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Research Burchard, A, Laurence, C, & Stocks, N 2011, 'Female international students and sexual health: A qualitative study into

knowledge, beliefs and attitudes', Australian Family Physician, 40, 10, p. 817 International students make up an increasing proportion of university students in Australia. Research suggests that they have poor sexual health knowledge compared with local students. Method Thematic analysis was undertaken on focus groups carried out at the University of Adelaide (South Australia), with 21 female international students from Malaysia and China. Findings Four themes were identified: poor sexual health knowledge; complex attitudes about premarital sex; difficulty accessing sexual health information, and poor understanding the role of general practitioners in this area; and ideas about future education. Participants believed that international students have insufficient sexual health education when they arrive in Australia. They were concerned that some students may become more sexually active in Australia, and may not have adequate access to health services and information. All participants felt it was necessary for international students to receive better sexual health education. International students are important to Australian universities, and it should be mandatory to ensure that culturally appropriate sex education is made available to this group. Virtues So what? Representatives from the ISC approached eligible students to see if theyd be interested Female and unmarried undergraduates from China or Malaysia (biggest groups at the university) Participants who were interested were invited to bring a friend as a snowball effect Focus groups of 4-7 women Interviews last 90 minutes and were in English for practical reasons $40.00 voucher Audio recorded and then transcribed Thematic analysis 21 students all up (four focus groups)

Alternative Contribution

Research SIEBOLD, C 2011, 'Factors influencing young women's sexual and reproductive health', Contemporary Nurse: A Journal For The Australian Nursing Profession, 37, 2, pp. 124-136 This descriptive study of first year university students, utilising a survey questionnaire, explored sources of information including, but not limited to, the media, factors influencing decision making and young womens health seeking behaviours in terms of reproductive and sexual health. The overall aim was to add to the body of knowledge for health professionals developing appropriate programs targeting adolescents and young women. Understanding of sexual and reproductive health was variable with only approximately half of respondents demonstrating an adequate understanding. Contrary to an increasing picture of this generation as increasingly engaging in risky and potentially damaging behaviour as depicted in Female chauvinist pigs: The rise of raunch culture by Levy (2005), respondents in this study appeared for the most part to take considered decisions utilising the sources at hand, including popular magazines, while also grappling with expectations imposed by a culture that sexualises girls at younger and younger ages and depicts promiscuity as the norm. The importance of family values, particularly mothers as role models, emerged as important determi- nants of behaviour, while religious values were identified as important to only 15% of respondents. At the same time, pressure to engage in sex at younger and younger ages and continuing pressure to engage in unprotected and risky sex was a concern. Cynicism was expressed regarding the double standard perceived to be still operating in relation to young mens and womens sexual health. Young women in the study were forceful in identifying a need for a much better approach to education within schools directed at both sexes and one that is factual, relevant and all encompassing. Method This descriptive study utilised a survey question- naire designed to gather quantitative and qualita- tive data and consisting of questions with fixed responses or options (26) with a Likert scale, as well as open ended questions (13). The survey consisted of four sections: demographic information; sources of information, including the media; factors influencing decision making; and health related knowledge and concerns regard- ing reproductive and sexual health. The survey questionnaire was deemed to have content and face validity as it reflected the literature and was deemed to elicit the information required (May, 2001). The survey instrument was also

tested for face validity by having two young women, aged 18 and 20 years, trial the questionnaire. Ethical approval was sought and gained from a university ethics committee. The sample comprised first year female univer- sity students enrolled in undergraduate nursing and midwifery courses and who met the criteria of being between the ages of 18 and 24 and who were born and/or raised in Australia. All students were initially approached in the first 2 weeks of semester, 2008 and invited to participate. Given that the students were nursing and midwifery students, accessing students in the first weeks before classes, some of which covered biology and public heath issues, was seen as important. Following an explanation of the study, those who did not meet the criteria self identified and did not receive a copy of the questionnaire. Approximately 150 survey questionnaires were distributed by the first year lecturers at the end of a block lecture, along with an envelope and instructions to return the completed survey to a designated locked mail- box situated on campus. Fifty completed surveys were returned, a return rate of 33%. Anecdotal evidence suggests this is a reasonable response for student based surveys across the University, how- ever it is a lower rate than for similar surveys, for example a rate of 61% for mail surveys is consid- ered satisfactory (De Vaus, 2002). Data analysis was assisted by the statistical pack- age for the social sciences, SPSS (quantitative data) and Word 7 (qualitative data). In terms of coding, much of the work of classifying responses was done at the design stage of the question- naire with construction of fixed response answers to questions and Likert scales. Allocated codes were subsequently entered into SPSS, with data then presented as frequency distributions in bar charts and tables. Thematic analysis of qualitative responses was assisted by Word 7. Findings Thirty-one of the respondents were aged between 18 and 20 years and 19 were between the ages of 2124. The majority (93.5%) were Australian born and the remainder had been brought up in Australia. More than half the respondents (52%) reported that they were single, that is, not cur- rently in a relationship, and just under half (48%) were in a relationship. The majority (70%) were living at home, 26% were living in a shared house and only 2% were living with a partner. Of the 50 respondents, only seven indicated they did not belong to any religion, with all but one of the remaining 43 (who was Buddhist) identifying as Christian. However, only 25 (50%) respondents identified a religious affiliation as having any allegiance to a church. It can be assumed that more than a third (18 or 36%) of the respondents were nominal Christians, as opposed to having a commitment to their named religion. Overall, 30% of respondents (including the seven who did not belong to any religion) rated religion as of little or no importance, 13% rated its impor- tance in their life as high to very high, with the remainder (57%) falling somewhere in between and tending towards the lower end of the scale. Respondents drew on multiple sources of infor- mation regarding sexual and reproductive health. The main sources of information were peers (78%), the

