Journal of Health Literacy

Journal of Health Literacy

Predictors of Mothers' Practices in Child Sexuality Education: The Role of Sexual Health Literacy in a Population-Based Study from Southeast Iran

Articles in Press

Document Type : Original Article

Authors
Maryam Dadvand 1
Hosein Izadirad 2
Fatemeh Azaryan 1
1 BSc. Student Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
2 Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
10.22038/jhl.2026.95474.1961
Abstract
Background and Objective: Child Sexuality Education (CSE) is vital for child development and preventing sexual harm. In conservative Iran, where formal sex education is limited, mothers are primary educators. While previous studies focused on cultural barriers or were qualitative, the role of modifiable SHL in maternal practices remains unexplored. This study examined the association between maternal SHL and practices in child sexuality education, controlling for demographics, in southeastern Iran.

Materials and Methods: This cross-sectional study was conducted on 300 mothers of children aged 5–12 years in Saravan, Iran, selected via multi-stage random sampling. Data were collected using the validated Sexual Health Literacy for Adults (SHELA) questionnaire and a localized, culturally adapted knowledge and practice questionnaire. The latter demonstrated strong psychometric properties (CVR=0.94; Cronbach's α=0.84; test-retest reliability coefficient=0.70). Hierarchical regression was employed to quantify the unique variance explained by SHL after controlling for demographic variables (age, education, marital status, income, and employment).

Results: The mean SHL score was 34.65 out of 100 (indicating an 'inadequate' level), and the mean practice score was 19.86 out of 45. The hierarchical model was significant (F(7, 292)=75.34, p<0.001) and accounted for 67.4% of the variance in practices (R²=0.674; Adjusted R²=0.665). After controlling for demographic factors, SHL emerged as the dominant correlate of maternal practices (β=0.777; 95% CI:0.350 to 0.424; p<0.001). Among demographic variables, only education remained a small but significant contributor (β=0.097; p=0.020).

Conclusion: The findings demonstrate a strong positive association between maternal SHL and practices in child sexuality education—an association that substantially outweighs demographic factors and underscores SHL's potential as a modifiable target for interventions, though causal inferences are precluded. The low SHL scores highlight an urgent need for targeted literacy-focused interventions; however, given the cross-sectional design, these findings suggest promise but require rigorous interventional and longitudinal studies to establish causality and effectiveness before widespread implementation. However, the cross-sectional design and single-city sampling preclude causal inference and limit generalizability. The potential influence of unmeasured confounders (e.g., cultural beliefs, prior educational exposure) should be acknowledged.
Keywords
Sexual Health
Child Rearing
Mothers
Parent-Child Relations
Health Knowledge, Attitudes, Practice
Iran

Acknowledgments: The authors would like to express their sincere gratitude to all the mothers who participated in this study, without whose cooperation this research would not have been possible. We also extend our thanks to the staff of the comprehensive health service centers in Saravan for their valuable assistance in the data collection process. 


Availability of data and materials: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.


Conflict of interest: The authors declare that they have no competing interests.


Consent for publication: Not applicable.


Ethics approval and consent to participate: This study was conducted in accordance with the ethical standards of the Declaration of Helsinki (1964) and its later amendments. The research protocol was approved by the Ethics Committee of Zahedan University of Medical Sciences (Ethical code: IR.ZAUMS.REC.1403.106). Written informed consent was obtained from all individual participants included in the study.


Funding: This research received financial support from Zahedan University of Medical Sciences. The funder had no role in the design, execution, or writing of the study.


Author contributions: Author 1 (Maryam Dadvand): Conceptualization, Methodology, Formal Analysis, Investigation, Writing – Original Draft, Project Administration. Author 2(Hossein Izadirad): Methodology, Validation, Investigation, Data Curation, Writing – Review & Editing. Author 3 (Fatemeh azaryan): Software, Formal Analysis, Resources, Writing – Review & Editing, Visualization. All authors reviewed and approved the final version of the manuscript.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/

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Journal of Health Literacy

Articles in Press, Accepted Manuscript
Available Online from 19 September 2026