Sexual Health Awareness Scale

The International Journal of Indian Psychology
ISSN 2348-5396 (Online) | ISSN: 2349-3429 (Print)

Volume 10, Issue 4, October- December, 2022
DIP: 18.01.074.20221004, DOI: 10.25215/1004.074
https://www.ijip.in
Research Paper
Sexual Health Awareness Scale (S.H.A.S)
Stuti Parasha Kashyap1, Ashwathy A N2, Shalini Pai3, Serena Ajith4*, Akhila
Asokan5, Grace Maria Jochan6, Trina Banerjee7
ABSTRACT
The understanding people have of sexual health is quiet outdated. This can lead to unsafe
sexual practices and unsatisfactory sexual experiences. The Sexual Health Awareness Scale
can help in analysisng the level of awareness an individual has about sexual health, thereby
providing a reference for sex educators and therapists. The scale explores three main domains
belies about sexual, attitude towards sexual health and sexual practices. The scale uses a
Likert scale. The scale is a self-inventory. Once the participants complete answering the
questions they are scored, interpreted and taken for further analysis. The validity of the scale
was done by the evaluation of subject matter experts. The questions in the scale were tested
for their reliability using SPSS.
Keywords: Sexual Health, Awareness, Scale
H umans have always aimed at improving their health. Though it is an important

component of our lives, the term "health" is frequently used to refer just to physical
well-being. Due to various current public awareness efforts and people discussing
their psychological well-being, the term "health" has been broadened to include mental
health as well. Physical and mental health are extremely significant for our well-being, but
there is a third component to consider when determining physical and mental health: sexual
wellness.
Sexual health has been defined as, “…a state of physical, emotional, mental and social well-
being in relation to sexuality; it is not merely the absence of disease, dysfunction or
infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual
relationships, as well as the possibility of having pleasurable and safe sexual experiences,
free of coercion, discrimination and violence. For sexual health to be attained and
maintained, the sexual rights of all persons must be respected, protected and fulfilled.”
1
I M. Sc. Psychology, Mount Carmel College, Bangalore
2
3
4
5
6
7
*Corresponding Author
Received: February 7, 2022; Revision Received: November 26, 2022; Accepted: December 04, 2022
© 2022, Stuti, P. K., Ashwathy, A. N., Shalini, P., Serena, A., Akhila, A., Grace, M. J. & Trina, B.; licensee IJIP. This
is an Open Access Research distributed under the terms of the Creative Commons Attribution License
(www.creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction
in any Medium, provided the original work is properly cited.
(WHO, 2006a). It is a broad understanding and education of sexuality, sexual rights, and
experiencing sexual closeness and pleasure, not just awareness of safe sex practices and
pregnancy. Sexual health entails being aware of your own and your partner's sexual needs
and boundaries.
Because sex and sexuality are taboo topics in many parts of India, most teenagers still lack
access to proper sex education. Only a few educational institutions provide pupils with sex
education. The general majority's lack of understanding might lead to hazardous sexual
habits. Sexual health is vital because it has an impact on other aspects of your health, such as
your physical and emotional well-being. It is critical to educate adolescents on these topics
in order for them to live a healthy lifestyle.
Certain factors help to identify whether or not a person is sexually healthy. Communication
is one of the most crucial factors. To set boundaries, an individual must be able to
communicate effectively with their relationship. They should also be able to accept their
spouses' refusals without becoming upset or hostile. Communication also necessitates
attentiveness to the partner's nonverbal clues. Knowing about the many types of
contraception and deciding with your partner which contraception best suits you based on
your body and other needs is also part of being sexually healthy. An individual should be
able to experience pleasure, enjoy the entire process leading up to sexual intercourse, and
not experience any bodily pain during sexual coitus. Apart from that, a person should be
able to maintain non-sexual interactions. Negative emotions should not be associated with
pleasurable activities that do not include a spouse.
The Government of India has included Adolescent Reproductive and Sexual Health (ARSH)
services in the school curriculum to help teenagers make educated decisions. However, there
are other challenges to raising awareness among adolescents, including the patriarchal
society and social barriers to speaking with teachers, parents, and elders. Even parents, who
are mainly unskilled and uneducated, limit their conversation with daughters to the topic of
menstruation and are hesitant to discuss problems of safe sex or reproductive health.
Furthermore, they believe that addressing these issues will dilute authoritative parenting and
promote sexual promiscuity.
This scale is used to determine or assess a person's level of sexual awareness. The scale's