media, including books, magazines, television and the internet (72%), followed by mothers (62%) and health professionals (62%; see Figure 1). The books respondents identified as helpful in providing information about sexual and repro- ductive health were those explaining reproduc- tion given to them by their mothers on reaching puberty (25%), school texts such as biology or health and human development texts (30%), and popular texts dealing with sexual and reproduc- tive health. Several respondents identified spe- cific texts they had found helpful, namely, Girl stuff: Your full on guide to the teen years by Cooke (2007), The handbook of sexual and reproductive health by Wingood and DiClemente (2002), and Our bodies ourselves: A new edition for a new era (Boston Womens Health Collective, 2005). One respondent identified novels with explicit sex scenes, such as The Bronze Horseman by Simons (2000), as helpful. Six respondents who returned surveys several weeks into semester also named medical and midwifery texts. The majority of respondents (88%) indicated they read magazines, with by far the most fre- quently cited by the 44 respondents being Cleo (27 or 61.5%) and Cosmopolitan (24 or 55.5%), followed by Marie Claire (7) and New Woman (6), with Dolly (6) and Girlfriend (4) noted as having been read when younger, aged 1416 years. Other magazines identified were Womens Weekly (3), Madison (3), New Woman (3) and Good Medicine (2). One respondent cited LOTL, a magazine for young lesbian women. The information provided by Cleo and Cosmopolitan was reported by those providing qualitative responses (40%) to be predominantly about sex, with the focus on sexual techniques aimed at improving the readers sex life. Other articles noted included those about STIs and safe sex practices and the importance of screen- ing programs such as pap smears and mammo- grams. It was noted by one respondent that, most magazines seem to give advice on how to have good sex, not necessarily safe sex, i.e. safe, both emotionally and physically. Dolly and Girlfriend were found to be helpful and entertaining with respect to reproductive and sexual issues, particularly during early teens, by pro- viding information in an easily accessible for- mat, without the embarrassment of having to ask somebody. They also were seen as providing information that answered a lot of the ques- tions I had regarding sexuality and reproduction when I was 1316 years old and made me feel normal, i.e. knowing everyone was experiencing the same thing. The magazines cited less often, and more likely to be cited by the respondents aged over 21, such as New Woman and Madison, were seen to provide relationship advice, medical advice, advice regarding safe sex practices, the importance of screening for breast and cervical cancer, information about alternative therapies and womens experiences of breast cancer and postnatal depression, as opposed to articles fea- turing explicit discussions about sex and sexual techniques. The extent to which the magazines were found to be helpful for the 88% who read them varied from very helpful (52%), to of some help (25%), to not helpful at all (23%). Those who found them very helpful noted that they were interest- ing and sometimes informative, provided relevant and up to date

information for their age group, as well as information not necessarily easily accessed elsewhere, such as from family members: They (Cleo and Cosmo) deal with relationships, guys opinions [re sex] in addition to sexual health you dont find in a text book and is rel- evant to my age. (Respondent 7) Yes. Cosmo is extremely helpful. It discusses many issues regarding sexual health from symptoms and advice to strategies for preven- tion. They give you the facts and tell it how it is! (Respondent 11) I believe that these days they are [useful] for they deal with and provide the right infor- mation about issues that are problems in our age group. They talk about most things that text books cover but in a more informal way that makes the reader feel more comfortable with it and [is] easier for them to understand. (Respondent 20) Helpful and appeal to my interests. Provide information about how to use condoms safely, new mothers experiences, sex positions [tech- niques], traumatic sexual experiences, etc. (Respondent 10) Cleo and Cosmo as well as a lot of rubbish, pro- vide detailed information on rape, abortion, STIs, etc, who to contact for assistance what to do, etc. in laymans terms. (Respondent 21) Magazines that had a section for readers to write in seeking medical advice were also seen as helpful: Good Medicine was helpful. They have a section where the readers can write in their problems/ questions to the doctor. Also provide educa- tion information. (Respondent 13) [When younger] I loved the Dear Dolly sec- tion for sexual education. (Respondent 16) Those that found magazines of no or limited help noted that while they found them entertain- ing, they took much of what was written at face value and wouldnt consider them the ultimate in professional advice. Another respondent stated that, while some magazine articles are helpful, I think they (particularly Cleo and Cosmo) encour- age a culture of sex obsession. Other sources of information identified included television programs (25%), most particularly Australian programs on channel SBS and ABC (public TV channels with little or no advertising). The ABC science program Catalyst was cited by four respondents with one stating that it provided expert and cutting edge advice. Fact sheets from chemists and doctors surgeries, newspaper articles and the internet were also cited as sources of information (50%). Understanding of reproductive and sexual health Not surprisingly, the majority (78%) indicated they understood their bodily reproductive func- tions. What was surprising was that 22% did not and of the 78% who said they did, 13 (23%) gave incomplete or incorrect estimates of their most fertile period, with one simply stating Im not sexually active. Another respondent who indicated she did not know her most fertile period saw it as irrelevant noting I dont intend to have sex until Im married. Only 48% indicated that they understood Chlamydia to be the most commonly

