092623X.2014.915903 To link to this article: http://dx.doi.org/10.1080/0092623X.2014.915903
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Utah] at 23:20 01 December 2014
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JOURNAL OF SEX & MARITAL THERAPY, 00(0), 1–7, 2014 C Taylor & Francis Group, LLC Copyright ISSN: 0092-623X print / 1521-0715 online DOI: 10.1080/0092623X.2014.915903
The Effect of Face-to-Face With Telephone-Based Counseling on Sexual Satisfaction Among Reproductive Aged Women in Iran
Downloaded by [University of Utah] at 23:20 01 December 2014
Shirin Zargar Shoushtari, Poorandokht Afshari, and Parvin Abedi Midwifery Department, Reproductive Health Promotion Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Hamed Tabesh Health Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
This study was designed to investigate and compare the effect of face-to-face with telephone-based counseling on sexual satisfaction in women of reproductive age in Iran. This study was a randomized controlled trial in which 46 married women who got married 1–5 years ago were randomly selected and assigned to 1 of 2 groups (face-to-face and telephone-based counseling). Two groups received counseling by a trained midwife once a week for 4 weeks. The sexual satisfaction (using the Sexual Satisfaction Index) score was calculated in the beginning of the study and after 4 weeks. An independent t test, chi-square test, likelihood ratio test, Fisher’s exact test, and linear-by-linear test were used for analyzing data. The mean score of sexual satisfaction in the face-to-face group was 93.6 (SD = 7.1) and improved significantly to 108.08 (SD = 5.44) after intervention (p = .001). The mean score of sexual satisfaction in the telephone-based counseling was 93.52 (SD = 5) and increased to 113 (SD = 6.07) after 4 weeks (p = .001). Telephone-based counseling could increase the sexual satisfaction better than face-to-face counseling (mean difference: 20.34 [SD = 7.38] vs. 14.47 [SD = 5.32], p = .003). The telephone-based counseling is an effective and affordable method to solve the sexual problems and could increase the sexual satisfaction. Using this method in public health centers is recommended.
Sexual satisfaction is a positive evaluation of the overall sexual relationship in which the sexual needs and expectation of couples are being met (Offman & Mattheson, 2005). An overall positive relationship depends on sexual satisfaction (Santtila et al., 2008). Sexual satisfaction is one of the human’s physiologic needs and has a direct relationship with human well-being. Lack of sexual satisfaction may cause physical and psychological pressure on a human’s body, may interfere with his or her health, and may reduce his or her creative ability (Litzinger & Gordon, 2005). A large survey in Australia showed that 88% of men and 80% of women believed that sex has an
Address correspondence to Poorandokht Afshari, Golestan Ave., Ahvaz Jundishapur University of Medical Sciences, Nursing & Midwifery School, Midwifery Department, Reproductive Health Promotion Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, 6135715794. E-mail: p [email protected]
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essential impact on their well-being (Richters & Rissel, 2005). One study showed that 38% of married women had anxiety during sexual intercourse and 16% did not have pleasure with their sexual activity and that, overall, 68% of women rated their sexual activity as satisfactory (Rosen, Taylor, Leiblum, & Bachmann, 1997). The prevalence of sexual dissatisfaction among women in the United States is 25% (Lima et al., 2009). In Iran, sexual dissatisfaction among women was reported to be 32% in 1999 (Mooshkbid Haghighi, Shams Mofarahe, Majd-Timory, & Hosseini, 2002) and 47.5% in 2008 (Shahvary, Gholizade, & Mohamad Hoseiny, 2010). Sexual counseling as a specialized method can provide necessary information for a healthy sexual relationship for couples to preserve their marital life. One study showed that when women and men participated in premarital sexual counseling, their level of sexual satisfaction increased significantly, and most of them had a problem-free sexual life (Vural & Temel, 2009). A couple of studies in Iran have shown that using sexual counseling will result in increased sexual satisfaction (Shahsiah, Bahrami, Etemadi, & Mohebi, 2011; Shams Mofarahe, Shahsiah, Mohebi, & Tabaraee, 2011). Dunn, Craft, and Hackett (1998) found that 52% of women need sexual counseling, whereas only 10% of them have benefited from counseling services. Different types of counseling, such as face-to face, telephone-based, video, and Internet-based counseling are in the common usage around the world. Telephone-based counseling is common because of accessibility; anonymity of the person who receives counseling is a good way to get information, advice, and support (Osman, Chaaya, Zein, Naassan, & Wick, 2010; Patel, Dale, & Crouch, 1997). Face-to face counseling is one of the most popular methods to educate and consult people in the health care system. However, because of the lack of fixed structure and need for more time, this method is not feasible in crowded public health centers (Baraz, Mohammadi, & Boroumand, 2006). In many advanced medical centers around the world, the telephone has been used for counseling to reduce unnecessary costs and to increase effectiveness of prevention and treatment (Huibers, Keizer, Giesen, Grol, & Wensing, 2012). Furthermore, telephone counseling could change care from being centered on hospitals to being centered on the community or client (Patel et al., 1997). In a study by Fozder and Kumer (2007), results showed that not only did approximately 70% of participants mention telephone as an emergency communication tool but also 73% of them believed that cell phone can act as a client-centered tool that has more flexibility compared with the traditional educational methods. In Khakbazan, GolyanTehrani, Payghambardoost, and Kazemnejad’s (2009) study in Iran on women in their postpartum period, results showed that by using phone counseling, women’s quality of life increased compared with the control group (p < .001). A randomized controlled trial showed that an Internet-based sexual counseling program designed for couples could improve the sexual function and satisfaction by functioning as traditional sex therapy in couples whose male partner was treated for prostate cancer (Schover et al., 2012). Because of a lack of enough information on the effect of phone counseling on sexual satisfaction, this study aimed to compare the effect of phone counseling with face-to-face counseling on sexual satisfaction among women of reproductive age in Iran.
