A brief blended training course was associated with better attitudes toward sexual health care and fewer perceived barriers to discussing it among nurses in a randomized trial. The differences were present at both one and three months, and nurses assigned to the course reported more discussions of sexual health with patients than at baseline, while changes in the standard-education group were not significant.
The intervention combined five 15-minute online courses with a two-hour in-person session and was added to standard in-service education. The comparison group received standard in-service education without the added course, so the trial compared the blended training with standard education.
How the trial was run
The study enrolled 150 in-service nurses and randomly assigned 75 to the course group and 75 to the standard-education group. It was a prospective, single-blinded, two-group randomized controlled trial registered at ClinicalTrials.gov and reported using CONSORT guidelines. An independently generated sequence and sealed opaque envelopes concealed allocation, and outcome assessors and analysts were blinded. All 150 completed the baseline assessment, but attrition occurred at the one-month and three-month follow-ups.
Researchers measured attitudes with a 17-item, three-point Sexual Health Care Scale-Attitudes, where higher scores meant more positive attitudes. Perceived barriers were measured with a 10-item, five-point scale ranging from 1, strongly agree, to 5, strongly disagree; higher scores indicated greater barriers. The reported internal consistency was .90 for the attitude measure and .79 for the barrier measure.
The biggest shifts were in attitudes and barriers
On the attitude scale, the intervention group’s standardized measure of change, Cohen’s d, was 1.22 at one month and 1.45 at three months. The control group’s corresponding values were 0.05 and 0.28. In plain terms, attitudes improved significantly in the intervention group at both follow-ups, while the control group showed no significant early change and only a small later improvement.
Perceived barriers moved in the opposite direction. The intervention group’s Cohen’s d was -0.95 at one month and -1.18 at three months, corresponding to substantial reductions in barrier scores. The control group’s values were -0.07 and -0.30, indicating smaller decreases. An analysis that compared change over time while adjusting for age, gender and sex education courses at work found that the groups changed differently for both outcomes at both follow-ups; all four group-by-time tests had p values below .001.
Patient conversations rose, but the measure was self-reported
The behavioral measure pointed in the same direction. At baseline, 8 of 75 nurses in the intervention group said they had discussed sexual health with patients. That number was 15 of 68 at one month and 19 of 60 at three months. Changes in the control group were not significant.
The changing follow-up denominators reflect attrition. The intervention group’s reported discussion rate was 10.7% at baseline, 22.1% at one month and 31.7% at three months. Because the measure was self-reported, the authors said the study could not provide certainty about the objective behavioral change.
The results need careful reading
The trial offers evidence of short-term differences between the groups, but its reach is limited. It was conducted at a single center, relied on self-reported outcomes and followed participants for three months. Those limits make it harder to know whether the changes would persist, whether they would appear in other settings, or how closely reported conversations reflect actual practice.
The randomized comparison supports short-term findings in this nurse sample, but it does not establish effects beyond three months or broad generalization. Longer follow-up, studies in more than one center and objective assessments would be needed to address the uncertainties identified by the authors.
Paper data and sources
Original title: Effectiveness of a Small Private Online Course in Sexual Health Communication for Registered Nurses: A Randomized Controlled Trial.
Authors: Hsien-Tsung Chang, Jia-Ling Tsai, Chiu-Tzu Lin et al.
Journal/Repository: The journal of nursing research : JNR
Status: Peer-reviewed
First online: 2026-10-01
DOI: 10.1097/jnr.0000000000000751
Original paper · Full text