findings can be utilised for counselling or any other type of intervention. The scale was also
created for those between the ages of 18 and 25. This can assist people in developing better
sex behaviours at a young age.
REVIEW OF LITERATURE
By the year 2014, the number of young adults contracting sexually transmitted diseases had
seen a rise and survey by the Centres for Disease Control and Prevention on Latinos and
African-Americans proved that many of the young adults between the ages of 13-24 years
did not use protection while having sexual intercourse. According to a study conducted by
researchers from the Penn University, most of young adults use social media as the main
source of information for sex-education. The study also found that participants who had
access to sexual risk reduction information were more prone to the use of birth-control or
protection (Berger, 2017). The above study sheds light on the fact that social media can be a
great tool that can be used by young adults to get information related to sexual health.
Moreover, teens self-socialize, that is, they learn behaviors, values, and their roles through
their interaction with the society. In this new era of digitalization, therefore young adults
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 764
resort to social media as the source for information. It is also a platform for them to explore
their identity and sexual experience anonymously (Nikkelen et al., 2020).
Gamble & Nelson (2016) conducted a study to understand the influence of television
watching and its effect on sexual relationship in young adults. The study indicated that
women were more prone to have higher sexual expectations after watching movies on
television and men generally had a consistent take on this. This result could be attributed to
the fact the movies and television shows indicate the unsatiable sexual nature of males.
Another aspect that could have caused these results would be the ‘the ceiling effect’ which
means that men generally have higher sexual expectations in their relationships so the
relationship television viewing may not have added anything substantially to their
expectations.
Young adult women have also reported having more issues relating to body and sexual
performance than a lot of young adult men. A study has also indicated that men have more
sexual performance expectations from their female partner than women had. This also
implies that viewing of visual pornographic content has caused dissatisfaction with the
partner’s physical appearance, therefore, creating an unrealistic sexual performance
expectation (Goldsmith et al., 2017). A survey report suggests that around 20% of young
adults between the ages of 13-19years have engaged in sending nude images or semi-nude
images or videos of themselves with another teenager. ‘Sexting’, which means sending,
receiving or forwarding sexually explicit messages on text through the use of technology
and internet, has also been reported to be common amongst teenagers (Cookingham & Ryan,
2015).
In India, many factors such as culture, lack of scientific evidence and lack of knowledge
among health care professionals have contributed to the lack of good sex-education (Ismail
et al., 2015). A good sex-education can also develop life-skills required by the individual to
face life and its challenges. Many of the schools and teachers just focus on only the
biological aspect of it, for example some teachers in Nepal but most of the students reported
that they want a sex-education that is more skill based therefore, it is important to shift the
focus from biology alone to skill-based sex education (Netsanet et al., 2012). In a video
released by Netflix in 2020 as a part of their promotions for sex-education series, an
interview was done with many youngsters and their parents on sex-education. There was a
certain discomfort associated with the topic that was evident on the faces of both the
children and their parents while discussing the topics. In the second part of the same video,
the parents and their children were asked to name all the reproductive as well as private parts
by looking at the images. Most of the participants and their parents weren’t able to name the
parts correctly indicating the lack knowledge related to sex (Channa & et.al, 2020).
Higgins, J. A., Mullinax, M., Trussell, J., Davidson Sr, J. K., & Moore, N. B. (2011)
conducted a study to investigate sexual satisfaction and sexual health among university
students in the United States. They surveyed 2168 university students in the United States
and asked them to rate their physiological and psychological satisfaction with their current
sexual lives. Many respondents reported that they were either satisfied (approximately half)
or very satisfied (approximately one third). In multivariate analyses, significant (P < .05)
correlates of both physiological and psychological satisfaction included sexual guilt, sexual
self-comfort, self-esteem (especially among men), relationship status, and sexual frequency.
They concluded that to enhance sexual well-being, public health practitioners should work
to improve sexual self-comfort, alleviate sexual guilt, and promote longer term relationships.
Hogarth, H., & Ingham, R. (2009) conducted an exploratory study to understand