MATERIALS AND METHODS In this randomized, controlled trial, we randomly selected and assigned 46 women of reproductive age to one of two groups: those receiving phone counseling (n = 23) and those receiving face-toface counseling (n = 23). This study was conducted in two public health centers in Ahvaz, Iran, from 2011 to 2012. Study design was approved by the Ethics Committee of Ahvaz Jundishapur
COUNSELING AND SEXUAL SATISFACTION
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University of Medical Sciences and was registered in the Iranian Centers for Clinical Trial. To be included in this study, women had to be recently married (i.e., 1–5 years ago), had to own a cell phone, had to have basic literacy skills, and had to acquire a score of 50–100 in the initial sexual satisfaction test (low or moderate sexual satisfaction). We excluded women who had a history of medical problems, those who had psychological disorders, those who were divorced, those who experienced the death of close relatives; sexual; those who abused alcohol and drugs; and those who were pregnant.
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Measures We used a questionnaire consisting of 26 questions to collect sociodemographic data. We used the Sexual Satisfaction Index to collect data regarding sexual satisfaction. In addition, we used content validity to assess the validity of the Sexual Satisfaction Index and test–retest to investigate reliability (r = 0.98) on 10 women (Shams Mofaraheh et al., 2011). One of the researchers (S.Z.S.) who participated in the sexual counseling workshop with a sexologist was responsible for counseling. Intervention All participants were given information about the objective of study and how long the intervention would take. Participants were also informed that there was no charge to participate and were free to withdraw from the study at any time they desired. We obtained written informed consent from each participant before we collected data. Both groups completed a demographic questionnaire and the Sexual Satisfaction Index in a separate and private room in the public health center. In the Sexual Satisfaction Index, scores were classified as follows: 100 (high) in terms of sexual satisfaction (Shams Mofaraheh et al., 2011). Women who identified as having low or moderate sexual satisfaction were randomly distributed to either the face-to-face or phone counseling group by a ratio of 1:1, whereas women who scored less than 50 were excluded and referred to psychologists. We performed a coin toss to randomize women into two groups: tails for phone counseling and heads for face-to-face counseling. Women in the face-to-face group received a sexual counseling session every week for 4 weeks in the public health center. In the phone counseling group, women received a phone call by the researcher once a week for counseling for 4 weeks. Women were free to call the researcher if they needed more time to speak. None of the clients were charged for phone calls. The content of counseling was informational and educational using the PLISSIT model (Annon, 1976). The average time devoted to counseling in the face-to-face group was 36.8 min, whereas in the phone group it was 20.5 min. In both groups, 1 month after the start of the consultation, and having a week without counseling, women were requested to attend the clinic, where they completed the Sexual Satisfaction Index. There was no intervention for women’s spouses. The content of some counseling session was as follows: If the client complained from pain during intercourse or vaginal dryness, the counselor advised her to have foreplay and to use lubricant. Women who complained from monotony in their sexual relationship were encouraged to change their sex position. For those who were tired of doing housework, the counselor suggested getting help from family members to complete the work. In general, in both types of counseling, women were encouraged to talk about their problem; then, on the basis of their talk, they were given advice. Intervention applied only to women individually, not with a husband.
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Statistics
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We used SPSS 20 to conduct data entry and analysis. We used an independent t test to testing differences between two groups regarding continuous variable such as age, marriage duration, number of children, and sexual satisfaction score. We used the chi-square test for the categorical data. Fisher’s exact test was used for those variables that could not reach the acceptable level for the chi-square test, such as job of women. We used the likelihood ratio test to test variables such as job of husband. The linear-by-linear test was used for variables such as education of wife and husband. All results were presented with 95% confidence intervals, and p < .05 was considered significant. RESULTS The findings of this study showed that the average age of participants in the phone counseling group was 24.8 years (SD = 3.9) and in the face-to-face group it was 24.9 years (SD = 3.3). Most participants in the two groups had one child and had a modest economic situation. The details of demographic characteristics of participants are listed in Table 1. The mean score of sexual TABLE 1 Sociodemographic Characteristics of Participants in the Face-to-Face and Phone Counseling Groups Phone counseling (n = 23) Variable Age (years) Marriage duration (years) Age gap with spouse (years) Income (Rials)∗ Number of children Education High school Diploma University education Job Working Housewife Education of spouse High school Diploma University education Job of spouse Employee Employer Unemployed ∗ One
Face-to face counseling (n = 23)
M
SD
M
SD
p
24.8 3.3 5.5 634,761 1
3.9 1.3 4.3 279,510 0.6
24.9 3.4 4.6 526,190 0.8
3.3 1.2 3 199,761 0.4
0.92 0.77 0.42 0.15 0.47
n
%
n
%
13 7 3
56.5 30.5 13
11 10 2
47.8 43.5 8.7
0.83
1 22
4.4 95.6
0 23
0 100
1
8 11 4
34.8 47.9 17.3
15 6 2
65.2 36.1 8.7
0.06
10 12 1
43.5 52.2 4.3
6 15 2
26.1 65.2 8.7
0.43
U.S. dollar is equal to 34,000–35,000 Rials at the time of data collection.
