Volume 12, Issue 3 (Summer 2024)                   Iran J Health Sci 2024, 12(3): 205-212 | Back to browse issues page

Ethics code: IR.MAZUMS.REC.1398.1281


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Nabavi H S, Ganji J, Mohammadpour R A, Hamidi F, Shahhosseini Z. Barriers to the Father-adolescent Sexual Communication: A Cross-sectional Study. Iran J Health Sci 2024; 12 (3) :205-212
URL: http://jhs.mazums.ac.ir/article-1-933-en.html
Department of Reproductive Health and Midwifery, Sexual and Reproductive Health Research Center, Nasibeh Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran. , zshahhosseini@yahoo.com
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Introduction
As a crucial stage in human development, adolescence is accompanied by changes in social, sexual, emotional, and cognitive functions [1]. These alterations cause adolescents to develop new demands, including sex education [2]. Various studies demonstrate that education related to sexual issues and reproductive health is conveyed through parent-adolescent sexual communication. Also, parents should talk about sex early and through multiple topics. They also advised parents to be open, honest, and realistic [3-7].
Sexual communication refers to the verbal and non-verbal exchange of feelings and thoughts about sexual issues such as sex education, the prevention of sexually transmitted infections, unintended pregnancies, and sexual violence [8, 9]. This instrument is primary and essential to transfer parents’ values, beliefs, knowledge, and expectations to teenagers regarding sexual issues [10]. Sexually risky behaviors among adolescents remain a major problem worldwide [11]. Studies show that parent-adolescent sexual communication effectively prevents high-risk sexual behaviors at an early age [12, 13]. Nevertheless, fathers may tend to talk to their children about sexual issues when they enter a romantic relationship [14, 15], or they may refrain from talking due to limited knowledge about sexual health and discomfort discussing sexual matters [1617]. However, research has indicated that delaying sexual communication increases the probability of engaging in sexual activity at a younger age [18-20] and leads to acquiring conflicting information and values from peers and the Internet [21-25].
The prevalence of sexual communication between parents and adolescents varies in different countries with different cultures. Research reveals that 90% of American adolescents discuss sex-related topics with their parents [14], whereas it is 33% in Mexico [26] and 17% in Nigeria [27]. Additionally, the prevalence of parent-adolescent sexual communication varies depending on the adolescent’s gender, so it is more likely that fathers have sexual communication with their sons than with their daughters [4]. On the other hand, fathers might discuss their daughters about menstruation two times more than they talk about it to their sons, while they speak of ejaculation and condom use to their daughters 60% less than they talk about it to their sons [26]. 
In addition to addressing the existing research gap concerning father-adolescent communication, it is pertinent to acknowledge the absence of studies examining barriers to such communication from the father’s perspective. While previous research has predominantly focused on maternal involvement in sexual communication with adolescents, there remains a significant knowledge gap regarding the unique challenges and obstacles faced by fathers in engaging in these conversations. This study aims to fill this void by identifying and exploring various barriers hindering sexual communication between fathers and adolescents. Specifically, this research will delve into barriers such as knowledge gaps, feelings of embarrassment, and perceived deficiencies in parenting skills that may impede fathers’ ability to communicate with their teenage children about sexual topics effectively. By comprehensively examining these barriers, this study seeks to provide valuable insights into how interventions and support mechanisms can be tailored to enhance father-adolescent sexual communication and promote healthier relationships within families.
Therefore, investigating the sexual communication between fathers and adolescents can partially deepen our knowledge of this issue in various communities, particularly developing countries. Consequently, this study intended to determine the barriers to sexual communication between fathers and adolescents.

Materials and Methods
Stud
y design
This cross-sectional study, recruiting fathers of adolescent children covered by health centers in Sari, northern Iran, was conducted between August 2020 and January 2021.

Sample size
Assuming P=50% (prevalence of parent-adolescent sexual communication), Z=1.96 (95% confidence interval [CI]), d=0.05 (margin of error), and 10% sample attrition (because of excluding samples during the study), the number of the initial samples was calculated 210 based on the Equation 1:



Sampling method
Using a random number table, the researchers selected 30 health facilities from the 133 centers in Sari’s West, East, and Central regions. Then, they obtained the list of households with at least one adolescent (girl or boy) from each center and contacted 210 fathers via phone based on the random sampling method (i.e. using a random number table). Fathers who met the inclusion criteria were invited to complete the self-report questionnaires in person at the health centers. 

