Development of a Web-based Sexual Health Program for Women Undergoing Treatment for Gynecologic Cancer and Their Partners

Ju-Hee Nho

doi:10.4069/kjwhn.2016.22.2.104

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Nho: Development of a Web-based Sexual Health Program for Women Undergoing Treatment for Gynecologic Cancer and Their Partners

Original Article

Korean Journal of Women Health Nursing 2016; 22(2): 104-115.

Published online: 28 June 2016

DOI: https://doi.org/10.4069/kjwhn.2016.22.2.104

Development of a Web-based Sexual Health Program for Women Undergoing Treatment for Gynecologic Cancer and Their Partners

Ju-Hee Nho

College of Nursing, Chonnam National University, Gwangju, Korea.

Corresponding author: Nho, Ju-Hee. College of Nursing, Chonnam National University, 160, Baekseo-ro, Dong-gu, Gwangju 61469, Korea. Tel: +82-62-530-4949, Fax: +82-62-227-4009, jhnho@jnu.ac.kr

Received 17 May 2016 Revised 16 June 2016 Accepted 16 June 2016

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to develop a web-based sexual health program for women undergoing treatment for gynecologic cancer and their partners, and to evaluate the validity of the developed program.

Methods

A web-based sexual health program was developed and evaluated: analysis (needs assessment on 23 patients and content analysis through literature review and web search), design, development, implementation, and evaluation.

Results

The web-based sexual health program for women undergoing treatment for gynecologic cancer and their partners was structured with sexual life, sexual response cycle, change of sexual function, sexual dysfunction related to treatment, and useful method for sexual dysfunction. This program included a video to improve for understanding and a bulletin board to promote bi-directional interactions between program users and providers. Experts and users rated this program in terms of efficacy, convenience, design, relevance, and usefulness. This program contents were found appropriate and satisfactory to both experts and users.

Conclusion

This web-based sexual health program for women undergoing treatment for gynecologic cancer and their partners would contribute to sexual health promotion for gynecologic cancer women and their partners.

Keywords: Gynecologic neoplasm, Internet, Sexual health

Figures and Tables

Figure 1

Program development process.

Table 1

Needs Assessment for Web based Program of Gynecologic Cancer Patients

Demographic characteristics		Categories	n (%) or M±SD
Age			52.6±7.8
Marital status		Married	23 (100.0)
Education level		≤Middle school	5 (21.7)
		High school	12 (52.2)
		≥College	6 (26.0)
Period after diagnosis (months)			6.22±8.41
Diagnosis		Cervix cancer	12 (52.2)
Diagnosis		Ovarian cancer	11 (47.8)
Stage		1	8 (34.8)
		2	4 (17.4)
		3	7 (30.4)
		4	4 (17.4)
Treatment (multiple choice)		Surgery (yes)	18 (78.3)
		Chemotherapy (yes)	23 (100)
		Radiation (yes)	9 (39.1)
Needs related to web based program	Need of web based program (yes)		23 (100.0)
	Intention of web based program (yes)		18 (78.2)
	Access to program	Internet	7 (30.4)
		Mobile	12 (52.2)
		No matter	4 (17.3)
	Reason for web based program (n=9)	Getting information	7 (77.8)
	Reason for web based program (n=9)	Embarrassed to ask healthcare provider	2 (22.2)
	Contents of web based program (open ended question, number of answer=116)	Anatomy of female reproductive system	17 (14.7)
		Sexual cycle	14 (12.1)
		Alterations of sexual function	29 (25.0)
		Helping method for sexual dysfunction	56 (48.3)
	Encourage and leading method to participate the program	One-on-one counseling	4 (17.4)
		Compensation	11 (47.8)
		Telephone counseling	4 (17.4)
		Text message and e-mail	3 (13.0)
		Continuous follow up	1 (4.3)
	Compensation	Gift card	13 (56.5)
		Educational brochure	4 (17.4)
		Cosmetics samples	4 (17.4)
		Lubrication	2 (8.7)
Environmental analysis	Internet available	Yes	23 (100)
	Internet using time/week		2.38±2.11
	Purpose of internet use	Shopping	14 (60.9)
		Search	3 (13.0)
		Study	2 (8.6)
		Others	4 (17.4)

Table 2

Summary of Literature Review on Studies related to Sexual Health of Gynecologic Cancer Women

