Adults with Visual Impairments Report on their Sex Education Experiences

By Tiffany A. Wild, Stacy M. Kelly, Mollie V. Blackburn, and Caitlin L. Ryan

Dr. Wild is an assistant professor in the Department of Teaching and Learning in the College of Education and Human Ecology at The Ohio State University (wild.13@osu.edu).

Dr. Kelly is an assistant professor in the Visual Disabilities Program in the Department of Special and Early Education at Northern Illinois University (skelly@niu.edu).

Dr. Blackburn is a professor in the Department of Teaching and Learning in the College of Education and Human Ecology at The Ohio State University (blackburn.99@osu.edu).

Dr. Ryan is an assistant professor in the Department of Literacy Studies, English Education and History Education in the College of Education at East Carolina University (ryanca@ecu.edu).

Abstract

This study seeks to understand and learn more about the sex education needs and experiences of students with visual impairments. Because research on this topic is scarce, this study examined the responses of 30 adults, 18-30 years of age, as they reflected on their sex education experiences through use of a survey including both open-ended and Likert-type questions. Data were analyzed using qualitative and quantitative methodologies. Overall, respondents indicated that having a visual impairment impacted their experiences in sex education. They reported that curricula were frequently limited to topics such as risks associated with sexual behavior and anatomical or biological information. Additionally, approaches to teaching regularly lacked accessible materials, other than the occasional use of scenario presentation, discussion, and explicit talk by instructors. Results also suggest that the sex education experienced by the respondents happened outside of the classroom, where they learned through methods that were more accessible to them about a wider range of topics than were presented in their schools. These results suggest sex education curricula for students with visual impairments should encompass a wider range of topics, including social information, and ways of teaching that would allow a greater degree of access to the materials and knowledge presented in school.

Keywords

Blind, Visually Impaired, Low Vision, Sexual Health, Contraception, Sexuality

Schuster (1986) defined sex education as “an effort to understand human sexuality which means an understanding of human growth, human development, and human interaction” (p. 675). Utilizing that definition, Schuster determined that three factors influence programs and curriculum to create a positive concept of sexuality for visually impaired children: (a) respect of the cultural norms and taboo behaviors within the society; (b) understanding of the family knowledge base with values and attitudes that reflect the ease and openness of parental exchange of information with the child; and (c) awareness of potential, interests, experiences, visual skills, intellect, and development of the student. Such an education that is informed by and responsive to such factors remains, however, uncommon for most students and even more so for students with visual impairments. We discuss the challenges unique to this population next (see Note 1).

 

Visual Impairments and Sex Education

When considering the sex education needs of students with visual impairments, it is instructional to consider that students who are blind (see Note 2) may have greater difficulty in “…synthesizing information due to inadequate simulation or data perception” (Schuster, 1986, p. 676,). They may rely on words to understand the world and societal norms while the sighted child can use both verbal and visual cues (Hicks, 1980; Schuster, 1986). In addition, children who are blind can have difficulty in emulating behavior patterns exhibited by adults or sighted peers. Since these skills and ways of interacting are often not explicitly taught to children who are blind, blind children may act in ways deemed inappropriate by societal standards. Such challenges may significantly impede the sex education of these students. For example, their knowledge of body and social skills can be affected by these difficulties (Hicks, 1980; Schuster, 1986), and they may exhibit a lack of mature cognitive development that could inhibit sexual understanding (Vaughan & Vaughan, 1987).

Such limitations in understandings can be a concern of adolescent students who are blind, particularly during puberty, when they might misinterpret normal changes in their bodies as they develop from children into adults (Schuster, 1986). Furthermore, adolescents who are blind may lack basic social skills related to courtship behaviors (Hicks, 1980). This is especially prevalent for those in residential schools who have no reliance on peers who are sighted for guidance (Foulke & Uhde, 1974; Schuster, 1986).

As the adolescent who is blind matures into an adult, this gap of knowledge and lack of awareness may lead to lack of maturity in sexual relationships. For example, adolescents may develop unrealistic theories concerning anatomy and the functions of sex (Foulke & Uhde, 1974). This may be due to a lack of understanding of two-dimensional model representations, which are commonly used over the more realistic three-dimensional, as well as a lack of information and understanding of how the male and female bodies are different (Hicks, 1980). Furthermore, students may learn the technical process of sex but may not understand sexual acts between partners.