sexu- ally transmitted infection. Some respondents (8) ticked Chlamydia along with other infec- tions such as Gonnorheoa (3), Syphilis (3) and HIV (2). Other responses ranged across the five options, usually ticking multiple boxes. When asked about their understanding of other infec- tions transmitted by sexual intercourse they were aware of with possible long term complications, five respondents cited the risk of contracting papillomavirus, two of whom later referred to the recent media attention the vaccine had received as very positive. Both had contracted the PPV. Individuals and factors influential in decision making The individuals viewed as influential to highly influential in decision making regarding sexual health were mothers (48%), partners (46%) and peers (40%; see Table 1). While peers scored highly as sources of infor- mation (see Figure 1), they were cited less often than mothers and partners as influential in deci- sion making. Factors identified as influential to highly influen- tial in decision making, both positive and negative, with regards to sexual and reproductive health were knowledge base (79%), followed closely by family values (71%), with use of alcohol and drugs also seen as influential by 42%, followed by magazines (27%), books (25%), TV and movies (19%). Knowledge base and family values were seen as largely exerting a positive influence, while the media including magazines, books, TV and the movies could be both. Use of alcohol and drugs not surprisingly was viewed as having a nega- tive influence on decisions, with three respon- dents reporting that decisions to have sex made while drunk were often poor decisions that were regretted. Religious beliefs were seen as least important, with only 15% viewing them as influ- ential. Not surprisingly, all but one of the 13% of respondents who rated the importance of religion in their lives as high to very high, also identified it as an important or very important factor in deci- sion making regarding sexual and reproductive health. The exception was the respondent who identified as Buddhist. Health seeking behaviours and use of services Nearly two-thirds (65.96%) had sought general health advice regarding sexual and reproductive health. Over half (54.17%) reported having regu- lar pap smears, with all but one of the respondents aged over 21 years indicating they had regular pap smears. Nearly half (47%) regularly examined their breasts. A majority (79.17%) had sought contraceptive advice from health professionals. General practitioners (GPs) were cited as the most frequently used service (86%), followed by Womens Clinics (16%) and Community Health Centres (8%). While Womens Clinics and Community Health Centres were found to be holistic and able to easily provide referrals to allied health professionals such as psycholo- gists, GPs were overwhelmingly seen as helpful, up to date and approachable. More than half the 86% who used the services of a GP indicated that their GP was female. All comments (and most chose to comment) regarding care received from GPs were positive and are reflected in the examples below: I can talk to her (GP) about issues and get her professional advice. (Respondent 7)

They (GPs) know what to look for and how to help clear concise information. (Respondent 30) My GP is very gentle, kind and compassion- ate as well. I feel very comfortable with her. (Respondent 36) Health concerns When asked to indicate from a list provided what constituted a health concern with regard to reproductive health, 28% saw smoking and 30% viewed excessive alcohol intake as risky in terms of long term reproductive health. In terms of sexual health, pressure to have sex was a concern for 36% of respondents, with pressure to engage in unprotected sex a concern for 40%. Over a third viewed excessive alcohol consumption (38%) and use of drugs (36%) as an issue in terms of decision making, followed by pressure to engage in sex perceived as risky (26%; see Figure 2). When asked to specify what constituted a risky sexual activity, 45 or 90% responded providing a range of activities including the following: unpro- tected sex, that is without a condom as well as without any form of contraception (almost all), multiple partners, one night stands, no knowledge of sexual history of casual partners, anonymous sex with a stranger, anything involving drugs, that is having sex while under the influence of drugs and/or alcohol, any situation where you feel threatened in or out of a relationship and finally anything you dont want to do is risky with one facetiously noting sex with a gay porn star. When asked to write about their thoughts, feelings and concerns regarding sexual and repro- ductive health, 20 respondents wrote at length. A number reiterated the concerns they, and/ or young women generally, felt to engage in sex and the difficulties experienced in saying no, the double standard that still operated, along with the problems they had experienced becoming comfortable and confident sexually: Another theme was the quality of education provided at school, with several respondents not- ing that magazines were useful to fill in the gaps: Other respondents in a similar vein, but far more critical of Catholic and fundamentalist Christian positions, bemoaned the lack of relevant education as a result of religious beliefs noting: Others considered that the availability of general education and information over and above that provided in schools was lacking and that as a consequence young women were being put at risk: Two young women also wrote of the regrets they had related to having their first sexual experi- ence when too young. One woman had her first sexual relationship with someone she had cared about, however she regretted it: Virtues So what? Alternative