masturbation among young women and associations with sexual health. Thematic analysis
of interview transcripts was employed to identify the range of reported experiences across
participants, as well as the relations between various aspects of sexual development and
experiences within participants. The findings revealed a broad continuum of views and
opinions on female masturbation, which had strong links with parent and partner
communication and the young women's beliefs and values concerning their sexual selves.
The article concludes by drawing attention to the apparent relation between positive early
childhood communication, young women's positive views of their sexual self, and their
subsequent sexual activity.
Birhan, Z., Tushune, K., & Jebena, M. G. (2018) conducted a study to explore Sexual and
reproductive health services use, perceptions, and barriers among young people in southwest
Oromia, Ethiopia. A cross sectional study was employed to collect data from 1,262 in-
school youths. Simple random sampling technique was used to select schools and study
participants.
Fifteen focus group discussions and 22 key informant interviews were conducted. Results
indicated that four hundred sixty (36.5%) of the respondents had utilized sexual and
reproductive health services. Advice on sexual and reproductive health was the major
(67.2%) service sought followed by seeking-treatments (23.3%). Health centers were the
major (65.0%) source of SRH services. Being married, being sexually active, father-child
communication, religion and place of residence were significantly associated with use of
sexual and reproductive health services (p<0.05). Lack of information about SRH, poor
perceptions about SRH, feeling of shame, fear of being seen by others, restrictive cultural
norms, lack of privacy, confidentiality and unavailability of services were deterring use of
sexual and reproductive health services.
Hayter, M., & Harrison, C. (2008) have done an investigation to study gendered attitudes
towards sexual relationships among adolescents attending nurse led sexual health clinics in
England. Ten focus groups (five male and five female) involving sexual health clinic
attendees aged between 14–16 years were conducted. Focus groups were asked to
comment on four sexual relationships ‘case studies’. Group discussions were recorded and
transcribed. Data were subject to thematic analysis. Three themes emerged from the data
analysis. ‘Empathy’ reflected how young women were more likely to try to see their
partner’s point of view. ‘Complexity’ also reflected that young women were more aware of
the complex nature of relationships than were the male participants. ‘Language’ related to
how young males used aggressive language in the context of relationships
– a feature absent from female participants’ discourse.
Weinstein, R. B., Walsh, J. L., & Ward, L. M. (2008) conducted a study to test a new
measure of sexual health knowledge and its connections to students' sex education,
communication, confidence, and condom use. They created a new, comprehensive sexual
health knowledge measure to assess 347 undergraduates' knowledge of reproductive health,
contraception, condom use, sexually transmitted diseases (STDs), and HIV/AIDS. Overall,
students demonstrated a fairly poor understanding of sexual health issues. Women were
more knowledgeable than men, specifically on the topics of contraception and STDs. Prior
exposure to sex education covering mainstream reproductive health issues or newer
contraception methods was correlated with greater knowledge across all domains,
particularly for men. Greater knowledge was also correlated with greater sexual
assertiveness and confidence with condoms among women.
Matsick, J. L., Conley, T. D., Ziegler, A., Moors, A. C., & Rubin, J. D. (2014) conducted a
study to examine whether individuals were more likely to stigmatise relationships that: (i)
focus on loving more than one person (which is characteristic of polyamory), (ii) focus on
having sex without love (which is characteristic of swinging lifestyles), or (iii) involve
having sex without love without a partner’s participation (which is characteristic of open
relationships). Participants were assigned to read a definition of one of the three CNM
relationship types (i.e., a swinging, polyamorous or open relationship) and to indicate their
attitudes towards individuals who participate in those relationships. Results show that
swingers were overwhelmingly perceived more negatively (e.g., less responsible) than
individuals in polyamorous relationships and that people in open relationships were
sometimes perceived more negatively (e.g., less moral) than people in polyamorous
relationships. Overall, findings suggest that people are more uncomfortable with the idea of
strictly sexual relationships (i.e., swinging relationships) than relationships involving
multiple romantic/emotional attachments (i.e., polyamorous relationships).
The paper ‘The sound of silence: talking about sexual orientation and schooling’ by Renee
DePalma and Elizabeth Atkinson is based on a Nuffield Foundation-funded online
discussion project in the United Kingdom, in which higher education students and faculty
were asked to reply to a series of assertions about sexual orientation in the context of
schooling. This research proposes that other degrees of silence functioning inside the
project's larger social, political, and educational environment may have exacerbated the
relative nonparticipation quiet. Data from web forums revealed that infants are viewed as
asexual individuals, that homosexuality is sexualized, and that there is a trend to segregate
the public and private worlds. They also discovered some political correctness, which
reflected the university's legitimized diversity discourses without necessarily addressing the
more uncomfortable questions that accompanied them. Participants also imagined parental,
teacher, or student concerns and shifted the conversation to other areas of concern, which
may have served to shield them from direct involvement with the issues at hand. It was
observed that when these elements are combined, they produce many levels of silence that
aid in the formation and maintenance of heteronormativity while also revealing the
heterosexual matrix's power in action, thereby asserting a need to provide sex education
concerning different sexual orientations.
The paper ‘Sexual and Reproductive Health Information: Disparities Across Sexual
Orientation Groups in Two Cohorts of US Women’ (Tabaac R et al., 2020), was primarily
aimed at discovering the difference in seeking and receiving sexual health information with
respect to a difference in the sexual orientation. The study was done on a sample of US
women with different sexual orientations. Most sexual minority populations were more
likely than the baseline to receive/seek knowledge from peers, the media, and other sources
(e.g., community centres). Sexual minority categories were more likely to receive/seek
information about contraception, with the exception of lesbians, while primarily straight and
bisexual women were more likely to receive information on sexually transmitted infections.
According to the findings, women of various sexual orientations require SRH knowledge
from a variety of sources, including schools, peers, and the media. Many SRH subjects are
received/sought by sexual minority women, indicating that changes to adapt instructional
resources within and outside of schools are needed to optimize SRH benefits to these
communities.
The role of external professionals in education about sexual orientation−towards good

