Determinants of sexual self-efficacy among Iranian married women: a path analysis using the WHO framework – BioMed Central

Research Methodology in Alignment with Sustainable Development Goals

Study Design and Participant Framework

A cross-sectional study was executed in 2025, involving 424 women at selected health centers in Tehran, Iran. This research directly supports the advancement of several Sustainable Development Goals (SDGs) by investigating key determinants of women’s health and well-being.

• Sample Size: A minimum requirement of 384 participants was calculated based on established formulas (Z = 1.96, σ = 6, d = 0.6). To account for potential attrition, the final sample size was increased by 10% to 424 participants.
• Core Focus: The study’s focus on sexual health aligns with SDG 3 (Good Health and Well-being), particularly Target 3.7 concerning universal access to sexual and reproductive health care, and SDG 5 (Gender Equality) by addressing a critical aspect of women’s health and empowerment.

Sampling Strategy and Contribution to SDG 10

A multistage sampling technique was employed to ensure a representative sample, thereby contributing to SDG 10 (Reduced Inequalities). The methodology was designed to capture socioeconomic diversity within the Tehran metropolitan area.

1. Clustering: Health Centers affiliated with Shahid Beheshti University of Medical Sciences were stratified into five geographic clusters (Center, North, South, East, and West) to reflect varied socioeconomic conditions.
2. Random Selection: From these clusters, ten centers were randomly selected (two from each region) using a random number table.
3. Participant Recruitment: Eligible individuals were then randomly selected from these designated centers.

Participant Selection Criteria

Strict inclusion and exclusion criteria were established to maintain the integrity of the data and ensure the study’s focus on the target demographic, further supporting the objectives of SDG 3 and SDG 5.

• Inclusion Criteria: Participants were required to be Iranian nationals, literate, married, and within the reproductive age range of 18–45 years.
• Exclusion Criteria: Individuals were excluded if they were unwilling to participate, provided incomplete responses, used medications affecting sexual function (e.g., SSRIs), had documented mental or physical conditions impacting sexual health (e.g., depression, diabetes), were pregnant or in the postpartum period, or had a history of specific gynecological surgeries (e.g., oophorectomy).

Data Collection Instruments and SDG Linkages

Data were gathered using a suite of validated questionnaires, each corresponding to specific social determinants of health and directly relevant to multiple SDGs.

• Sexual Self-Efficacy Questionnaire (SSEQ): This 10-item tool measures a key component of sexual well-being. Its use provides critical data for SDG 3 (Good Health and Well-being) and informs efforts toward female empowerment under SDG 5 (Gender Equality).
• Multidimensional Scale of Perceived Social Support (MSPSS): This 12-item scale assesses social support systems, a crucial factor for mental health and resilience, aligning with the holistic health approach of SDG 3.
• WHO Intimate Partner Violence Questionnaire: This instrument directly measures physical, sexual, and emotional violence. The data collected are vital for monitoring progress on SDG 5 (Gender Equality), specifically Target 5.2 (eliminate violence against women), and SDG 16 (Peace, Justice and Strong Institutions), specifically Target 16.1 (reduce all forms of violence).
• Perceived Stress Scale (PSS): This 14-item scale evaluates stress levels, a significant determinant of mental and physical health, contributing valuable insights for SDG 3.
• Ghodratnama Socioeconomic Status (SES) Questionnaire: This 12-item survey assesses socioeconomic determinants. Its inclusion is fundamental to understanding and addressing health disparities, directly supporting the mission of SDG 10 (Reduced Inequalities).

Ethical Framework and Alignment with SDG 16

The study adhered to rigorous ethical standards, reflecting the principles of SDG 16 (Peace, Justice and Strong Institutions), which advocates for accountable and inclusive institutions. The protocol was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.PHARMACY.REC.1403.285). All participants were fully informed of the study’s objectives and provided written consent. Confidentiality and the voluntary nature of participation were guaranteed, ensuring that participants’ rights were protected throughout the research process.

Data Analysis and Conceptual Model

Data were analyzed using SPSS-21 and AMOS 24 software. The analysis employed descriptive statistics and path analysis to examine the relationships between variables. The conceptual model was structured according to the WHO framework on social determinants of health, providing a clear pathway for understanding how various factors impact health outcomes relevant to the SDGs.