This poor understanding may be due to a lack of meaningful sex education experiences. For example, in a recent study, Krupa and Esmail (2010) interviewed eight people with visual impairments. The respondents identified the following issues as having influenced poor dissemination of information on sexual health for individuals with visual impairments: (a) inability to acquire information visually; (b) restriction of tactile learning due to societal norms; (c) lack of appropriate information specifically for those with visual impairments in appropriate media forms; (d) inadequate preparation of families, teachers, and counselors; and (e) the lack of nonverbal communication skills of people with visual impairments. Krupa and Esmail (2010) reaffirm that while blind students may miss visual cues, they also are kept from accessing the information they need to make up for that absence successfully.

Such restricted access to information has consequences. According to statistics from the Centers for Disease Control (CDC) (2007), young adults (ages 15-24) engaged in sexual activity are among those with the highest rates of sexually transmitted diseases (STDs). Since Kelly & Kapperman (2012) recently found that students with visual impairments are engaging in sexual activity just two to three years later in age than their sighted peers (i.e., more often in early adulthood years), we know that young adults with visual impairments are included in these statistics that pertain to sexually active individuals 15-24 years of age. This shows that sexual activity and any attendant consequences happen among the population of individuals with visual impairments just as among those who are sighted, even if slightly later.

One major concern is the sexual assault of people with visual impairments. According to research conducted by Pava (1994), one in three (of 161) respondents, all of whom had visual impairments, had been victims of either attempted or actual sexual or physical assault at some point in their lives. Although the study did not distinguish between physical and sexual assault, it still concluded that both men and women with visual impairments are at risk for attempted and actual assault, including but not limited to sexual assault. More recently, Kvam (2005) found that people with visual impairments are more likely to experience sexual abuse than the sighted population. 

Given these needs, numerous professionals within the field of visual impairment have stated a need for a well-written sex education curriculum that specifically addresses the needs of people with visual impairments (Dodge, 1979; Foulke & Uhde, 1974; Hicks, 1980; Kelly & Kapperman, 2012; Kent, 2002; Krupa & Esmail, 2010; Schuster, 1986; Vaughan & Vaughan, 1987). However, this curriculum does not yet exist. This study will guide the development of such an instructional tool.

Purpose

The purpose of the present study was to gather data from adults with visual impairments about their sex education experiences. The guiding question for the study was: What do students who are visually impaired, blind, or have low vision need to know to assert their agency concerning sexuality? This question was further divided into the following sub-questions for analysis:

  • What does this population learn, in terms of sex education, in school curriculum? How? What do they think about this?
  • What does this population learn, in terms of sex education, beyond the school curriculum? How? What do they think about this?
  • What do they wish they had learned? How do they wish they had learned it?

We sought answers to our research questions through a survey study, which included a combination of questions to obtain both quantitative and qualitative data.   

Methodology

Ethics clearance for the present study was obtained from the Institutional Review Board (IRB) of the Ohio State University, Columbus, Ohio, U.S.A. The survey was conducted using an online survey instrument.  

Participants

Members of the National Federation of the Blind (NFB) between the ages of 18 and 30 were asked to participate in this study. Participants were recruited through the NFB’s electronic listserv notification system. The NFB was chosen as the basis for the convenience sample for the present study because the NFB is the largest consumer organization for individuals who are blind or have low vision. In total, 30 individuals with visual impairments responded to the listserv notification and participated in this study.

Table 1: Demographic Characteristics of Participant Sample

                                                                     

Characteristic

% of sample

Age

 

   18-19

10

   20-21

23

   22-23

23

   24-25

-

   26-27

13

   28-29

-

   30

10

   Unknown or refused

-

Gender

 

   Male

33

   Female

60

Other

-

Race or ethnicity

 

   Asian American or Pacific Islander

13

   Bi/multiracial

10

   Latino/Latina

10

   Native American

10

   White

67

   Unknown or refused

-

Sexual orientation

 

   Bi-sexual

10

   Heterosexual

80

   Homosexual

-

   Unknown or refused

-

Degree of visual impairment

 

   Blind

73

   Visually impaired

20

   Low vision

-

   Other

10

Type of school placement

 

   Itinerant model

70

   Residential model

23

   Other

13

   Unknown or refused

-

Note: Demographic data that included less than 10% of the participant sample has been suppressed in compliance with IRB reporting restrictions.