practice (Douglas et al., 2001): As part of their Personal, Social, and Health Education,
young people in England are entitled to a thorough sex education program (PSHE). New
government recommendations on sex and relationship education, as well as pre-existing
concerns about homophobic bullying, sexual health, and mental health, are informing
current debates regarding the content of such a program. An externally sponsored Young
Gay and Bisexual Men's Development Worker in an English local authority delivered
educational activities to four schools to address sexual orientation and identity concerns. The
goal of an evaluation was to determine whether or not success had been achieved and, if so,
why. Another goal was to uncover helpful knowledge on the role of outside specialists in
providing successful sexual orientation education to young people in schools. The
evaluation was created with a number of 'real-world' constraints in mind. Despite this, a
large number of project accomplishments (as well as opportunities for improvement) were
reported. Raising awareness of important topics among students and assisting teachers who
are involved in PSHE were examples of successes. A considered approach to building
partnerships with schools and working with young people were key factors contributing to
success. Other factors include adequate preparation of teachers and pupils in schools, an
appropriately skilled and experienced project worker, and a considered approach to building
partnerships with schools and working with young people. The research, therefore, points
out the importance of the role of teachers and coworkers in improving the efficiency of sex
education programs.
Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex
Education in the U.S: (Stanger-Hall & Hall, 2011)
In terms of teen pregnancies and sexually transmitted diseases, the United States leads the
developed world. For more than a decade, the US government had supported abstinence-
only sex education programmes in an effort to lower these rates. However, there was still
debate among the public over whether this investment was worthwhile and whether these
programmes should be sustained. This study shows that increased emphasis on abstinence
education is positively connected with teenage pregnancy and birth rates using the most
recent national data (2005) from all U.S. states with information on sex education laws or
policies. After controlling for socioeconomic level, teen educational attainment, the ethnic
composition of the teen population, and the availability of Medicaid waivers for family
planning services in each state, this trend remains substantial. The findings clearly
demonstrate that abstinence-only education as a state policy is unsuccessful in avoiding teen
pregnancy and may even be contributing to the country's high teenage pregnancy rates. The
study, therefore, proposes integrating comprehensive sex and STD education into the
biology curriculum in middle and high school science classes, as well as a parallel social
studies curriculum that addresses risk-aversion behaviours and planning for the future, in
accordance with the new evidence-based Teen Pregnancy Prevention Initiative and the
Precaution Adoption Process Model advocated by the National Institutes of Health.
Adolescent sex education in India: Current perspectives (Sathyanarayana Rao et al., 2015):
Adolescent sexual and reproductive health needs in India are currently ignored or
misunderstood by India's healthcare system. This could be due to a lack of scientific
knowledge as well as the public health system's complete lack of preparedness. Healthcare
personnel frequently lack knowledge, which has an impact on their ability to provide
information to the adolescent population. Due to cultural and traditional norms in society,
thorough sexual histories are frequently not taken, and sexual health is seldom freely
discussed. Incorrect information can lead to misunderstanding among youth, making them
less likely to adopt healthy sexual behaviours and attitudes that will help them maintain their
sexual health throughout their lives. After an exploration of information through these pre-
existing data, the paper arrived at certain important conclusions. The provision of
appropriate sex education to adolescent boys and girls may result in a variety of benefits,
including a delay in sexual activity, a reduction in unplanned and early pregnancies and their
associated complications, fewer unwanted children, reduced risks of sexual abuse, greater
completion of education and later marriages, reduced recourse to abortion and the
consequences of unsafe abortion, and a reduction in the spread of sexually transmitted
diseases, such as HIV. To ensure that the process of imparting sex education to stakeholders
is adequately measured and less controversial, a balance between the eagerness and
ambitious plans of NGO's to implement different sexuality education in schools and the
restrictive approach of legislators must be achieved. Incorporating the expertise of
healthcare professionals such as psychologists, social workers, psychiatrists, obstetricians
and gynaecologists, and genito-urinary physicians can help tailor the existing programme so
that it is more likely to be effective in the medium to long term in changing the attitudes and
behaviour of Indian adolescents in a way that benefits their overall and sexual health.
METHODOLOGY
Instructions
“The Sexual Health Awareness Scale consists of 48 statements. Five options are
corresponding to each statement, ranging from Strongly Agree to Strongly Disagree. Read
each statement carefully and choose the most appropriate option that represents you. None
of the answers are right or wrong, therefore please feel free to choose any option. Try not to
use the ‘neutral’ option unless or until it's necessary. There is no time limit to answering the
questionnaire. If you have any doubts regarding the statements, please feel free to clear them
at any point while answering. Please make sure that you have answered all the 48 items
before submitting”.
Precautions/Control
• Make sure the room is properly lit and the environment is noise free.
• The items required for administration of the test (writing material, Sexual Health
Awareness Scale, scoring key and norms) should be arranged before the subject.
• It is made sure that the subject has understood all the instructions clearly.
Scoring
The Sexual Health Awareness Scale uses a five point likert scale ranging from Strongly
Agree, Agree, Neutral, Disagree to Strongly Disagree. The scoring procedure in Sexual
Health.
Awareness Scale is quite objective. The scoring of the 48 items is divided into positive and
negative scoring.
The items3, 4, 5, 6, 7, 8, 9, 10, 13, 14, 15, 16,17, 18, 19, 26, 28, 34, 36, 37, 39, 42, 43, 45,
and 47 are positively scored. These items are scored as mentioned below.
Strongly agree - 5 Agree - 4