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TABLE 2 Sexual Satisfaction Score and Number of Sexual Intercourses in the Face-to-Face and Phone Counseling Groups Phone counseling (n = 23) Variables
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Sexual satisfaction score before intervention Sexual satisfaction score after intervention Mean difference p value within group Number of sexual intercourses
Face-to face counseling (n = 23)
M
SD
M
SD
p value between groups
93 114 20
5 6 7
94 108 14
7 5 5
0.003
1
1
0.90
0.02
.001 2
.001
satisfaction did not have significant difference in the beginning of the study (93.6 [SD = 7.1] in the face-to-face group vs. 93.5 [SD = 5] in the phone counseling group), p = .96 (Table 2). The mean sexual satisfaction score was significantly increased in the phone counseling group after 4 weeks compared with the face-to-face group (113.8 [SD = 6.07] vs. 108 [SD = 5.44]), p = .003. Also, the frequency of sexual intercourse was increased in the phone counseling group in comparison with the face-to-face group (p = .02, Table 2). Also, there were no dropouts in the study. DISCUSSION This study aimed to compare the effect of phone counseling versus face-to-face counseling on sexual satisfaction among women of reproductive age. The sexual satisfaction before counseling in both groups was low or moderate. The average of sexual satisfaction score was increased from moderate to high in both groups after intervention; however, the mean difference in the phone counseling was more obvious. Pakgohar, Vijeh, Babaei, Ramazanzadeh, and Abedi Nia (2006), who conducted a study on 100 infertile women in Tehran, Iran, found that counseling in general could increase the sexual satisfaction score in comparison with the women who did not receive counseling (p = .002). A study by Lindberg and Maddow-Zimet (2012) showed that sex education among teenagers and young adult could significantly increase the sexual behaviors and outcomes compared with the group who did not receive any education. One study showed that when female adolescents discussed condom use and number of sexual partners, they could improve their behavior about these issues significantly more than could adolescents who had not heard about these issues (Berenson et al., 2006). Also, there was significant changed in sexual satisfaction score before and after counseling in two groups. Our results are in line with Pakgohar and colleagues (2006), Lindberg and Maddow-Zimet (2012), and Berenson, Wu, Breitkopf, and Newman (2006). In this study, we used the PLISSIT model. Other researchers have also found that PLISSIT model can be an effective model for decreasing sexual problems (Ayaz & Kubilay, 2009; Chun, 2011). Our results are in line with Remschmidt, Hirsch, and Mattejat (2003), who found that phone counseling is a valid and reliable method for prevention and treatment of sexual problems among
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patients. The results of the present study show that the frequency of sexual intercourse increased significantly in the phone counseling group compared with the face-to-face group. Higher sexual satisfaction is an important factor to increase the frequency of sexual intercourse. Other studies have also shown that there is a positive relation between sexual satisfaction and the frequency of sexual intercourse (Litzinger & Gordon, 2005). Khosro-Shahi (2003) in Iran found that there is a negative relation between the request for sexual intercourse from the male partner and sexual satisfaction in the female partner.
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Strengths and Limitations of the Study This is the first time in Iran that the effect of phone and face-to-face counseling on sexual satisfaction has been compared. On the basis of the cultural situation of society in Iran, it is not easy for women to talk about their sexual issues. Also, public health clinics in Iran lack sexual counseling centers. Even if sexual counseling centers existed, scheduling conflicts would prevent women from going to the clinics. In contrast, phone counseling enables participants to call the counselor when they have free time. Usually, people call a counselor when they are in trouble; therefore, they will provide more details about their problem. In this study, we did not assess the sexual function of participants. Perhaps information about sexual function could help to understand sexual satisfaction. Also, we did not assess the sexual satisfaction of the partner of participants. However, improvement in the sexual satisfaction of women would be a factor that is related to the sexual satisfaction of husbands. Another limitation is that we did not use the standard grading system; instead, we implemented the scoring previously used by an Iranian research team (Shams Mofarahe et al., 2011). Conclusion Telephone-based counseling is an effective and affordable method to solve sexual problems in couples and could increase couples’ sexual satisfaction. Health policy makers may consider this method in public health centers for decreasing sexual problems of couples. ACKNOWLEDGMENTS This study comprises the results of Shirin Zargar Shoushtari’s master’s thesis. This work was financially supported by the Vice-Chancellor for Research Affairs of Ahvaz Jundishapur University of Medical Sciences, Iran. REFERENCES Annon, J. S. (1976). The PLISSIT model: A proposed conceptual scheme for the behavioral treatment of sexual problems. Journal of Sex Education and Therapy, 2, 1–15. Ayaz, S., & Kubilay, G. (2009). Effectiveness of the PLISSIT model for solving the sexual problems of patients with stoma. Journal of Clinical Nursing, 18, 89–98. doi:10.1111/j.1365-2702.2008.02282.x Baraz, S. H., Mohammadi, I., & Boroumand, B. (2006). A comparative study on the effect of two methods of self-care education (direct and indirect) on quality of life and physical problems of hemodialysis patients. Arak University of Medical Sciences Journal, 9, 1–16.
