An Investigation of the Sexual Health Promotion Needs of Undergraduate Women Aged 18-25 years within a Recognised Sexual Health Risk Window

  • Jenny Rosalie

Student thesis: Doctoral ThesisDoctor of Health (DHealth)


AbstractThe aim of this study was to investigate the sexual health needs of undergraduate women aged 18-25 years old who were sexually active but not married or cohabiting; in order to put forward recommendations for a health promotion intervention which may be applied in the practice setting.The thesis consists of three linked qualitative studies. The Part 1 study was an in-depth exploration of the women’s sexual lifestyles and behaviours to identify their health promotion needs. This study was conducted using a phenomenological approach employing Interpretative Phenomenological Analysis (IPA). The Part 2 study was the systematic development of theoretically robust, evidence based intervention to respond to the health promotion needs identified in the Part 1 study. The third study was a consultation review of the initial materials with focus groups of undergraduate women aged 18-25 years old. The aim of which was to refine and amend the intervention to reflect the women’s perspectives. To undertake these tasks Intervention Mapping (IM) (Bartholomew et al., 2006) a health promotion programme planning framework was used as a guiding framework for the thesis. This study revealed the women traversed different types of sexual relationships. Within all types of relationships the women reported being risk averse and valued positive sexual health. Where a threat to sexual health was identified, they took action to reduce the threat. The threats identified differed depending on the relationship type. The distinct relationship types presented differing patterns of decision making, influenced by their values, emotional salience of the relationships and perception of sexual health risk. As such the different sexual health practices presented differing sexual health challenges and health promotion needs. This thesis suggests a quaternary model of female sexual agency outlining four distinct types of relationships - type (1) sexual debut and initial relationships, characterised by high emotion, type (2) casual sexual relationships, characterised by increasing sexual confidence and hedonistic attitudes, type (3) established but not permanent relationships, characterised by relationship stability but not sexual exclusivity (i.e. biological concurrency/behavioural concurrency) and type(4) marriage/cohabitation type relationships, characterised by increased sexual exclusivity.Many women described moving from type 1 relationships into type 2 relationships and then onto a type 3 relationship. However, once beyond type 1 the relationship types were not linear, the women described movement back and forth between type 2 and type 3 relationships. These were frequently with different partners, but could be with the same partner, for example; previous type 3 partners (established) could become a type 2 (casual partner). The study brought to light differing social constructs and expressions of female sexuality and sexual agency within the different relationship types. This enabled the identification of risk behaviours and their determinants, which in turn facilitated the process of intervention development. This enabled the creation of a tailored response to the women’s sexual health needs; thereby assisting the women to make fully informed contraceptive and sexual health choices. The study revealed how each step of the IM process contributes to the whole, augmenting the potential efficacy of the health promotion tools produced.
Date of Award1 Sept 2014
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorFiona Gillison (Supervisor)


  • Sexual health
  • Young women
  • Health Promotion

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