Neutral - 3
Disagree - 2
Strongly Disagree - 1
The items 1, 2, 11, 12, 19, 20, 21, 22, 23, 24, 25, 27, 29, 30, 31, 32, 33, 35, 38, 40, 41, 44,
46 and 48 are negatively scored. These items are scored as mentioned below.
Strongly agree - 1 Agree - 2

Neutral - 3
Disagree - 4
Strongly Disagree - 5
Negatively scored items are added to remove aspects such as participant inattention and
satisficing. In the case of this scale, negative items indicate a lack of sexual health awareness
whereas positive items indicate awareness about sexual health practices.
Example of positively scored items:

Q3. “At the beginning of my teenage I was given appropriate sex education” - A person who
‘strongly agrees with this statement is well educated in terms of sexual health, therefore
showing heightened sexual health awareness. Therefore, the statement is positively scored,
where strongly agree = 5.
Example of negatively scored items:

Q1. “I expect my partner to imitate the same behaviour that I see in pornography” - A person
who ‘Strongly agrees’ to this statement does not understand that human sexual behaviour is
unique and are therefore unaware of various aspects of sexual health practices in the domain
of sexual intercourse. Therefore, the item is negatively scored, where strongly disagree = 5
Analysis of scores
After the scores are obtained for each item, add up the scores for the positive and negative
items together. The score thus obtained will be your Sexual Health Awareness score. The
range of the scores can be from 40-240. The 192 points are further divided into three equal
sections with 64 points each (48-112, 113-176, 177-240). The scores thus obtained can be
interpreted according to the range mentioned below.
48 - 112 = Low level of Sexual Health Awareness
113 - 176 = Average level of Sexual Health Awareness
177 - 240 = High level of Sexual Health Awareness
Scale Items
1. I expect my partner to imitate the same behaviour that I see in pornography.
2. I feel that I need to use a different gender on social media than what I generally
identify myself with.
3. At the beginning of my teenage I was given appropriate sex education.
4. I am fully aware of the various risks of teenage pregnancy.
5. I believe that teenage pregnancy results from a lack of sex education.
6. I know all the different methods of contraception
7. I am comfortable speaking about sexual health with friends of the opposite sex.
8. I understand the concept of consent in sexual relationships.
9. Appropriate communication with my partner can improve our sexual relationship.
10. I feel comfortable addressing sexual concerns with my parents
11. I feel masturbation is an act of shame.
12. I believe that in a sexual relationship, both partners should be equally concerned with
each other's pleasure as they are with their own.
13. Sex is a basic human physical need like every other basic human needs of hunger,
thirst, safety and security, etc.
14. I believe sex education and talking about sex openly should be normalized
15. I understand that inability to release the built up sexual energies may lead to sexual
frustration which in turn can affect mental health
16. Sex education is essential for preventing sexually transmitted diseases in youth
17. I know about the different types of sexually transmitted diseases.(STD's)
18. I am comfortable with the sex assigned to me at birth and know the difference
between sex and gender.
19. Sex education is unethical and unnecessary.
20. Parents and teachers are the only ones responsible for teaching kids about sex
education
21. I feel guilty after engaging in any sexually arousing activities or fantasizing about
those.
22. I watch pornographic content often.
23. I learnt about sex by watching pornographic content.
24. I follow social media handles/contents related to sex.
25. I am comfortable sharing photos of my private parts with strangers
26. I accept follow/friend requests from strangers who post explicit photos of
themselves.
27. A man and a woman both should share the responsibility of birth control.
28. I do not hesitate to involve in unprotected sex.
29. I engage in sexually pleasurable activities (like masturbation) independent of any
partner.
30. I believe porn always shows the truth about sex.
31. I believe that actors in pornographic films always enjoy the act of sex.
32. I believe the sexual enhancement pills that are often shown in advertisements work.
33. I believe media (movies/videos/songs) that degrade sexual intercourse are good.
34. At the beginning of my teenage, I was given appropriate sex education.
35. I believe it is inappropriate to engage in sex during adolescence.
36. Masturbation has no side effects to health
37. I believe a partner is not necessary to experience sexual stimulation
38. The ultimate goal of any sexual activity/engagement with a partner must be an
orgasm.
39. I think pleasure is not equivalent to orgasm but it's about the entire journey of sexual
experience.
40. I believe sex can be solely defined in terms of sexual intercourse.
41. I believe sex education can escalate engaging in sexual activities.
42. I am aware of the different sexual identities, orientation
43. I am aware of the LGBTQ community.
44. Learning about sexual education may lead to more sexual assaults.
45. I am familiar with the various biological terminology for private parts
46. I believe sexual intercourse should only be done after marriage
47. Society looks down on talking about sexual education
48. I prefer searching for my doubts on sexual education online rather than asking a