Author(s) (Year of publication)	Contents
Falk et al. (2013); DeSimone et al. (2014); Bodurka et al. (2006); Nho et al. (2012); Pinar et al. (2016); Carter et al. (2013); Katz (2008); Chow et al. (2014); Sun et al. (2005); Brotto et al. (2008); Nho (2013); Hawkins et al. (2009); Ratner et al. (2010); Hunter (2014); Hill et al. (2011); Hummel et al. (2015); Chun (2011); Krychman (2006)	Sexual dysfunction of gynecologic cancer women
	- Decreased libido, pain, menopausal symptom, decreased orgasm, shortened vagina, psychosocial distress, decreased intimacy
Katz (2009); Nho (2013); Brotto et al. (2008); Chun (2011); Moon (2011); Manne et al. (2005); Kalaitzi et al. (2007); Massimo et al. (2009); Rosemary et al. (2009); Ryu (2010); Shah et al . (2016); Babor et al. (2016); Hummel et al. (2015); Hill et al. (2011); Yun et al. (2012); Jones et al. (2011)	Helping methods for sexual activity in gynecologic cancer women
	- Finding erogenous zone, feeling orgasm, various position, lubrication, vaginal dilator, Kegel exercise, focus sensation exercise, communication method
Schover et al. (2012); Wang et al. (2015); Cox et al. (2009); Schover et al. (2013); Classen et al. (2013)	Effects of web based program -Enhancement of sexual function and relationship, decreased sexual distress
World Health Organization, Medicinenet, Cancer.net, MD Anderson cancer clinic, Memorial Sloan Kettering Cancer Center, Dana Farber Cancer Institute, National Comprehensive Cancer Network, Cancer-sexuality.com, University of Wisconsin health center, Mayo clinic, Massachusetts General Hospital, Harvard Medical School, American Cancer Society, Asan Medical center, Samsung Medical center	Web site review
	- Definition of gynecologic cancer, treatment modality, sexual dysfunction, helping methods for sexual activity (hormone therapy, lubrication, vaginal dilatation, Kegel exercise, focus sensation exercise, communication method)

Table 3

Contents of Web based Sexual Health Program

Heading	Contents
Gynecologic cancer patients and sexual life	· Overview of sexual activity in gynecologic cancer patients
	· Misunderstanding about sexual life in cancer patients
	· Female anatomy structure
Sexual response cycle	· Desire, plateau, orgasm, resolution
Change of sexual function	· Decreased libido, pain, menopausal symptom, decreased orgasm
Sexual dysfunction related to treatment	· Surgery: post operation care, shortened vagina after radical hysterectomy, infection and discomfort, discomfort according to stoma, stoma care
	· Radiation therapy: stricture of vagina, pain
	· Chemotherapy: physical problem (fatigue, nasea/vomiting, anorexia), psychological problem (body image, anxiety, depression), financial problem, fertility
	· Hormone therapy: atrophy of vagina, decreased lubrication
Helping methods	· Finding erogenous zone: difference women and man, using cotton or feather
	· Feeling orgasm: imagery, various position, stimulation of erogenous zone
	· Using various tools: using lubrication and vaginal dilator, management of menopausal symptoms (hormone therapy, rest, restrict caffeine)
	· Kegel exercise: finding vaginal muscle, method of exercise
	· Focus sensation exercise: facial and body focus sensation exercise
	· Communication skill: I-message
Video of cancer and sexual life	· Provide an information about cancer and sexual life of women
Bulletin board/ notice	· One-on-one counseling between program experts and users
Bulletin board/ notice	· Sharing information between program users
Questionnaire	· Evaluation of appropriateness and satisfaction about the program

Table 4

Evaluation of Satisfaction of Web based Program (N=51)

Variables	Categories	Experts (n=23)	Users (n=28)
Variables	Categories	M±SD	M±SD
System efficiency		4.20±0.75	4.14±0.59
	Easy to connect	4.22±0.74	4.21±0.79
	Fast to search information	4.17±0.83	4.07±0.60
System convenience		4.23±0.65	4.07±0.50
	Easy contact to operator	4.13±0.87	4.00±0.67
	Easy to use the system	4.39±0.78	4.11±0.57
	Friendly to use	4.17±0.72	4.11±0.69
Design	Fancy design	4.00±0.67	3.96±0.74
Information relevance		4.32±0.58	4.19±0.44
	Well arranged information	4.39±0.72	4.21±0.74
	Up-to-date information	4.22±0.80	4.14±0.65
	Clear information	4.26±0.75	4.21±0.57
	Necessary information	4.52±0.59	4.29±0.81
	Reliable information	4.52±0.51	4.14±0.59
	Accurate contents	4.30±0.63	4.14±0.71
	Rich contents	4.17±0.78	4.14±0.59
	Detailed contents	4.17±0.78	4.21±0.69
Information usefulness		4.42±0.65	4.21±0.53
	Information related to patients	4.30±0.76	4.32±0.55
	Useful for health behavior	4.43±0.66	4.21±0.63
	Easy to understand	4.52±0.67	4.11±0.69

Notes

This study was financially supported by Chonnam National University(Grant number: 2015-0608/2016-0312).

Summary Statement

▪ What is already known about this topic?

Sexual dysfunction is a major problem for gynecologic cancer patients. Healthcare professionals need to consider their sexual health.

▪ What this paper adds?

A web-based sexual health program for women undergoing treatment for gynecologic cancer and their partners was developed in response to the need of assessment for gynecologic cancer patients and literature reviews. This program showed high level of satisfaction from gynecologic cancer patients and healthcare providers.

▪ Implications for practice, education and/or policy

This web-based sexual health program can be applied and extended not only to gynecologic cancer patients and their partners but also to other cancer patients in various clinical conditions.

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