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Berenson, A., Wu, Z. H., Breitkopf, C. R., & Newman, J. (2006). The relationship between source of sexual information and sexual behavior among female adolescents. Contraception, 73, 274–278. Chun, N. (2011). Effectiveness of PLISSIT model sexual program on female sexual function for women with gynecologic cancer. Journal of Korean Academy of Nursing, 41, 471–480. Dunn, K. M., Craft, P. R., & Hackett, G. I. (1998). Sexual problems: A study of the prevalence and need for healthcare in the general population. Family Practice, 15, 519–524. Fozder, B. F., & Kumar, L. S. (2007, June). Mobile learning and student retention. International Review of Research in Open and Distance Learning, 8(2). Available http://www.irrodl.org/index.php/irrodl/issue/view/29 Huibers, L., Keizer, E., Giesen, P., Grol, R., & Wensing, M. (2012). Nurse telephone triage: Good quality associated with appropriate decisions. Family Practice, 29, 547–552. Khakbazan, Z., GolyanTehrani, S. H., Payghambardoost, R., & Kazemnejad, A. (2009). Effect of telephone counseling during post-partum period on women’s quality of life. Hayat, 15, 5–12. Khosro-Shahi, Z. (2003). The prevalence of sexual dysfunction, incidence and risk factors in causing sexual dysfunction in the relationship between married women’s of medical education. First Congress of Family and Sexual Problems. Litzinger, S., & Gordon, K. C. (2005). Exploring relationships among communication, sexual satisfaction, and marital satisfaction. Journal of Sex & Marital Therapy, 31, 409–424. Lima, A. P., Salles, A. A., Dias, A. P., Amed, A. M., De Souza, E., & Camano, L. (2009). Prevalence of sexual dysfunction during pregnancy. Revista da Associac¸a˜ o M´edica Brasileira, 55, 563–568. Lindberg, L.D., & Maddow-Zimet, I. (2012). Consequences of sex education on teen and young adult sexual behaviours and outcomes. Journal of Adolescent Health, 51, 332–338. doi:10.1016/j.jadohealth.2011.12.028 Mooshkbid Haghighi, M., Shams Mofarahe, Z., Majd-Timory, M. M., & Hosseini, F. (2002).The effect of marital counseling on sexual satisfaction of couples. Iran Journal of Nursing, 32–33(15–16), 15–19. Offman, A., & Mattheson, K. (2005). Sexual compatibility and sexual functioning in intimate relationships. The Canadian Journal of Human Sexuality, 14, 31–39. Osman, H., Chaaya, M., Zein, L. E., Naassan, G., & Wick, L. (2010). What do first-time mothers worry about? A study of usage patterns and content of calls made to a postpartum support telephone hotline. BMC Public Health, 10, 611–616. doi:10.1186/1471-2458-10-611 Pakgohar, M., Vijeh, M., Babaei, G. R., Ramazanzadeh, F., & Abedi Nia, N. (2006). Counseling in infertile women on sexual satisfaction. Hayat, 14, 21–23. Patel, A., Dale, J., & Crouch, R. (1997). Satisfaction with telephone advice from an accident and emergency department: Identifying areas for service improvement. Quality in Health Care, 6, 140–145. Remschmidt, H., Hirsch, O., & Mattejat, F. (2003). Reliability and validity of evaluation data collected by telephone. Zeitschrift fur Kinder-und Jugendpsychiatrie und Psychotherapie, 31, 35–49. Richters, J., & Rissel, C. E. (2005). Doing it Down Under: The sexual lives of Australians. Crows Nest, New South Wales, Australia: Allen & Unwin. Rosen, R. C., Taylor, J. F., Leiblum, S. R., & Bachmann, G. A. (1993). Prevalence of sexual dysfunction in women: Results of a survey study of 329 women in an outpatient gynecological clinic. Journal of Sex & Marital Therapy, 19, 171–188. Santtila, P., Wager, I., Witting, K., Harlaar, N., Jern, P., Johansson, A., . . . Sandnabba, N. K. (2008). Discrepancies between sexual desire and sexual activity: Gender differences and associations with relationship satisfaction. Journal Sex & Marital Therapy, 34, 29–42. doi:10.1080/00926230701620548 Schover, L. R., Canada, A. L., Yuan, Y., Sui, D., Neese, L., Jenkins, R., & Rhodes, M. M. (2012). A randomized trial of Internet-based versus traditional sexual counseling for couples after localized prostate cancer treatment. Cancer, 118, 500–509. doi:10.1002/cncr.26308 Shahsiah, M., Bahrami, F., Etemadi, O., & Mohebi, S. (2011). Effect of sex education on improving couples marital satisfaction in Esfahan. Health System Research, 6, 690–697. Shahvary, Z., Gholizade, L., & Mohamad Hoseiny, S. (2010). Determination of some related factors on women sexual satisfaction Gachsaran (south-west of Iran). Journal of Gorgan University of Medical Sciences, 11, 51–56. Shams Mofarahe, Z., Shahsiah, M., Mohebi, S., & Tabaraee, Y. (2011). The effect of marital counseling on sexual satisfaction on couple in Shiraz city. Journal of Research & Health, 6, 417–424. Vural, B. K., & Temel, A. B. (2009). Effectiveness of premarital sexual counselling program on sexual satisfaction of recently married couples. Sexual Health, 6, 222–232. doi:10.1071/SH08065
Journal of Sex & Marital Therapy Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/usmt20
The Effect of Face-to-Face With Telephone-Based Counseling on Sexual Satisfaction Among Reproductive Aged Women in Iran a
a
a
Shirin Zargar Shoushtari , Poorandokht Afshari , Parvin Abedi & b
Hamed Tabesh a
Midwifery Department, Reproductive Health Promotion Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran b
Health Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Accepted author version posted online: 25 Apr 2014.Published online: 19 May 2014.