Inclusion and exclusion criteria
The inclusion criteria included fathers having at least one 15- to 19-year-old adolescent child (girl or boy) and having elementary literacy, whereas the exclusion criterion was single-parent households.

Measurements
The socio-demographic information form asks questions about the adolescent’s age and gender and the father’s education, employment status, sources of information, satisfaction with the family’s socioeconomic class, and alcohol or drug use.
The researcher-constructed scale, “parent-adolescent sexual communication topics,” contains 23 phrases with a 3-point Likert scale (including never: 1, sometimes: 2, and often: 3). The sum of the scores ranges from 23 to 69. The content validity of this scale was assessed and approved using the opinion of 10 experts (3 psychologists, 4 psychiatrists, and 3 professors in midwifery). The researchers measured its reliability in a two-stage study with 20 fathers who completed the questionnaire at a two-week interval. The Cronbach α of both stages was 0.96 with a correlation coefficient of 0.99 (P<0.01), indicating the acceptable reliability of the scale [28]. In the present study, a score equal to the median (median=30) and below was considered the lack of sexual communication between fathers and adolescents [29].
The barriers to parent-adolescent sexual communication questionnaire, with 17 items, was developed by Jaccard et al. [30]. The researchers measured the reliability of this questionnaire in a two-stage study with 20 fathers who completed the questionnaire at a two-week interval. The Cronbach α was 0.92 at the first stage and 0.90 at the second stage, with a correlation coefficient of 0.99 (P<0.01), indicating the acceptable reliability of the questionnaire. Also, the validity and reliability of this questionnaire were assessed and proved in Iran [31].

Data analysis
Data analysis was done using SPSS software version 18, calculating the Mean±SD, frequency, and percentage. Moreover, the logistic regression test was run at a significance level 0.05.

Results
In the present study, 13 fathers declined to participate despite the initial agreement and many phone follow-ups. Overall, 196 questionnaires were completed (93% response rate). Among the participants, 104 fathers (53%) had sons, and 92(47%) had daughters. The mean age was 47.38±5.04 for fathers, 16.79±1.46 for boys, and 17.00±1.30 for girls. Table 1 summarizes the demographic features of the participants.


Overall, 88 participants (44.9%) reported father-adolescent sexual communication. The frequency of father-daughter communication was 51.1%, whereas that of father-son communication was 55.8%. The results show that the most discussed sexual topic between father and son is puberty changes (29.8%), while it is about prevention from sexual abuse (21.7%) between father and daughter. According to the findings, 91.3% of fathers have never talked to their sons, and 97.8% have never spoken to their daughters about high-risk sex.
According to Table 2, most fathers (47.4%) considered puberty the most appropriate time to start sexual communication with a teenager, and the main reason was the father’s initiative (74.9%).


Based on the findings, fathers believed that the three main barriers to father-son sexual communication included creating a sense of curiosity in the adolescents (54.8%), embarrassing them (45.2%), and approving the sexual relationship (40.4%). In addition, they declared that three significant barriers in their sexual communication with their daughters included embarrassing the adolescent (73.9%), creating a sense of curiosity in the adolescent (71.8%), and not talking with the adolescent because they obtained the information from other sources (54.4%).
Investigating the predictors of sexual communication between fathers and adolescents using logistic regression demonstrated that the odds of sexual communication were 86% less in fathers who believed that talking about sexual topics would embarrass their children, 65% less in fathers who believed if they talked to their children about sexual health topics, they would think that they approved of them having sex, and 71% less in fathers who believed if they talked to their children about sexual issues, they felt they did not trust them. According to the study results, the odds of father-adolescent sexual communication in fathers, who believe that if they talked to their children about sexual issues, they might ask more private questions, were five times more than others (Table 3).