person
Psychometric properties
The original sample for which the scale was developed in 2022 consisted of 252 young
adults (between 18-25 years of age) in India. The scale generally has high reliability and
good content validity. To obtain norms for a sample similar to your own, you must search
the academic literature to find research using similar samples.
Reliability
• Internal consistency is in the range of .805 to .824, and Cronbach's alpha for various
samples are in the range of .795 to .812
• The Sexual Health Awareness Scale presented high ratings in reliability areas;
internal consistency was 0.805.
Validity
This scale has good content validity as the mental health professional’s expertise in this
field. These include
1) Ms. Roseline Florence Gomes: Assistant Professor Department of psychology Jyoti
Nivas College Bangalore
2) Vasundharaa S Nair: Senior Research Fellow - UGC Dept. of Psychiatric Social
Work, NIMHANS, Bengaluru
3) Ms. Aishwarya N: Assistant Professor Department of psychology Christ(Deemed to
be University), Bangalore
Interpretation
The aim of the present research was to develop a tool that measures sexual health awareness
of the young adulthood population. The data was put into SPSS and reliability analysis was
performed. The Cronbach's alpha was found to be 0.78 and after deleting 2 items, the
correlation was increased to 0.804.
Diagramatic representation 1 (Analysis of questions 1-25)
Diagrmatic Representation 2(Analysis of questions 26-50)
It can be observed that the 6th question i.e., “I know all the different methods of
contraception” has an item-total correlation of .439, which can be interpreted as a good
correlation with other items. The item is based on awareness about sexual health which the
scale is aiming to measure. Being aware of all the different methods of contraception is
important before making any decision about engaging in sexual activity with a partner and it
contributes to sexual well-being. Therefore, this is a good item.
It can be seen that the 7th question i.e., “I’m comfortable speaking about sexual health with
friends of the opposite sex” has a corrected item correlation of 0.440, which can be
interpreted as a good correlation with other items. The item is based on the topic of sexual
health conversation with the opposite sex which is a true representation of what the scale
aims to measure. It’s important to have an open conversation about sex and topics related to
it in order to promote and have sexual health awareness. Conversation with the opposite sex
is focused on the item because of the boundaries and distinctions set by the society based on
gender due to which people are conditioned to be ashamed of talking about these matters
with the opposite sex. It’s important to know about different experiences related to sex to
broaden one’s awareness. Hence conversation is important. This indicates that the item is a
good item.
The 11th question i.e., “I feel masturbation is an act of shame” has a good correlation with
other items with a corrected item-total correlation of 0.451. The item is negatively framed
i.e., opposite to what scale is measuring to see the direction of the responses and ensure the
item is read properly before responding. The item is good as it measures what it aims to
measure. Self-stimulating activities like masturbation are prohibited in many religious and
cultural beliefs (Aneja. J, Grover. S, Avasthi. A, 2015) and there is a shame attached to
female masturbation in the society (Clayton. W & Humphreys. G, 2017). However,
masturbation actually has no side effects to health and in fact, it can be good for health both
mentally and physically, contributing to sexual and overall well being.
The 12th item i.e., “I care about my partner's pleasure more than my own” has a corrected
item-total correlation of -0.044 which is not indicative of a good correlation with other
items. However, this item was decided to be kept because it has a good theoretical
framework. In a sexual relationship, it’s important to care about each other’s pleasure
equally, in the same way as they care about their own for a healthy relationship as sexual
satisfaction is important from both sides and influences the relationship (Rokach. A., Patel.
K., 2021). It’s important to know this for sexual awareness and practice this for promoting
good sexual health and well being. Therefore we decided to reframe this item into “I believe
that in a sexual relationship, both partners should be equally concerned with each other's
pleasure as they are with their own” and keep it.
The 16th and 17th items i.e., “sex education is essential for preventing sexually transmitted
diseases in youth” and “I know about the different types of sexually transmitted diseases”
has a good corrected item-total correlation of 0.421 and 0.407. It’s important to obtain the
right sex education to prevent sexually transmitted diseases in youth (Cortínez-López. A,
Cuesta-Lozano. D, and Luengo-González. R, 2021) as they are the important population
who are primarily suffering from the lack of sex education and poor sexual health well
being. It’s also important to know different types of sexually transmitted diseases. These are
the factors that together contribute to sexual health awareness and sexual well being. These
are the factors indicative of a good item for the tool.
The 20th item i.e., “Parents and teachers are the only ones responsible for teaching kids
about sex education” has a good correlation with other items with a corrected item-total