To cite this article: Shirin Zargar Shoushtari, Poorandokht Afshari, Parvin Abedi & Hamed Tabesh (2014): The Effect of Face-to-Face With Telephone-Based Counseling on Sexual Satisfaction Among Reproductive Aged Women in Iran, Journal of Sex & Marital Therapy, DOI: 10.1080/0092623X.2014.915903 To link to this article: http://dx.doi.org/10.1080/0092623X.2014.915903
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Utah] at 23:20 01 December 2014
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
JOURNAL OF SEX & MARITAL THERAPY, 00(0), 1–7, 2014 C Taylor & Francis Group, LLC Copyright ISSN: 0092-623X print / 1521-0715 online DOI: 10.1080/0092623X.2014.915903
The Effect of Face-to-Face With Telephone-Based Counseling on Sexual Satisfaction Among Reproductive Aged Women in Iran
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Shirin Zargar Shoushtari, Poorandokht Afshari, and Parvin Abedi Midwifery Department, Reproductive Health Promotion Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Hamed Tabesh Health Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
This study was designed to investigate and compare the effect of face-to-face with telephone-based counseling on sexual satisfaction in women of reproductive age in Iran. This study was a randomized controlled trial in which 46 married women who got married 1–5 years ago were randomly selected and assigned to 1 of 2 groups (face-to-face and telephone-based counseling). Two groups received counseling by a trained midwife once a week for 4 weeks. The sexual satisfaction (using the Sexual Satisfaction Index) score was calculated in the beginning of the study and after 4 weeks. An independent t test, chi-square test, likelihood ratio test, Fisher’s exact test, and linear-by-linear test were used for analyzing data. The mean score of sexual satisfaction in the face-to-face group was 93.6 (SD = 7.1) and improved significantly to 108.08 (SD = 5.44) after intervention (p = .001). The mean score of sexual satisfaction in the telephone-based counseling was 93.52 (SD = 5) and increased to 113 (SD = 6.07) after 4 weeks (p = .001). Telephone-based counseling could increase the sexual satisfaction better than face-to-face counseling (mean difference: 20.34 [SD = 7.38] vs. 14.47 [SD = 5.32], p = .003). The telephone-based counseling is an effective and affordable method to solve the sexual problems and could increase the sexual satisfaction. Using this method in public health centers is recommended.
Sexual satisfaction is a positive evaluation of the overall sexual relationship in which the sexual needs and expectation of couples are being met (Offman & Mattheson, 2005). An overall positive relationship depends on sexual satisfaction (Santtila et al., 2008). Sexual satisfaction is one of the human’s physiologic needs and has a direct relationship with human well-being. Lack of sexual satisfaction may cause physical and psychological pressure on a human’s body, may interfere with his or her health, and may reduce his or her creative ability (Litzinger & Gordon, 2005). A large survey in Australia showed that 88% of men and 80% of women believed that sex has an
Address correspondence to Poorandokht Afshari, Golestan Ave., Ahvaz Jundishapur University of Medical Sciences, Nursing & Midwifery School, Midwifery Department, Reproductive Health Promotion Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, 6135715794. E-mail: p [email protected]
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essential impact on their well-being (Richters & Rissel, 2005). One study showed that 38% of married women had anxiety during sexual intercourse and 16% did not have pleasure with their sexual activity and that, overall, 68% of women rated their sexual activity as satisfactory (Rosen, Taylor, Leiblum, & Bachmann, 1997). The prevalence of sexual dissatisfaction among women in the United States is 25% (Lima et al., 2009). In Iran, sexual dissatisfaction among women was reported to be 32% in 1999 (Mooshkbid Haghighi, Shams Mofarahe, Majd-Timory, & Hosseini, 2002) and 47.5% in 2008 (Shahvary, Gholizade, & Mohamad Hoseiny, 2010). Sexual counseling as a specialized method can provide necessary information for a healthy sexual relationship for couples to preserve their marital life. One study showed that when women and men participated in premarital sexual counseling, their level of sexual satisfaction increased significantly, and most of them had a problem-free sexual life (Vural & Temel, 2009). A couple of studies in Iran have shown that using sexual counseling will result in increased sexual satisfaction (Shahsiah, Bahrami, Etemadi, & Mohebi, 2011; Shams Mofarahe, Shahsiah, Mohebi, & Tabaraee, 2011). Dunn, Craft, and Hackett (1998) found that 52% of women need sexual counseling, whereas only 10% of them have benefited from counseling services. Different types of counseling, such as face-to face, telephone-based, video, and Internet-based counseling are in the common usage around the world. Telephone-based counseling is common because of accessibility; anonymity of the person who receives counseling is a good way to get information, advice, and support (Osman, Chaaya, Zein, Naassan, & Wick, 2010; Patel, Dale, & Crouch, 1997). Face-to face counseling is one of the most popular methods to educate and consult people in the health care system. However, because of the lack of fixed structure and need for more time, this method is not feasible in crowded public health centers (Baraz, Mohammadi, & Boroumand, 2006). In many advanced medical centers around the world, the telephone has been used for counseling to reduce unnecessary costs and to increase effectiveness of prevention and treatment (Huibers, Keizer, Giesen, Grol, & Wensing, 2012). Furthermore, telephone counseling could change care from being centered on hospitals to being centered on the community or client (Patel et al., 1997). In a study by Fozder and Kumer (2007), results showed that not only did approximately 70% of participants mention telephone as an emergency communication tool but also 73% of them believed that cell phone can act as a client-centered tool that has more flexibility compared with the traditional educational methods. In Khakbazan, GolyanTehrani, Payghambardoost, and Kazemnejad’s (2009) study in Iran on women in their postpartum period, results showed that by using phone counseling, women’s quality of life increased compared with the control group (p < .001). A randomized controlled trial showed that an Internet-based sexual counseling program designed for couples could improve the sexual function and satisfaction by functioning as traditional sex therapy in couples whose male partner was treated for prostate cancer (Schover et al., 2012). Because of a lack of enough information on the effect of phone counseling on sexual satisfaction, this study aimed to compare the effect of phone counseling with face-to-face counseling on sexual satisfaction among women of reproductive age in Iran.
