Study design and setting

This research is a mixed-method study of sequential exploratory type (Qual-quan) which will be conducted in two phases. At the beginning of the first phase, a qualitative study will be conducted to explore the needs to acquire sexual competence in young adult women and discover ways to improve it. Based on the findings of this study and after reviewing the literature, an intervention program to improve sexual competence in young adult women will be designed and prepared. After the experts approve the intervention program, in the second phase, a quantitative study will be conducted to determine the effect of the intervention program on improving the sexual competence of young adult women about to get married.

The first phase: This phase includes the steps of qualitative study, literature review, and development of an intervention program to improve the sexual competence of young adult women, which is as follows:

First step: a qualitative study

In this phase, to identify the needs of acquiring sexual competence and to explore the strategies for improving sexual competence, a qualitative study will be conducted with a content analysis approach.

Study participants and sampling method

The participants in this phase of the study are young adult women aged 18 to 25 who go to counseling centers, clinics, and health centers to receive health services and pre-marital education. Also, the teachers of pre-marriage classes, midwives, gynecologists, reproductive health specialists, psychiatrists, and psychologists who work in the field of sexual health will be participants. For young adult women about to get married, Purposive sampling will be with maximum diversity in terms of characteristics such as age, occupation, level of education, economic status, way of getting to know the spouse, and birth rank (the number of children in the family). The selection of other participants in the research will also start in a Purposive manner and will continue with the strategy of maximum diversity in terms of work experience.

Inclusion criteria for adult women about to get married are

Informed consent to participate in the study, ability to communicate and interview, no history of attending pre-marriage classes, young adult women about to get married for the first time.

Inclusion criteria for other contributors include

Informed consent to participate in the study, teaching experience in pre-marriage classes for more than 2 years (about pre-marriage class teachers).

Data collection technique

To collect data, in-depth individual interviews will be conducted in a semi-structured way. At first, the researcher introduces herself to the participants and establishes a friendly relationship with the people, the objectives of the research will be explained and they are assured of the complete confidentiality of their answers. Written informed consent will also be obtained. The location of the interview will be determined according to the wishes of the people, and then the interviews will begin using guide questions (Table 1).

Table 1 An example of interview guide questions

To deeply analyze the data, the interview sessions are recorded. After the analysis, if needed, additional interviews will be conducted with the participants or other people who can have more key information related to the phenomenon under study. Immediately after each session, all recorded conversations are written in full. In this research, taking notes in the field will also be used to collect data, for this purpose, the researcher will pay attention to the non-verbal behaviors of the participants and their attitudes and interactions during the interviews and will note them down.

Sampling continues gradually until data saturation is reached. In other words, until no more new information is obtained during data analysis and coding (saturation); Sampling will continue.

Data analysis

To analyze the data, the conventional content analysis method with the approach proposed by Graneheim and Lundman will be used. After each interview, the recorded interview is transcribed verbatim. Then, by repeatedly reading all the data, the researcher will get an overview that leads to the formation of a semantic unit. In the next step, the semantic units are converted into a more concise and dense form, and at this time, the words that contain the key concepts are highlighted, and thus the codes will be extracted. Then, different codes are placed in sub-categories based on their relationship with each other, and these sub-categories form category based on similarities and differences with each other. Finally, the category will form the main category based on their similarities and differences with each other [29]. MAXQDA 10 software will be used for better data management.

Trustworthiness of qualitative data

To ensure the accuracy of the research findings, four criteria will be used (credibility, dependability, conformability, and transferability) [30]. To ensure the credibility of the study, in-depth interviews at different times and places, selection of participants with maximum variety, peer debriefing and, member check will be used. To ensure the dependability of the findings, all the activities and steps of the work will be described in detail. Also, the external observer will be used to check his/her possible similar understanding with the researchers and search for discrepancies. To confirm the transferability, the research results will be presented to four people with the profiles of the participants who did not participate in the research. For conformability, the extracted codes will be given to several faculty members who are familiar with the method of qualitative research analysis and did not participate in the research team, so that the correctness of the coding and class extraction process can be checked.