correlation of 0.179. It’s a good item as it’s important to be aware of the fact that parents and
teachers are not the only ones responsible for it but the media and society as a whole are
responsible to promote sexual health. Knowing about this contributes to good awareness of
sexual health.
The 21st item i.e., “I feel guilty after engaging in any sexually arousing activities or
fantasizing about those” has a corrected item-total correlation of 0.464. The positive
correlation and good theoretical framework supported preventing the item from deletion.
Guilt experienced after engaging in masturbation or any such sexually arousing activities
can be associated with poor mental health (Aneja. J, Grover. S, Avasthi. A, 2015), and the
guilt maybe be because of a variety of factors and one of the factors might be lack of sex
education leading to poor sexual awareness. Therefore, it suggests that it’s a good item.
The 31st item i.e., “I believe that actors in pornographic films always enjoy the act of sex”
has a good corrected item-total correlation of 0.362 indicating a good correlation with other
items and that it’s a good item. It’s important to know that the actors do not always enjoy the
act of sex as shown in those films because most of the youth of our nation lacks sex
education and therefore one of the sources from where they learn about sex is a
pornographic film. They tend to believe that whatever is shown is the right thing and the
experience of pleasure that is shown applies to everyone. So they try to imitate what is
shown in the film. But the truth is those films only set unrealistic standards and the
experiences that bring pleasure are subjective and can be different for different people
(Quadara. A, El- Murr. A, Latham. J, 2017). Therefore not knowing about the above factors
can be attributed to low sexual awareness. The above factors indicate that it’s a good item
and tends to measure what it aims to measure.
The 41st item i.e., “I believe sex education can escalate engaging in sexual activities” has a
good corrected item-total correlation of 0.101 which is indicative of a relatively good
correlation with other items. It’s a wrong interpretation of people that sex education
escalates engaging in sexual activities. Studies show that sex education delays sex among
youths and increase knowledge about reproductive health and results in safe sexual activities
(Barnett. B, 1997). Knowing about this fact can significantly contribute to eradicating the
stigma attached to sex education and therefore improve overall sexual health awareness
among youth. The item is framed in the opposite direction of what the scale aims to measure
to see if the people believe in the widely accepted myth about sex education which can have
an impact on the level of sexual awareness. Therefore, this item is a good one.
The 45th item i.e., “I’m familiar with the various biological terminology about private parts”
has a corrected item-total correlation of 0.429 which is indicative of a good correlation with
other items on the scale. Knowing the various biological terminology about private parts is
important to determine sexual health awareness. Therefore, the item measures what the scale
intends to measure, which is indicative of a good item.
When the questionnaire was initially designed, it comprised 50 questions. Two of these
items were removed after being subject to reliability analysis. The item "I believe that my
society is sexually uninformed" has a corrected item correlation of -.195. The value of
Cronbach's alpha also remains close to .79 after deletion, suggesting an increase in the
Cronbach's value. The item "I always use the internet to clarify my doubts whenever I am
curious about subjects related to sex" has a corrected item correlation of -.053. The value of
Cronbach’s alpha also remains close to .792 after deletion, suggesting an increase in the
Cronbach's value. It was also discovered that the aspects measured by this question were
measured by a similar question. Therefore, these two questions were deleted.
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Acknowledgement
The author appreciates all those who participated in the study and helped to facilitate the
research process.
Conflict of Interest
The author declared no conflict of interest.
How to cite this article: Stuti, P. K., Ashwathy, A. N., Shalini, P., Serena, A., Akhila, A.,
Grace, M. J. & Trina, B. (2022). Sexual Health Awareness Scale (S.H.A.S). International
Journal of Indian Psychology, 10(4), 763-779. DIP:18.01.074.20221004, DOI:10.25215/1004
.074
Appendix
Appendix A Table A1
Item no. Corrected Item-Total Correlation Cronbach's Alpha if Item Deleted
Q1 .326 .800 Q2 .078 .806 Q3 .007 .811 Q4 .377 .798 Q5 .204 .803
Q6 .440 .796 Q7 .441 .795 Q8 .495 .797 Q9 .360 .800 Q10 .184 .805
Q11 .452 .796 Q12 .464 .795 Q13 -.044 .811 Q14 .203 .803 Q15 .402
.799 Q16 .283 .801 Q17 .422 .799 Q18 .408 .797 Q19 .268 .802 Q20
.179 .804 Q21 -.036 .812
Q22 .246 .802 Q23 -.147 .815 Q24 .012 .807 Q25 .121 .805 Q26
.204 .803 Q27 .121 .806 Q28 .180 .805 Q29 .351 .801 Q30 .462 .797
Q31 .362 .799 Q32 .279 .801 Q33 .386 .798 Q34 .006 .811 Q35 .167
.805 Q36 .310 .800 Q37 .373 .798 Q38 .339 .799 Q39 .446 .797 Q40
.329 .800 Q41 .101 .807 Q42 .472 .796 Q43 .386 .799 Q44 .311 .801
Q45 .430 .797 Q46 .364 .798 Q47 .211 .803 Q48 .142 .805
Table A2
Cronbach’s Alpha Cronbach'
Alpha Based on Standardized Items
N of items
.805 .824 48
Appendix B
S. H. A. S: Sexual Health Awareness Scale