MATERIALS AND METHODS In this randomized, controlled trial, we randomly selected and assigned 46 women of reproductive age to one of two groups: those receiving phone counseling (n = 23) and those receiving face-toface counseling (n = 23). This study was conducted in two public health centers in Ahvaz, Iran, from 2011 to 2012. Study design was approved by the Ethics Committee of Ahvaz Jundishapur
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University of Medical Sciences and was registered in the Iranian Centers for Clinical Trial. To be included in this study, women had to be recently married (i.e., 1–5 years ago), had to own a cell phone, had to have basic literacy skills, and had to acquire a score of 50–100 in the initial sexual satisfaction test (low or moderate sexual satisfaction). We excluded women who had a history of medical problems, those who had psychological disorders, those who were divorced, those who experienced the death of close relatives; sexual; those who abused alcohol and drugs; and those who were pregnant.
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Measures We used a questionnaire consisting of 26 questions to collect sociodemographic data. We used the Sexual Satisfaction Index to collect data regarding sexual satisfaction. In addition, we used content validity to assess the validity of the Sexual Satisfaction Index and test–retest to investigate reliability (r = 0.98) on 10 women (Shams Mofaraheh et al., 2011). One of the researchers (S.Z.S.) who participated in the sexual counseling workshop with a sexologist was responsible for counseling. Intervention All participants were given information about the objective of study and how long the intervention would take. Participants were also informed that there was no charge to participate and were free to withdraw from the study at any time they desired. We obtained written informed consent from each participant before we collected data. Both groups completed a demographic questionnaire and the Sexual Satisfaction Index in a separate and private room in the public health center. In the Sexual Satisfaction Index, scores were classified as follows: 100 (high) in terms of sexual satisfaction (Shams Mofaraheh et al., 2011). Women who identified as having low or moderate sexual satisfaction were randomly distributed to either the face-to-face or phone counseling group by a ratio of 1:1, whereas women who scored less than 50 were excluded and referred to psychologists. We performed a coin toss to randomize women into two groups: tails for phone counseling and heads for face-to-face counseling. Women in the face-to-face group received a sexual counseling session every week for 4 weeks in the public health center. In the phone counseling group, women received a phone call by the researcher once a week for counseling for 4 weeks. Women were free to call the researcher if they needed more time to speak. None of the clients were charged for phone calls. The content of counseling was informational and educational using the PLISSIT model (Annon, 1976). The average time devoted to counseling in the face-to-face group was 36.8 min, whereas in the phone group it was 20.5 min. In both groups, 1 month after the start of the consultation, and having a week without counseling, women were requested to attend the clinic, where they completed the Sexual Satisfaction Index. There was no intervention for women’s spouses. The content of some counseling session was as follows: If the client complained from pain during intercourse or vaginal dryness, the counselor advised her to have foreplay and to use lubricant. Women who complained from monotony in their sexual relationship were encouraged to change their sex position. For those who were tired of doing housework, the counselor suggested getting help from family members to complete the work. In general, in both types of counseling, women were encouraged to talk about their problem; then, on the basis of their talk, they were given advice. Intervention applied only to women individually, not with a husband.
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Statistics
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We used SPSS 20 to conduct data entry and analysis. We used an independent t test to testing differences between two groups regarding continuous variable such as age, marriage duration, number of children, and sexual satisfaction score. We used the chi-square test for the categorical data. Fisher’s exact test was used for those variables that could not reach the acceptable level for the chi-square test, such as job of women. We used the likelihood ratio test to test variables such as job of husband. The linear-by-linear test was used for variables such as education of wife and husband. All results were presented with 95% confidence intervals, and p < .05 was considered significant. RESULTS The findings of this study showed that the average age of participants in the phone counseling group was 24.8 years (SD = 3.9) and in the face-to-face group it was 24.9 years (SD = 3.3). Most participants in the two groups had one child and had a modest economic situation. The details of demographic characteristics of participants are listed in Table 1. The mean score of sexual TABLE 1 Sociodemographic Characteristics of Participants in the Face-to-Face and Phone Counseling Groups Phone counseling (n = 23) Variable Age (years) Marriage duration (years) Age gap with spouse (years) Income (Rials)∗ Number of children Education High school Diploma University education Job Working Housewife Education of spouse High school Diploma University education Job of spouse Employee Employer Unemployed ∗ One
Face-to face counseling (n = 23)
M
SD
M
SD
p
24.8 3.3 5.5 634,761 1
3.9 1.3 4.3 279,510 0.6
24.9 3.4 4.6 526,190 0.8
3.3 1.2 3 199,761 0.4
0.92 0.77 0.42 0.15 0.47
n
%
n
%
13 7 3
56.5 30.5 13
11 10 2
47.8 43.5 8.7
0.83
1 22
4.4 95.6
0 23
0 100
1
8 11 4
34.8 47.9 17.3
15 6 2
65.2 36.1 8.7
0.06
10 12 1
43.5 52.2 4.3
6 15 2
26.1 65.2 8.7
0.43
U.S. dollar is equal to 34,000–35,000 Rials at the time of data collection.
