Let's Talk About Sex - Or Not: Sexual Communication, Self-Efficacy, and Sexual Healthcare Use Among Individuals With and Without Communication Difficulties

Abstract

Sexual communication is an essential element of sexual satisfaction and wellbeing. However, individuals with communication difficulties (in reading, writing, speaking, or understanding language) may face barriers to sexual communication in interpersonal and healthcare contexts. Based on previous research, communication difficulties are associated with reduced intimacy (Lemieux et al., 2001; Korpelainen et al., 1999), difficulty accessing healthcare (Stransky et al., 2018), and increased vulnerability to sexual assault (Brownlie et al., 2007; 2017). Individuals with communication difficulties also report lower general and social self-efficacy compared to individuals without communication difficulties (Botting et al., 2016; Durkin et al., 2017). Given these low levels of self-efficacy, it was hypothesized that individuals with communication difficulties may have less confidence in their ability to navigate discussions of sex and sexual health. Using Social Cognitive Theory (SCT) (Bandura; 1986) as a framework, this study explored the relationship between self-efficacy and subsequent sexual behaviours (use of sexual healthcare services, avoidance of sexual healthcare services, use of protection during sexual encounters, and frequency of sexual health discussions with a partner). Participants with and without communication difficulties completed an anonymous online survey (N = 262; N = 43 with self-reported communication difficulties; Mage = 28.39, SDage = 10.97; 185 females). Mann Whitney U-tests compared individuals with and without communication difficulties on three measures of self-efficacy (general, sexual communication, and healthcare communication), as well as level of self-reported comfort and confidence in accessing sexual health services. Significant differences were found between groups, with individuals who reported communication difficulties scoring lower on all five variables. Regression analyses were used to explore the utility of the three self-efficacy constructs in predicting behavioural outcomes. Healthcare communication self-efficacy predicted access to sexual healthcare, and less avoidance. Sexual communication self-efficacy predicted less avoidance of sexual healthcare. These findings suggest that individuals with communication difficulties experience greater barriers to sexual communication and sexual healthcare than the general population, and that specific self-efficacy constructs predict sexual healthcare utilization. Potential implications for clinical practice are discussed, including the importance of initiating conversations about sexuality and building task-specific forms of self-efficacy in communication intervention.