Participant demographics included a range of ages, gender identities, races, and sexual orientations. Additionally, the respondents were diverse in their degrees of visual impairment and types of school placements. Table 1 shows the demographic characteristics for this participant sample. We note that each of the response choices for the demographic survey items were not mutually exclusive categories to provide participants with the opportunity to select the response choice or choices that best represented their particular characteristics.  

Data Collection

Data were collected using a survey instrument developed by the researchers. The survey was posted online through Survey Monkey and piloted to ensure it was fully accessible. The e-mail distributed via the NFB’s listserv included a direct link to the area of the Survey Monkey website where the online survey was located. A reminder e-mail was distributed approximately two weeks after the original electronic mailing. In compliance with the aforementioned IRB protocol, names of participants were not collected in order to preserve the anonymity of all the survey responses. Furthermore, respondents had the opportunity to refuse to respond to any or all survey items or to reply that they “did not know” to any or all survey items.

Development of survey items. The researchers developed an instrument that contained a series of items requesting participants to make judgments about their sex education knowledge and experience. The instrument included questions that were asked by the CDC (2007) report on sexual activity as well as questions written by researchers reflecting literature reviews on the topic. Questions were categorized into six themes within the survey: (a) school and demographic information, (b) topics addressed in the sex education experience of the respondents, (c) topics that should be addressed in sex education, (d) pedagogy used in the sex education experience of the respondents, (e) sex educational experiences beyond school curriculum, and (f) the respondents perceptions of the characteristics of an ideal sex education. The number of questions in each section varied depending on the topic and how the participant responded. For instance, if a participant responded positively to certain items, additional questions would appear that would ask for more information. If the participant answered no, those additional questions would not appear. 

Many items asked participants to report their extent of agreement. For these a standard five-point Likert scale of agreement was used. This scale always has a middle neutral point, which provides respondents the opportunity to express which side and to what degree they would take in answering the question. From a statistical perspective, the five-point Likert scale tends to show answers as a normal distribution toward a larger middle portion of answers as compared with a four-point scale option that tends to skew too much to one side (Garland, 1991).

Likert scale response options for the frequency with which particular sex education topics were taught in the school were: 1 = never; 2 = little; 3 = somewhat; 4 = much; 5 = a great deal; 6 = do not know; and 7 = refuse. The same Likert scale was used to measure the degree to which particular ways of teaching sex education were used in the school sex education curriculum of the participants, which sex education topics were learned about outside the school curriculum, and which particular ways of teaching would work well or not so well for the participants. The Likert scale used to measure the degree of desirability among particular methods of presenting instructional materials in sex education was as follows: 1 = very poor; 2 = poor; 3 = barely acceptable; 4 = good; 5 = very good; 6 = do not know; and 7 = refuse. Open-ended response questions provided participants with the opportunity to provide further details regarding their responses to the Likert scale questions. A copy of the research instrument can be found in Appendix A.   

Data Analysis

Data generated by the online survey instrument were organized using a coding system for responses to select Likert-type and open-ended response type items. Having both quantitative and qualitative data in this study strengthened our analytic approach in that it allowed for a better understanding of the data provided while also increasing the validity and reliability of results with less bias than more traditional approaches to research (Greene, Kreider, & Mayer, 2005). In addition, we were able to gain more insight and understanding into the social constructs of this work through the implementation of this design.

The quantitative data were acquired and coded from responses to the selected response type items and then formatted into a data file for statistical analysis and interpretation. This included responses to each of the Likert scale items. The resulting data was aggregated, analyzed, and interpreted. Quantitative data analysis strategies included descriptive analysis that provided information pertaining to the proportion of respondents indicating each response. In addition, each specific question or “item” had responses analyzed across the entire participant sample. Analysis methods used for individual questions that yielded quantifiable data included central tendency summarized by presenting the overall mean response rates.

Three qualitative researchers analyzed open-response data. The data were analyzed to look for major themes and patterns across data when answering each research question. Major themes of the data pertaining to each question, where agreement was evident by participants, are reported. Due to IRB restrictions no outlier data can be presented in this paper.  