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TABLE 2 Sexual Satisfaction Score and Number of Sexual Intercourses in the Face-to-Face and Phone Counseling Groups Phone counseling (n = 23) Variables
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Sexual satisfaction score before intervention Sexual satisfaction score after intervention Mean difference p value within group Number of sexual intercourses
Face-to face counseling (n = 23)
M
SD
M
SD
p value between groups
93 114 20
5 6 7
94 108 14
7 5 5
0.003
1
1
0.90
0.02
.001 2
.001
satisfaction did not have significant difference in the beginning of the study (93.6 [SD = 7.1] in the face-to-face group vs. 93.5 [SD = 5] in the phone counseling group), p = .96 (Table 2). The mean sexual satisfaction score was significantly increased in the phone counseling group after 4 weeks compared with the face-to-face group (113.8 [SD = 6.07] vs. 108 [SD = 5.44]), p = .003. Also, the frequency of sexual intercourse was increased in the phone counseling group in comparison with the face-to-face group (p = .02, Table 2). Also, there were no dropouts in the study. DISCUSSION This study aimed to compare the effect of phone counseling versus face-to-face counseling on sexual satisfaction among women of reproductive age. The sexual satisfaction before counseling in both groups was low or moderate. The average of sexual satisfaction score was increased from moderate to high in both groups after intervention; however, the mean difference in the phone counseling was more obvious. Pakgohar, Vijeh, Babaei, Ramazanzadeh, and Abedi Nia (2006), who conducted a study on 100 infertile women in Tehran, Iran, found that counseling in general could increase the sexual satisfaction score in comparison with the women who did not receive counseling (p = .002). A study by Lindberg and Maddow-Zimet (2012) showed that sex education among teenagers and young adult could significantly increase the sexual behaviors and outcomes compared with the group who did not receive any education. One study showed that when female adolescents discussed condom use and number of sexual partners, they could improve their behavior about these issues significantly more than could adolescents who had not heard about these issues (Berenson et al., 2006). Also, there was significant changed in sexual satisfaction score before and after counseling in two groups. Our results are in line with Pakgohar and colleagues (2006), Lindberg and Maddow-Zimet (2012), and Berenson, Wu, Breitkopf, and Newman (2006). In this study, we used the PLISSIT model. Other researchers have also found that PLISSIT model can be an effective model for decreasing sexual problems (Ayaz & Kubilay, 2009; Chun, 2011). Our results are in line with Remschmidt, Hirsch, and Mattejat (2003), who found that phone counseling is a valid and reliable method for prevention and treatment of sexual problems among
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patients. The results of the present study show that the frequency of sexual intercourse increased significantly in the phone counseling group compared with the face-to-face group. Higher sexual satisfaction is an important factor to increase the frequency of sexual intercourse. Other studies have also shown that there is a positive relation between sexual satisfaction and the frequency of sexual intercourse (Litzinger & Gordon, 2005). Khosro-Shahi (2003) in Iran found that there is a negative relation between the request for sexual intercourse from the male partner and sexual satisfaction in the female partner.
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Strengths and Limitations of the Study This is the first time in Iran that the effect of phone and face-to-face counseling on sexual satisfaction has been compared. On the basis of the cultural situation of society in Iran, it is not easy for women to talk about their sexual issues. Also, public health clinics in Iran lack sexual counseling centers. Even if sexual counseling centers existed, scheduling conflicts would prevent women from going to the clinics. In contrast, phone counseling enables participants to call the counselor when they have free time. Usually, people call a counselor when they are in trouble; therefore, they will provide more details about their problem. In this study, we did not assess the sexual function of participants. Perhaps information about sexual function could help to understand sexual satisfaction. Also, we did not assess the sexual satisfaction of the partner of participants. However, improvement in the sexual satisfaction of women would be a factor that is related to the sexual satisfaction of husbands. Another limitation is that we did not use the standard grading system; instead, we implemented the scoring previously used by an Iranian research team (Shams Mofarahe et al., 2011). Conclusion Telephone-based counseling is an effective and affordable method to solve sexual problems in couples and could increase couples’ sexual satisfaction. Health policy makers may consider this method in public health centers for decreasing sexual problems of couples. ACKNOWLEDGMENTS This study comprises the results of Shirin Zargar Shoushtari’s master’s thesis. This work was financially supported by the Vice-Chancellor for Research Affairs of Ahvaz Jundishapur University of Medical Sciences, Iran. REFERENCES Annon, J. S. (1976). The PLISSIT model: A proposed conceptual scheme for the behavioral treatment of sexual problems. Journal of Sex Education and Therapy, 2, 1–15. Ayaz, S., & Kubilay, G. (2009). Effectiveness of the PLISSIT model for solving the sexual problems of patients with stoma. Journal of Clinical Nursing, 18, 89–98. doi:10.1111/j.1365-2702.2008.02282.x Baraz, S. H., Mohammadi, I., & Boroumand, B. (2006). A comparative study on the effect of two methods of self-care education (direct and indirect) on quality of life and physical problems of hemodialysis patients. Arak University of Medical Sciences Journal, 9, 1–16.
