Exploring the role of sexual attitude reassessment and restructuring (SAR) in current sexology education: for whom, how and why?

Figures & data

Figure 1. Flow chart detailing literature search.

Table 1. Study quality assessment according to the mixed methods appraisal tool, MMAT.

Table 2. Detailed description of studies included in the systematic review of SAR as a pedagogical tool for education in sexology.

Year, Author(s), Country & Publication type	Participants	Study design	Intervention or SAR aspect examined	Outcome measures	Main results
1974 Held, Cournoyer, Held & Chilgren USA Scientific paper	93 physicians, 103 nurses, 178 medical students, 49 clergy	Quantitative descriptive	2, 3 and 7-day SAR, including small group discussions, large group discussions, explicit movies and slides	5-item questionnaire immediately post seminars (96% response rate) in 1973.	Overall positive responses on experiences of the SAR seminars.
1975 Held, Cole, Held, Anderson & Chilgren USA Scientific paper	53 professionals: 51% men, 49% women 68% were between 27 and 45 years old Control group: 18 first-year medical students 72% men, 28% women, 18 to 35 years old	Quantitative non-randomised	3 x 2-day SAR including small group discussions, large group discussions, explicit movies, music and slides	Intervention group: 14-item Sexual Attitudes Scales before the workshop, end of first two days, before and after third day, six weeks post workshop Control group: Pre workshop and post workshop	Intervention group: Significant changes in 9 of 14 items in the direction of increased comfort increased comfort in relation to self or others engaging in certain sexual activities. Control group: No significant changes
1976 Halstead, Halstead Salhoot, Stock & Sparks USA Scientific paper	508 participants: 55% women, 53% over 27 years 48% were healthcare professionals, 23% students, and 15% patients with physical disability	Quantitative non-randomised	2.5-day SAR workshop including films, tapes, slides, talks and small group discussion	Programme evaluation questionnaire post workshop, Minnesota Sexual Attitudes Scales immediately before and after workshop	In programme evaluation, 97% said the workshop was beneficial, 96% enjoyed the programme, 91% could now discuss sex more freely, 97% stated the workshop dispelled myths about sex, and 88% that SAR workshop should be part of professional training. Mean scores (206 respondents) for all 9 items of the Minnesota Sexual Attitudes Scales changed in a positive direction, 6 of 9 items showed significant changes
1978 Held & Rosenberg USA Scientific paper	200 SAR small group leaders	Mixed methods	Describes recruitment, training, and evaluation of SAR small group leaders, based on authors’ experience and on SAR participants’ evaluation	SAR small-group leaders were evaluated using a 1 to 5 scale including four elements (peer evaluation, participant evaluation, level of training in sexology and small group process, and experience)	No result from the numeric evaluation is presented, only reflections based on authors’ experiences of being small-group leaders.
1978 Wollert USA Scientific paper	11 SAR directors	Quantitative descriptive	Examines SAR directors	37-item questionnaire concerning various aspects of SAR	SAR directors show both similarities (programme titles, sponsoring agencies, client populations, and goals) and differences (degree of control exercised by leaders, emphasis on attitude change, and participation pressure). They uniformly rated their programmes as effective and considered minimal negative psychological effects.
1979 Graves USA Doctoral dissertation	18 counsellors-in-training: 8 males, 10 females	Quantitative non-randomised	12-hour SAR workshop	Pre and post-test two weeks before and after with Sex Knowledge Attitude Test, Heterosexual Relations Scale, Sexual Myths Scale, and Autoeroticism Scale	No significant change in sexual attitudes or in sexual knowledge but in sexual counselling confidence.
1982 Aja USA Doctoral dissertation	45 nursing home staff (registered nurses, licenced practitioners, nurse’s aides, administrators, and activities directors)	Quantitative randomised control trial	Randomly allocated to two experimental groups with 2-day SAR workshop for 1) low dogmatism group who received explicit sexual material SAR or 2) high dogmatism group who received implicit sexual material SAR or 3) control group.	Intervention group: Dogmatism Scale, Sexual Knowledge and Attitudes Scale, and Attitude Rating Scale pre- and 1-week post intervention. Control group: Same instruments pre workshop	Nursing home staff can change sexual attitudes after SAR workshop. Implicit and explicit film differentially affected staff attitudes about sexual behaviour
1983 Halstead & Halstead USA Scientific paper	398 participants in 10 consecutive 3-day SAR workshops	Quantitative descriptive	SAR small group process	A conceptual framework with six stages that occur during most SAR small-group experiences. Anonymous evaluations of 398 participants regarding various aspects of the small-group experience for groups facilitated by the authors and those facilitated by other staff members during ten consecutive SAR workshops.	Differences in how SAR participants rate their experiences between the groups facilitated by the authors (more satisfied) and by other facilitators (less satisfied)
1986 Friend USA Doctoral dissertation	48 subjects divided into SAR group with explicit film and SAR group without explicit film	Quantitative non-randomised	The relationship between group cohesion and the development of pluralism in sexual attitudes as a function of the small-group component of SAR	Change in self-acceptance measured with Sexual Opinion Scale pre- and post-SAR Change in acceptance of others measured with Sexual Attitudes Scale pre- and post-SAR	No significant differences between groups on the predicted relationships between cohesion and changes in self-acceptance and acceptance of others
2002 Rodriguez-Kitkowski USA Doctoral dissertation	23 counsellor students at master’s level	Quantitative randomised control trial	Subjects randomly assigned to one of two treatment groups (moral development group or knowledge and attitude group) and attended two weekends with seminars (a human sexuality topics portion and a SAR portion) each weekend.	Pre-test and post-test after each weekend with Defining Issue test and Sexual Myths Attitudinal Score	No statistically significant differences in moral development, knowledge, or attitudes between groups
2018 Lin & Lin Taiwan Scientific paper	32 graduate students in human sexuality: 38.9% females and 61.1% males, 21 to 51+ years old	Mixed methods	A modified one-term SAR curriculum: in total, 32 hours for 16 weeks.	Pre-test and post-test with a customised sexual attitude scale Focus group interviews	Changes in students’ attitudes, particularly for those who had more conservative or negative sexual attitudes. Thematic analysis of focus group interviews resulted in students changing their attitudes about sexuality due to the desensitisation, sensitisation and integration effects.