Results

The results are presented in order of the three research sub-questions. We first discuss reports about the experiences of the students with the school sex education curriculum, their experiences beyond this curriculum, and, finally, what these respondents believe would comprise ideal sex education. Each section presents the quantitative data first, followed by any written responses to open-ended questions. When reporting on the written responses, the data presented represent those categories with the largest agreement level. As a result of the respondents having the opportunity to refuse to respond to any or all survey items and being able to select more than one response option for many of the survey items, the number of responses and respondents vary across the data presented in the results section. We address the overarching question in the discussion.

School Curriculum Learning

Using a Likert Scale, respondents were asked about the presentation of sex education topics. Table 2 shows the mean Likert scale rating results of participants’ responses to the survey question that asked the degree to which they learned about sex education topics in their school curriculum. According to the participants, the majority of the school curriculum was spent talking about risks associated with sexual behavior and anatomical/biological information.

Table 2: Mean Ratings of Sex Education Topics Learned Within and Outside the School Curriculum

 

Sex Education Topic

 M
(within the school curriculum)

SD
(within the school curriculum)

 M
(outside the school curriculum)

SD
(outside the school curriculum)

 

Anatomical and biological information, like body parts and how they function

 

3 (somewhat)

 

1.05

 

4 (much)

 

1.20

Intimate relationships, including how to communicate what you do and do not desire

2 (little)

.91

3 (somewhat)

1.40

Social norms associated with sexual behaviors, including fetishes, sexual identities, and same sex desire

1 (never)

1.14

4 (much)

1.38

Legal issues surrounding sexual behaviors, including what counts as consensual

2 (little)

1.13

X

X

Risks associated with sexual behavior, including pregnancy, sexually transmitted diseases (STDs), HIV/AIDS, and assault

4 (much)

.92

4 (much)

1.46

Safer choices, including masturbation and/or the use of condoms, dental dams, and other tools for preventing the transmission of STDs.

2 (little)

1.49

4 (much)

1.33

The role of media and technology in sexual relationships, including sexting, social networking sites, chat rooms, etc.

1 (never)

1.29

3 (somewhat)

1.63

Where to get further information, both within the school, like the nurse or psychologist, and outside of school, like your doctor or medical service organizations, like Planned Parenthood

2 (little)

1.19

3 (somewhat)

1.47

Note: M = mean; SD = standard deviation; X = not asked in this survey item.

To further investigate the sex education experiences of respondents within the school curriculum, we asked the respondents about the degree to which different ways of teaching sex education were used in their school sex education curriculum. They answered using the same Likert scale and response system described above. We specifically asked about pedagogical practices widely used in other subject content areas with students who are visually impaired (e.g., scenarios, role plays, explicit talk, tactile graphics, etc.) Respondents indicated that most ways of teaching that we inquired about were never used to teach sex education. Table 3 shows the mean Likert scale rating results of the responses to the survey question that asked the degree to which different ways of teaching were used in their school sex education curriculum.

Table 3: Mean Ratings of Sex Education Teaching Methods Used in School

 Teaching method

 M

 SD

 

Scenarios presented and discussed

 

3 (somewhat)

 

1.09

Role plays of challenging discussions

1 (never)

.99

Explicit talk

2 (little)

1.16

Tactile graphics

1 (never)

1.15

Electronic materials such as podcasts

1 (never)

1.26

Anatomically correct models

1 (never)

1.30

Note: M = mean; SD = standard deviation.

Using an open-ended question, respondents were asked about the impact their visual impairment had on their sex education. The majority of the participant sample (61% or n = 13) indicated that their visual impairment had an impact on the way in which they were able to participate in sex education. Those issues include (but are not limited to) limiting their ability to see and comprehend videos, diagrams, and pictures and having access to very little sex education and basic sexual information. Instead, respondents stated that they had to learn by active participation in sexual activities or through the use of sexually explicit books. They also commented on their reliance upon explanations from teachers.

Learning Beyond School

Quantitative results for the second research sub-question showed that respondents were highly engaged in learning about sex education outside of the school curriculum. For instance, respondents were asked to report the degree to which they learned about sex education topics outside of the school curriculum; the same topics asked about earlier in the survey were presented again here. The results in mean Likert scale ratings are shown in Table 2 and demonstrate that the respondents learned “much” or “somewhat” for each topic we inquired about outside of the school curriculum.