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Berenson, A., Wu, Z. H., Breitkopf, C. R., & Newman, J. (2006). The relationship between source of sexual information and sexual behavior among female adolescents. Contraception, 73, 274–278. Chun, N. (2011). Effectiveness of PLISSIT model sexual program on female sexual function for women with gynecologic cancer. Journal of Korean Academy of Nursing, 41, 471–480. Dunn, K. M., Craft, P. R., & Hackett, G. I. (1998). Sexual problems: A study of the prevalence and need for healthcare in the general population. Family Practice, 15, 519–524. Fozder, B. F., & Kumar, L. S. (2007, June). Mobile learning and student retention. International Review of Research in Open and Distance Learning, 8(2). Available http://www.irrodl.org/index.php/irrodl/issue/view/29 Huibers, L., Keizer, E., Giesen, P., Grol, R., & Wensing, M. (2012). Nurse telephone triage: Good quality associated with appropriate decisions. Family Practice, 29, 547–552. Khakbazan, Z., GolyanTehrani, S. H., Payghambardoost, R., & Kazemnejad, A. (2009). Effect of telephone counseling during post-partum period on women’s quality of life. Hayat, 15, 5–12. Khosro-Shahi, Z. (2003). The prevalence of sexual dysfunction, incidence and risk factors in causing sexual dysfunction in the relationship between married women’s of medical education. First Congress of Family and Sexual Problems. Litzinger, S., & Gordon, K. C. (2005). Exploring relationships among communication, sexual satisfaction, and marital satisfaction. Journal of Sex & Marital Therapy, 31, 409–424. Lima, A. P., Salles, A. A., Dias, A. P., Amed, A. M., De Souza, E., & Camano, L. (2009). Prevalence of sexual dysfunction during pregnancy. Revista da Associac¸a˜ o M´edica Brasileira, 55, 563–568. Lindberg, L.D., & Maddow-Zimet, I. (2012). Consequences of sex education on teen and young adult sexual behaviours and outcomes. Journal of Adolescent Health, 51, 332–338. doi:10.1016/j.jadohealth.2011.12.028 Mooshkbid Haghighi, M., Shams Mofarahe, Z., Majd-Timory, M. M., & Hosseini, F. (2002).The effect of marital counseling on sexual satisfaction of couples. Iran Journal of Nursing, 32–33(15–16), 15–19. Offman, A., & Mattheson, K. (2005). Sexual compatibility and sexual functioning in intimate relationships. The Canadian Journal of Human Sexuality, 14, 31–39. Osman, H., Chaaya, M., Zein, L. E., Naassan, G., & Wick, L. (2010). What do first-time mothers worry about? A study of usage patterns and content of calls made to a postpartum support telephone hotline. BMC Public Health, 10, 611–616. doi:10.1186/1471-2458-10-611 Pakgohar, M., Vijeh, M., Babaei, G. R., Ramazanzadeh, F., & Abedi Nia, N. (2006). Counseling in infertile women on sexual satisfaction. Hayat, 14, 21–23. Patel, A., Dale, J., & Crouch, R. (1997). Satisfaction with telephone advice from an accident and emergency department: Identifying areas for service improvement. Quality in Health Care, 6, 140–145. Remschmidt, H., Hirsch, O., & Mattejat, F. (2003). Reliability and validity of evaluation data collected by telephone. Zeitschrift fur Kinder-und Jugendpsychiatrie und Psychotherapie, 31, 35–49. Richters, J., & Rissel, C. E. (2005). Doing it Down Under: The sexual lives of Australians. Crows Nest, New South Wales, Australia: Allen & Unwin. Rosen, R. C., Taylor, J. F., Leiblum, S. R., & Bachmann, G. A. (1993). Prevalence of sexual dysfunction in women: Results of a survey study of 329 women in an outpatient gynecological clinic. Journal of Sex & Marital Therapy, 19, 171–188. Santtila, P., Wager, I., Witting, K., Harlaar, N., Jern, P., Johansson, A., . . . Sandnabba, N. K. (2008). Discrepancies between sexual desire and sexual activity: Gender differences and associations with relationship satisfaction. Journal Sex & Marital Therapy, 34, 29–42. doi:10.1080/00926230701620548 Schover, L. R., Canada, A. L., Yuan, Y., Sui, D., Neese, L., Jenkins, R., & Rhodes, M. M. (2012). A randomized trial of Internet-based versus traditional sexual counseling for couples after localized prostate cancer treatment. Cancer, 118, 500–509. doi:10.1002/cncr.26308 Shahsiah, M., Bahrami, F., Etemadi, O., & Mohebi, S. (2011). Effect of sex education on improving couples marital satisfaction in Esfahan. Health System Research, 6, 690–697. Shahvary, Z., Gholizade, L., & Mohamad Hoseiny, S. (2010). Determination of some related factors on women sexual satisfaction Gachsaran (south-west of Iran). Journal of Gorgan University of Medical Sciences, 11, 51–56. Shams Mofarahe, Z., Shahsiah, M., Mohebi, S., & Tabaraee, Y. (2011). The effect of marital counseling on sexual satisfaction on couple in Shiraz city. Journal of Research & Health, 6, 417–424. Vural, B. K., & Temel, A. B. (2009). Effectiveness of premarital sexual counselling program on sexual satisfaction of recently married couples. Sexual Health, 6, 222–232. doi:10.1071/SH08065