• Statistical Methods: The analysis utilized Pearson’s and Spearman’s correlation coefficients and path analysis, with a significance level set at p
• Conceptual Model Determinants:
  • Structural Determinants: Socioeconomic status, spouse’s education, and age were analyzed as foundational factors, linking directly to SDG 10 (Reduced Inequalities).
  • Intermediate Determinants: Intimate partner violence, perceived stress, and perceived social support were examined as intermediary factors that connect structural conditions to health outcomes, reflecting the concerns of SDG 3, SDG 5, and SDG 16.
  • Health Outcome: Sexual self-efficacy was the primary health outcome, representing a key indicator for progress in SDG 3 and SDG 5.

Sustainable Development Goals (SDGs) Analysis

1. Relevant Sustainable Development Goals (SDGs)

1. SDG 3: Good Health and Well-being
   • The article is fundamentally a health study, focusing on the “sexual health outcomes” and “sexual self-efficacy” of reproductive-aged women. It investigates factors that impact women’s health, such as stress and violence, which directly aligns with the goal of ensuring healthy lives and promoting well-being.
2. SDG 5: Gender Equality
   • The study exclusively targets women and measures “Intimate Partner Violence” (IPV), including physical, psychological, and sexual violence. This directly addresses the goal of eliminating all forms of violence against women and promoting their empowerment and health. The focus on women’s sexual health is also a key component of gender equality.
3. SDG 10: Reduced Inequalities
   • The research framework is built on the “social determinants of health,” explicitly measuring “Socioeconomic Status (SES)” through factors like income, education, and housing. By analyzing how these structural determinants impact health outcomes (sexual self-efficacy), the study directly investigates health inequalities within a population, which is a core concern of SDG 10.

2. Specific SDG Targets

1. Target 3.7: Ensure universal access to sexual and reproductive health-care services.
   • The article’s central theme is “sexual self-efficacy,” a crucial component of sexual and reproductive health. By studying the factors that affect women’s sexual health, the research provides data essential for developing strategies and programs aimed at improving access to information and services related to sexual well-being, as called for in this target.
2. Target 5.2: Eliminate all forms of violence against all women and girls in the public and private spheres.
   • This target is directly addressed through the use of the “WHO Intimate Partner Violence Questionnaire.” The article details the measurement of “physical, psychological, or sexual violence” experienced by women from their partners. This data collection method is designed to quantify the prevalence of violence against women, which is the primary focus of Target 5.2.
3. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of… economic or other status.
   • The study’s methodology, which examines the relationship between “Socioeconomic Status (SES)” and health outcomes, is directly relevant to this target. It seeks to understand how economic disparities (measured by the SES questionnaire) create inequalities in health and well-being. This analysis is crucial for identifying and addressing the social exclusion faced by individuals of lower socioeconomic status.

3. Indicators for Measuring Progress

1. Indicator related to Target 5.2 (Specifically Indicator 5.2.1): Proportion of ever-partnered women subjected to physical, sexual or psychological violence by a current or former intimate partner.
   • The article explicitly mentions using the “WHO Intimate Partner Violence Questionnaire” to assess “physical, psychological, or sexual violence.” The methodology describes that “Individuals who respond positively to any question in the survey are classified as experiencing violence.” This method directly collects the data needed to calculate this specific UN indicator.
2. Implied Indicator for Target 3.7: Measures of sexual health and well-being.
   • While not a formal UN indicator, the “Sexual Self-Efficacy Questionnaire (SSEQ)” serves as a practical indicator for measuring progress towards sexual health. The article states that scores from this questionnaire indicate “low, moderate, and high levels of self-efficacy,” providing a quantifiable measure of an important aspect of sexual and reproductive health.
3. Implied Indicator for Target 10.2: Disaggregation of health data by socioeconomic status.
   • The article uses the “Ghodratnama Socioeconomic Status (SES) questionnaire” to classify participants based on economic class, income, education, and housing. By analyzing health outcomes (sexual self-efficacy) in relation to these SES scores, the study employs a methodology of data disaggregation. This process is a key indicator of efforts to monitor and reduce health inequalities based on economic status.

Summary Table of Findings

Source: reproductive-health-journal.biomedcentral.com