We were also interested in finding out from whom the respondents learned about sex education topics outside of the school curriculum. Respondents could select any or all answer choices that applied to them. The vast majority of participants reported that they learned about sex education topics outside of the school curriculum from their friends (86% or n = 18), significant others (71% or n = 15), and family members (57% or n = 12). Participants learned about the topics from peers that were not their friends 38% of the time (or n = 8). Adult coaches/mentors were the source for learning these topics 19% of the time (or n = 4). Just under half (47% or n = 10) of respondents reported that they learned about the topics from “others” not specifically mentioned such as medical professionals, church leaders, educational media, radio talk shows, and college classes. Lastly, there were two respondents (9%) who did not know where they had learned about the topics outside of the school curriculum.

Additionally, we also asked where they learned about sex education topics outside of school. The most frequent response was the internet, including X-rated fan fiction, followed by books, television and movies, and radio talk shows.  

We took a closer look at the opportunities to learn about sex education outside of the school curriculum among the respondents that had lived at residential schools. Of the participants who reported they lived in residential schools and responded to this particular survey question, 50% responded that the activities that took place after school had an impact on their knowledge of sex education while 50% responded it did not. Similarly, 50% of the respondents who reported they lived at a residential school were impacted in their sex education knowledge by the activities that took place in the cottages/dorms and 50% were not impacted. The activities that impacted them, according to their reports, were talking about sex education, having a “first sexual experience,” and the active prohibition of sexual encounters. In addition to sex education, we asked questions about sexual behaviors and 36% of respondents stated they were sexually active when they were in school, while 64% stated they were not. Among those who were sexually active, 50% said they used a condom, 38% said they did not, and 12% said they did not know. Of those that responded to this survey item, 66% said they used something else to prevent pregnancy. Other preventative measures included birth control pills or Depo-Provera injections, for example. An additional 33% of the respondents said they did not use an alternative to condoms. Further analysis showed that 85% of respondents who were sexually active reported engaging in sexual activity with people of the opposite gender, 14% with people of the same gender, and 28% with people of both genders. Respondents listed homes, isolated places in the outdoors, and vehicles as the places where they most often engaged in sexual activity. Other places for their sexual activity included dorms or other private places at schools. 

When asked whether there were any consequences for their sexual activity, six people chose to respond, half of them stating there were no consequences. Due to IRB reporting restrictions, this is the extent of information we can report regarding this component of the survey.

Ideal Curriculum

We present the findings regarding ideal curriculum in three thematic clusters: curriculum and pedagogy, setting and age, and educators and roles. In part, these clusters were shaped by the ways we asked questions, particularly in the case of the first two, with curriculum and pedagogy being followed by setting and age. However, the clusters were also shaped by the responses of the participants, particularly the last of educators and roles.

Curriculum and pedagogy. Quantitative results that pertained to curriculum and pedagogy revealed that the participants had a high degree of desirability for ways of teaching that allowed them a greater degree of access to the sex education curriculum presented to them in school. Participants were specifically asked to what degree ways of teaching sex education in the school curriculum would work well or not so well for them. The same ways of teaching that were presented to the participants about their actual experience in school were also presented to them in this instance. Table 4 shows the mean ratings for the Likert scale responses. In all instances the mean rating was 4 (or “good”) for how well each particular way of teaching sex education in the school curriculum would have worked for the respondents.

Table 4: Mean Ratings of Desirability of Sex Education Teaching Methods for the School Curriculum

Teaching method

 M

 SD

 

Scenarios presented and discussed

 

4 (good)

 

1.60

Role plays of challenging discussions

4 (good)

1.84

Explicit talk

4 (good)

1.92

Tactile graphics

4 (good)

2.30

Electronic materials such as podcasts

4 (good)

1.70

Anatomically correct models

4 (good)

1.97

Note: M = mean; SD = standard deviation.

When asked to qualitatively describe additional sex education topics that should be taught in school, participants generated a long list of topics. Topics most often mentioned by the participants were physiological processes of sexual intercourse and the consequences of having sex including emotions related to sex and contraception. Their requests for information about physiological processes included details of men’s and women’s anatomy and how those parts are (or could be) used in sexual experiences. Their focus on consequences included information about social or emotional consequences of deciding to be sexually active and physical consequences such as STDs and pregnancy. Participants suggested that an ideal sex education curriculum, therefore, would include information on decision making and confidence-building, the effective use of condoms and other safe sex practices, and descriptions of a wide range of contraception options. Participants wanted information about materials and methods that were not limited by “moral controversy” but helped them access a wide range of information. The remaining answers provided included information about the cultural norms and myths about sex, resources for sexual products and information, communication and flirting, masturbation, the legality of sex, exploration of gendered products, such as women’s makeup, and information about sexual orientations.

