# Assessing Nursing Students’ Readiness to Address Sexual Health: Psychometric and A Mixed-Method Approach

## TL;DR

This study evaluates a tool to assess Serbian nursing students' readiness to discuss sexual health and finds they face communication barriers despite positive attitudes.

## Contribution

The study validates a culturally adapted Serbian version of the SA-SH-Ext tool and explores barriers to sexual health communication among nursing students.

## Key findings

- A four-factor model explaining 60.6% of variance was identified in the Serbian SA-SH-Ext scale.
- Male and younger students reported higher comfort levels in discussing sexual health.
- Qualitative analysis revealed discomfort and limited training as major barriers to communication.

## Abstract

Background/Objectives: Sexual health is a crucial yet often overlooked aspect of nursing care, and nursing students often lack the communication skills needed to discuss it. Although several instruments are available to evaluate students’ attitudes and barriers, evidence on culturally adapted tools for Serbian nursing students remains limited. Therefore, the study aimed to assess the psychometric properties of the Serbian version of the SA-SH-Ext and to explore nursing students’ attitudes and barriers to sexual health communication. Methods: A sequential mixed-methods design was used. A total of 180 nursing students completed the SA-SH-Ext and SABS scales, followed by psychometric analysis including exploratory and confirmatory factor analyses and reliability testing. Semi-structured interviews with 20 students were thematically analysed to explore experiences and communication challenges. Results: Factor analysis yielded a four-factor model with the factors Being Comfortable, Communication with People with Disabilities, Future Patient and Working Relations, and Education and Competence, which explained 60.6% of the variance. The scale demonstrated strong internal consistency. Male and younger students reported higher comfort levels. Qualitative findings revealed discomfort, limited training, and fear of patient reactions, especially when discussing sexual health with older, disabled, or terminally ill patients. Conclusions: The Serbian SA-SH-Ext is a valid and reliable tool for assessing readiness to address sexual health. Despite positive attitudes, students face significant barriers. Integrating structured education into nursing curricula is essential to building competence and reducing stigma around sexual health in clinical practice.