Discussion
In the discussion, the findings underscore the prevalence of father-adolescent sexual communication, albeit at varying frequencies between father-daughter and father-son dyads. The topics discussed also differed, with puberty changes dominating conversations with sons, while prevention from sexual abuse was more prevalent in discussions with daughters. Notably, a significant portion of fathers had not broached the topic of high-risk sexual behavior with their adolescent children, indicating potential communication gaps that may leave adolescents vulnerable. 
The timing and initiation of sexual communication were largely attributed to the father’s initiative around the onset of puberty. Identified barriers to communication included concerns about embarrassing the adolescent, fostering curiosity, and perceptions of approval or trust. Logistic regression analysis revealed that these barriers significantly influenced the likelihood of engaging in sexual communication, highlighting the need for targeted interventions to address them and facilitate more open and effective dialogue between fathers and adolescents about sexual matters.
Father-child sexual communication, as one of the main pillars of communication on sexual topics in families, depends on various factors in the socio-cultural context of the societies [32]. The present study investigated the barriers to sexual communication between fathers and adolescents. Since few studies have been conducted in this field, it can expand the depth of our knowledge about this issue.
The results show that less than half of the fathers have sexual communication with their children, whereas Dessie et al. [33] demonstrate that it is 30.9%, less than the prevalence obtained in the present study. In the current study, the most sexual communication between fathers and sons was about puberty and its changes, which is in line with the findings of Lehr et al. [34]. They revealed a relationship between the boys’ puberty-related growth and development and the amount of father-son sexual communication. According to the results, the topics discussed between fathers and daughters are primarily about how to prevent sexual abuse. This finding is consistent with Miller et al., declaring that fathers are more willing to talk to girls about their partner’s pressure to have sex [35]. Similar to other studies [19, 24], most fathers believe that the most appropriate time to start sexual communication with a teenager is during early puberty (10-13 years old) and middle (14-17 years old), and the main reason that triggers sexual communication with a teenager is the father’s initiative [19, 36]. Thus, fathers must create a more open atmosphere in the family so that teenagers can freely raise their questions and concerns regarding sexual issues.
Consistent with Jaccard et al. [30], fathers believe that one of the main barriers to sexual communication with their children is the adolescent’s embarrassment. Another barrier is that they think talking to teenagers about such issues approves of them having sex; therefore, they refuse to talk about sex with their children [3738]. Similar to previous literature [39, 40], fathers state that it is difficult to discuss sexual issues with their children. Hence, their inability to communicate with their children and initiate a conversation should be considered in programs to improve their communication skills. 
In this study, 25% of fathers declare that talking about sexual issues may make teenagers think that they do not trust them. This concern has resulted in a 71% decrease in the probability of father-adolescent sexual communication, although it may not be only for parents. Correspondingly, Cederbaum et al. [41] report that girls avoid talking to their mothers about sex out of fear of losing their trust.
In contrast to Jaccard et al. [30], this study reveals that fathers who believe their teenagers will ask them more personal questions when discussing sexual issues talk about sexual matters with their children five times more than others. Research shows that adolescents’ access to various information sources regarding sexual and reproductive health is related to the increased probability of sexual communication with their parents, and this knowledge can prime them to communicate and initiate such conversation [42]. Therefore, it seems that raising private questions by adolescents leads to increased participation in sexual communication, resulting in the maintenance of adolescent-father sexual communication. 

Conclusion
The present study investigated father-adolescent sexual communication, the discussed sexual topics, the barriers, and the related factors. Identifying the current situation by considering obstacles such as the adolescents’ embarrassment, fathers’ concern about adolescents becoming curious about sex, and the difficulty of talking about sexual topics for fathers can be helpful for the policymakers to develop effective counseling and psychological interventions for the adolescents’ health. This will create a more suitable space for fathers and teenagers, especially fathers and daughters, and facilitate such family communication.

Study limitations
Like any other study, this study was subjected to some limitations. First, the sexual communication between fathers and adolescents was measured only based on the answers provided by the fathers. Moreover, the cultural sensitivity to the research questions might have caused information bias. Finally, cause and effect relationships could not be established between the investigated variables due to the study’s cross-sectional nature.

Ethical Considerations
Compliance with ethical guidelines

The study protocol was performed according to the Helsinki Declaration. Informed consent was obtained from the participants. Written informed consent was obtained from the participants for publication and any accompanying images. The Ethics Committee of Mazandaran University of Medical Sciences approved this study (Code: IR.MAZUMS.REC.1398.1281). 

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Authors contributions
All authors equally contributed to preparing this article.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgements
The authors express their gratitude to all study participants.


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Type of Study: Original Article | Subject: Midwifery

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