Document Type : Original Article
Authors
1 Department of Management, Tehran Medical Sciences Branch Islamic Azad University, Tehran, Iran
2 Department of Nursing and Midwifery, Tehran Medical Sciences Branch Islamic Azad University, Tehran, Iran
3 Department of Psychology, Tehran Medical Sciences Branch Islamic Azad University, Tehran, Iran
4 4Iranian Center of Excellence in Health Management (IceHM), Tabriz University of Medical Sciences, Tabriz, Iran
Abstract
Keywords
Health literacy represents the capacity of a person to
access, interpret, and apply health information as well as
make decisions to use existing health services (
Several studies have been conducted to determine the
effects of health literacy on different health outcomes. In
this regard, we can refer to the impact of health literacy
on quality of life, medication and adherence to clinical
recommendations, taking advantage of contraceptive
and emergency services, reducing the risk of mortality,
utilization of services and knowledge related to asthma,
the use of mammography and effective use of health
information sources (
Good sexual function between couples includes regu.
lar willingness to participate in sexual acts, sexual arous.
al, and reaching orgasm and increase their marital satisfaction (
Studies of health literacy among pregnant women in
Tehran showed literacy to be adequate in 45.4%. The proportion
of people with marginal and inadequate health literacy
was respectively 24.6 and 30% (
Health literacy is one of the factors that affect health behaviors and several aspects of health. These include sexual function and sexual satisfaction, which in turn affect quality of life in terms marital satisfaction. Therefore, in this study, the relationship between health literacy and sexual function and sexual satisfaction was investigated in infertile couples referred to the Royan Institute in 2016.
In this descriptive study conducted in 2016 health literacy, sexual function and sexual satisfaction and correlations between them were examined. The research field was Royan Institute in Tehran and the research population included all of the couples (with primary and secondary infertility) referred to the Institute during the study. The Cochran formula was used to calculate the sample size (z=1.96, a=0.05, p=0.5, q=0.5, and d=0.05). A sample of 386 people was selected to give the ability to detect differences with a significance level of 0.05 and a power of 80%.
The sample of 193 women and 193 men was selected
using availability sampling by researchers who visited
the Institute on specific days. Participants of the study
included couples who lived together and were both willing
to participate in the study. They also had either a
diagnosis of primary infertility (no pregnancy for 12
months despite marital relations without contraception
and no history of previous pregnancy) or a diagnosis of
secondary infertility (no pregnancy despite a history of
previous pregnancy) (
These included a demographic characteristics questionnaire,
the Test of Functional Health Literacy in
Adults (TOFHLA), a standard sexual functioning questionnaire
(separate versions for women and men) and the
Iranian version of the sexual satisfaction questionnaire
(separate versions for women and men). The first questionnaire
collected information on age, education, housing,
household income, age at marriage, occupation,
disease and habit (cigarette, alcohol, and drug) history
of each individual and their relatives, marriage duration,
weight, height, number of children, pregnancy history,
abortion experience, treatment seeking, diagnosis, infertility
cause, and contraception method. The TOFHLA
questionnaire of Parker et al. (
Face validity, content validity and reliability of this tool
(translated version) were studied and verified in the study
conducted by Javadzade et al. (
To measure sexual function in men, the International
Index of Erectile Function (IIEF) was used. The questionnaire,
developed by Rosen et al, includes five dimensions
of erectile function, ejaculatory function, sexual stimulation,
satisfaction during intercourse, and overall satisfaction
in 15 questions. Each items are scored from 0 to 5,
or 1 to 5, in which higher scores indicate better sexual
performance (
The study was designed in accordance with ethical rules approved by the Ethical Committee of the Islamic Azad University of Tehran Medical branch (IR.IAU.TMU. REC.1394.23).
The data collected in this study were analyzed using SPSS 23.0 statistical software (SPSS, Inc., Chicago, IL, USA). Descriptive statistics including percent’s and frequencies are reported. Chi-square tests were used to analyze the associations between sexual function or sexual satisfaction and heath literacy at significant level of 0.05. Although the chi-squared test can indicate whether or not there is a relationship between 2 qualitative variables, it cannot indicate the strength of the association. The Cramer’s V test was thus used to determine the strength of the associations and, consequently, their importance.
Demographic variables are shown in Table 1. Besides that, about 64% of the participants weighed 60 kg or above, and the height of the majority (48.7%) was in the range of 150-170 cm. Although 86% of subjects had no children, only 10.6% had a history of non-pregnancy among family members and close relatives. Additionally, 85.5% of participants had no history of previous pregnancy and the percentage that had experienced an abortion was estimated 3.1%. For 63.2% of the participants this was their first referral to a health center for follow up of their infertility status, and only 40.4% of them had a diagnosis of the cause of their infertility. Twenty eight percent of the 40.4% infertility was due to the woman, and 59.1% of the participants used medicinal methods of contraception.