Stuti Parasha Kashyap
Ashwathy A N
Shalini Pai
Serena Ajith
Akhila Asokan
Please fill up the following information:

Name:
Age:
Gender:
Education:
Date:
Instructions:
There are some statements given in the following pages, read each statement carefully and
choose the option you think is the most appropriate. There are five alternatives for each
statement- Strongly Agree (SA), Agree (A), Neutral (N), Disagree (D) and Strongly
Disagree (SD). Put a cross mark ( X ) against the option you choose. However, choose the
Neutral (N) option only if you absolutely do not agree with the other options.
SA- Strongly Agree
A- Agree
N- Neutral
D- Disagree
SD- Strongly Disagree
SN Questions SA A N D SD
1 I expect my partner to imitate the same behaviour that I see in pornography.
2 I feel that I need to use a different gender on social media than what I
generally identify myself with.
3 At the beginning of my teenage I was given appropriate sex education.
4 I am fully aware of the various risks of teenage pregnancy.
5 I believe that teenage pregnancy results from a lack of sex
6 education. I know all the different methods of contraception
7 I am comfortable speaking about sexual health with friends of the
opposite sex
8 I understand the concept of consent in sexual relationships.
9 Appropriate communication with my partner can improve our
sexual relationship.
10 I feel comfortable addressing sexual concerns with my parents
11 I feel masturbation is an act of shame.
12 I feel guilty after engaging in any sexually arousing activities or fantasizing
about those.
13 I care about my partner’s pleasure more than my own
14 Sex is a basic human physical need like every other basic need of hunger,
thirst, safety, security, etc.
15 I believe sex education and talking about sex openly should be normalized
16 I understand that inability to release the built-up sexual energies may lead to
sexual frustration which in turn can affect mental health
17 Sex education is essential for preventing sexually transmitted diseases in
youth
18 I know about the different types of sexually transmitted diseases.(STD's)
19 I am comfortable with the sex assigned to me at birth and know the
difference between sex and gender.
20 Parents and teachers are the only ones responsible for teaching kids about
sex education
21 I watch pornographic content often.
22 I learnt about sex by watching pornographic content.
23 I follow social media handles/content related to sex.
24 I am comfortable sharing photos of my private parts with strangers
25 I accept follow/friend requests from strangers who post explicit
photos of themselves.
26 A man and a woman both should share the responsibility of birth
control.
27 I do not hesitate to involve in unprotected sex.
28 I engage in sexually pleasurable activities (like masturbation) independent of
any partner.
29 Sex Education is unethical and unnecessary.
30 I believe porn always shows the truth about sex.
31 I believe that actors in pornographic films always enjoy the act of sex.
32 I believe the sexual enhancement pills that are often shown in
advertisements work.
33 I believe media (movies/videos/songs) that degrade sexual intercourse are
good.
34 At the beginning of my teenage, I was given appropriate sex education.

35 I believe it is inappropriate to engage in sex during adolescence.
36 Masturbation has no side effects on health
37 I believe a partner is not necessary to experience sexual stimulation
38 The ultimate goal of any sexual activity/engagement with a partner must be
an orgasm.
39 I think pleasure is not equivalent to orgasm but it's about the entire journey
of sexual experience.
40 I believe sex can be solely defined in terms of sexual intercourse.
41 I believe sex education can escalate engaging in sexual activities.
42 I am aware of the different sexual identities, orientation
43 I am aware of the LGBTQ community.
44 Learning about sexual education may lead to more sexual assaults.
45 I am familiar with the various biological terminology for private parts
46 I believe sexual intercourse should only be done after marriage
47 Society looks down on talking about sexual education
48 I prefer searching for my doubts on sexual education online rather than
asking a person
S. H. A. S
Scoring manual for Sexual Health Awareness Scale
Question Number Scoring
3, 4, 5, 6, 7, 8, 9, 10, 13, 14, 15, 16,17, 18, 19,
26, 28, 34, 36, 37, 39, 42, 43, 45, 47
SA A N D SD
54321
1, 2, 11, 12, 20, 21, 22, 23, 24, 25, 27, 29, 30, 31,
32, 33, 35, 38, 40, 41, 44, 46, 48
SA A N D SD
12345
Calculate the Total score and interpret using the following table.
Total Score Interpretation.
177 - 240 High level of Sexual Health Awareness
113 - 176 Average level of Sexual Health Awareness
48 - 112 Low level of Sexual Health Awareness

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The International Journal of Indian Psychology

ISSN 2348-5396 (Online) | ISSN: 2349-3429 (Print)

Sexual Health Awareness Scale (S.H.A.S)

Keywords: Sexual Health, Awareness, Scale

H umans have always aimed at improving their health. Though it is an important

Hogarth, H., & Ingham, R. (2009) conducted an exploratory study to understand

The role of external professionals in education about sexual orientation−towards good

Strongly agree - 5 Agree - 4

Strongly agree - 1 Agree - 2

Example of positively scored items:

Example of negatively scored items:

Diagramatic representation 1 (Analysis of questions 1-25)

Diagrmatic Representation 2(Analysis of questions 26-50)

S. H. A. S: Sexual Health Awareness Scale

Please fill up the following information:

34 At the beginning of my teenage, I was given appropriate sex education.

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