Second step: literature review

At this stage, the researcher will review the texts using the matrix method to review the existing knowledge in the field of sexual competence needs, strategies, programs and interventions to promote sexual competence and to confirm and complete the needs discovered in the qualitative phase. Search in Persian electronic databases: SID, Magiran, and English databases: ProQuest, Web of Sciences, PubMed, Cochrane Library, Scopus, using the keywords “program” AND “Pre-marriage classes” OR “sexual competence” OR “first sex” AND “young adult” will be done in the period between 2000 and 2023. Also, to complete the search, international guidelines, sex education books and contents of world-reputable sites such as UNESCO, World Health Organization, etc. will also be reviewed.

Inclusion criteria include: full text of studies with quantitative, qualitative, and mixed methods, book review and review of texts in Farsi and English, articles published in the period from 2000 to 2023. Exclusion criteria include: inappropriate content and insufficient data of articles, articles presented in conferences, abstracts and letters to editors.

Third step: Development of an intervention program to improve the sexual competence of young adult women.

At this stage, using the results of the qualitative study and literature review, a draft of the intervention program to improve the sexual competence of young adult women who are about to get married will be developed. Finally, to check the content of the intervention program and validate it, a panel of experts will be held at Isfahan Nursing and Midwifery College. After reviewing the draft program in the panel of experts, if necessary, changes will be made to it according to the experts’ opinions and the intervention program will be finalized for implementation in the next phase. The members of the expert panel will be 15 people and include pre-marital class teachers, midwives, gynecologists, reproductive health specialists, psychiatrists, and psychologists who work in the field of sexual health. Inclusion criteria for expert panel members are having experience and expertise in sexual health, teaching experience in pre-marriage classes for more than 2 years (about pre-marriage class teachers), and willingness to attend panel meetings.

Phase II: quantitative study

The aim of the quantitative study is to determine the impact of the intervention program on the sexual competence of young adult women about to get married. This study is a semi-experimental two-group and three-stage study (before, immediately and, 4 months after the intervention) that will be implemented in premarital counseling centers and selected health centers in Isfahan.

Study participants

It will include young adult women about to get married.

Inclusion criteria include: willingness to participate in the research, age between 18 and 25 years, Iranian nationality, and exclusion criteria include: unwillingness to continue cooperation at any stage of the research and incomplete questionnaires.

Data collection method

At this stage, by referring to premarital counseling centers and health centers, the samples with the Inclusion criteria are selected for the available sampling method. Before the implementation of the program, written informed consent will be obtained from the samples, and then the allocation of the samples into two control and intervention groups will be done by randomization.

Sample size

The sample size was calculated according to (α = 0.05, β = 0.1, SD1 = 8.5, and SD2 = 19.8), 37 people in each group; However, due to increasing the validity of the study and considering at least 20% dropout, the number of samples will be 110 people (55 people in the intervention group and 55 people in the control group).

Methods

The program designed in the previous phase will be implemented for young adult women about to get married in the intervention group. For members of the control group the intervention program will not be implemented; At the end of the study, the content of the sexual competence promotion program will be presented. To evaluate the improvement of sexual competence, the researcher-made questionnaire of sexual competence of young adult women, whose validity and reliability will be determined before the start of the study, will be used in two intervention and control groups before, immediately, and 4 months after the intervention.

Data analysis

Statistical analysis will be done at two descriptive and inferential levels. At the descriptive level, the mean and standard deviation indicators will be used, and at the inferential level, the Variance analysis model with 2 × 3 repeated measures will be used. Statistical analysis is done using SPSS statistical software version 22 and, in all tests, a maximum error of 5% is accepted.

Ethical considerations

This study has been approved by the Ethical Committee of Isfahan University of Medical Sciences. (IR.MUI.NUREMA.REC.1402.160). The researcher will obtain informed consent from the participants for each step of the research. If the participants do not want to continue the study, they can withdraw from the study. In the literature review phase, the principles of literary rights will be observed and the most accurate translation of the contents into Farsi will be done along with citing the sources.