Descriptive results related to health literacy, sexual function, and sexual satisfaction variables are shown in Table 2. The results reported in Table 2 show that a marginal level of health literacy (44.1% in women and 49.7% in men) was more common that an adequate or inadequate level. In both sexes the percentages of participants with an inadequate level of health literacy was lower than those with an adequate level. In addition, 57.0% of women had normal sexual function and 69.9% of men had appropriate or perfect sexual function. The percentage of participants with good or very good sexual satisfaction was 57.0% in women and 67.4% in men.
demographic variables for infertile couples referred to the Royan Institute in 2016
Variable | Subgroup | Frequency (%) | Variable | Subgroup | Frequency (%) |
---|---|---|---|---|---|
Age (Y) | <20 | 9 (2.4) | Marriage age (Y) | <20 | 41 (10.6) |
20-30 | 143 (37.0) | 20-30 | 265 (68.7) | ||
31-40 | 173 (44.8) | 31-40 | 61 (15.8) | ||
>40 | 61 (15.8) | >40 | 19 (4.9) | ||
Total | 386 (100) | Total | 386 (100) | ||
Education | Illiterate | 5 (1.3) | Occupation | Housewife | 27 (7.0) |
Primary | 56 (14.5) | Worker | 88 (22.8) | ||
≤Diploma | 163 (42.3) | Employee | 99 (25.7) | ||
Bachelor | 133 (34.4) | Self-Employed | 160 (41.4) | ||
>Bachelor | 29 (7.5) | Unemployed | 12 (3.1) | ||
Total | 386 (100) | Total | 386 (100) | ||
Housing | Owner- Occupied | 108 (28.0) | History: individual (I), relatives (R) | Special diseases (I&R) | 17 (12.0) |
Rented | 218 (56.5) | Chronic diseases (I) | 38 (27.0) | ||
Corporate Home | 42 (10.9) | Genetic diseases (I&R) | 13 (9.2) | ||
Relative’s | 18 (4.6) | Cigarette, alcohol, and drug (I) | 73 (51.8) | ||
Total | 386 (100) | Total | 141 (100) | ||
Household income (Million Rial) | <1 | 6 (1.5) | Marriage duration (Y) | <1 | 8 (2) |
1-2 | 154 (39.9) | 1-5 | 152 (39.4) | ||
2-3 | 174 (45.1) | 6-10 | 174 (45.1) | ||
>3 | 52 (13.5) | >10 | 52 (13.5) | ||
Total | 386(100) | Total | 386(100) | ||
Health literacy, sexual function, and sexual satisfaction in infertile couples referred to the Royan Institute in 2016
Variable | Sample | Level of variable | Frequency (%) |
---|---|---|---|
Health literacy | Woman | Inadequate | 46 (23.8) |
Marginal | 85 (44.1) | ||
Adequate | 62 (32.1) | ||
Total | 193 (100) | ||
Man | Inadequate | 42 (21.8) | |
Marginal | 96 (49.7) | ||
Adequate | 55 (28.5) | ||
Total | 193 (100) | ||
Sexual function | Woman | Dysfunction | 83 (43.1) |
Normal | 110 (57.1) | ||
Total | 193 (100) | ||
Man | Inappropriate | 3 (1.6) | |
Medium | 11 (5.7) | ||
Medium to Good | 44 (22.8) | ||
Appropriate | 103 (53.3) | ||
Perfect | 32 (16.6) | ||
Total | 193 (100) | ||
Sexual satisfaction | Woman | Low | 27 (14.0) |
Medium | 56 (29.0) | ||
Good | 89 (46.1) | ||
Very Good | 21 (10.9) | ||
Total | 193 (100) | ||
Man | Low | 17 (8.8) | |
Medium | 46 (23.8) | ||
Good | 98 (50.8) | ||
Very Good | 32 (16.6) | ||
Total | 193 (100) | ||
The relationships between health literacy, sexual function, and sexual satisfaction were examined using the chi-square test and are presented in Table 3. The results show a significant relationship (P<0.05) between the level of health literacy, sexual function, and sexual satisfaction in infertile women and men referred to the Royan Institute. Cramer's V indicated that the strength of the association between health literacy and sexual function in women is 0.33 and 0.18 for men. The Cramer’s V results indicate that these relationships can be considered as moderate to weak.
Marginal health literacy, 49.7% among men and 44.1%
among women, was more common than adequate or inadequate
health literacy. Ghanbari et al. (
In relation to sexual functioning, our study showed 43
percent of the women had sexual dysfunction and 53.3%
of men had appropriate sexual function. Results of other
studies in Iran are not in line whit our study. In the North
of Tehran, the prevalence of sexual dysfunction among
women was 64% (
Cai et al. (
The third variable examined in this study was sexual
satisfaction, and, based on the findings, 57% of women
and 67.4% of men had good or very good sexual satisfaction.
Ramazani et al. (
Results of Chi-square and Cramer’s V tests to examine the relationship between health literacy, sexual function, and sexual satisfaction in infertile couples referred to the Royan Institute in 2016
Variable | Sample | Sexual function | Sexual satisfaction | ||||
---|---|---|---|---|---|---|---|
df | P value | Cramer’s V | df | P value | Cramer’s V | ||
Health literacy | Woman | 2 | 0.005 | 0.33 | 6 | 0.007 | 0.17 |
Man | 8 | 0.017 | 0.18 | 6 | 0.038 | 0.16 | |
df; Degree of freedom.
A significant relationship between health literacy and
sexual function and between health literacy and sexual
satisfaction was observed in this study. Health literacy
affects attitude, mental condition, behaviors related to
health, and thus, physical health status. In addition, health
literacy can affect the use of information and sexual function
in couples (
Although the research has reached its aims, there were some unavoidable limitations. First, this study was cross-sectional and conducted in one center. Second, research variables are dependent on the socio-cultural environment. Therefore, to generalize the results for large groups in different settings, it is recommended that studies be performed in other places and with a larger sample. Also, it can be recommended to conduct a meta- analysis of existing literature to further understanding in this field.
The results of this study showed that marginal health literacy was more common than adequate or inadequate health literacy in both sexes. Additionally, our study confirmed the relationship between health literacy and sexual function and sexual satisfaction. Accordingly, it is recommended that applied and practical plans be developed in order to improve health literacy at the level of the community, especially among infertile couples.