When asked to describe the kinds of teaching that would effectively convey that information, the overwhelming majority of participants stated that the use of realistic anatomical models was needed. In addition, participants wanted other types of accessible materials such as braille, multi-media, and tactile graphics to be used in the classroom. Participants also advocated for the use of verbalization with explicit language in the classroom in addition to having the ability to touch models and conduct demos such as properly putting on a condom. Role-playing situations involving relationships and sex were also recommended highly by participants. Additional techniques requested included providing one-on-one instruction.

Setting and age. Participants were asked to think further about their ideal sex education experience and where they would have wanted to learn this (e.g., at home, in science class, in health class, etc.). Respondents could select any or all answer choices that applied to them or select an “other” category and fill it in. The vast majority of respondents would have preferred to learn about sex education in health class (80% or n = 16) or at home (65% or n = 13). Seven participants (35%) indicated they would have wanted to learn sex education in science class and two participants (10%) listed school without a more specific response. There were two participants (10%) that indicated they would have wanted to learn sex education in a separate sex education class and two respondents (10%) that listed “other” as their response choice. Open-ended questions produced similar results, with health class the most cited response. Although participants often listed it as just one of several options they imagined being most effective, they generally added additional answers which included home, science class, church, internet, or separate classes for sex education.  The perspectives of the participants concerning when this ideal sex education instruction should be conducted varied. Most suggested middle school or “gradually” over the entire education of a student, while a few suggested it wait until high school. The responses of the participants indicated that the teaching needed to match a developmental timeline so students had the information they might need as they physically and sexually matured in order to apply it within their own lives. For example, several participants suggested the physical changes that happen to people’s bodies during puberty be taught earlier than information about contraception.

Educators and roles. The last quantifiable survey question about participant perspectives about an ideal sex education experience asked from whom they would have wanted to have learned sex education (e.g., parents, guardians, general education teachers, special education teacher, counselor, nurse, etc.) Respondents could select any or all answer choices that applied to them or select an “other” category and fill it in. Nearly half of the sample (44% or n = 8) would have wanted to learn sex education from their parents. There were seven participants (38%) who reported they would have wanted to learn sex education from their general education teachers. The same number of participants indicated they would have wanted to learn sex education from their school nurse. Other desired sources for learning sex education included a school counselor (33% or n = 6), a group setting (11% or n = 2), and a specially trained teacher (11% or n = 2). There were 12 respondents (65%) that indicated “other.”

When thinking about from whom they would have wanted to learn in an ideal sex education curriculum, most participants used their open-ended responses to list several different roles they felt would be acceptable. Sometimes they specified that a wide range of people (including parents, guardians, general education teachers, special education teachers, counselors, and nurses) would be sufficient, although more often they envisioned different people playing different roles in their sex education and/or that different people would play roles in their sex education at different times. Sometimes, participants suggested these people because they wanted to learn from those with whom they were closely connected.  Therefore, they would trust the teaching that might come from that closeness. Other participants, however, felt the opposite way: they preferred learning about sex from people with whom they were not as intimately connected. There was also some variation among participants’ views of family members in sex education. Less common responses included a desire for other sources of information such as people from church, volunteers from the community, friends and mentors, and books.

For a few participants, the accuracy of information (including the professional training of the instructor) and the accessibility of curriculum delivery were more of a concern than the particular person doing the teaching. In these responses we saw that the “what” of an ideal curriculum could not be separated from other factors such as how it was taught, when, and by whom.

Discussion

We began this paper with the claim of Schuster (1986) which states that sex education needs to exhibit a respect for cultural norms, knowledge of the values of families, and awareness of the needs of the students. This study brings us closer to understanding the needs of students who are visually impaired, blind, or have low vision. That is, it begins to answer what these students need to know to assert their agency concerning sexuality. They need to know more about the social context around sexuality and to learn in different ways from people who are available and receptive to them.

With respect to the sex education respondents experienced through sanctioned curriculum and pedagogy, the content was focused primarily on risks associated with sexual behavior and anatomical or biological information. The approach to teaching included presentation, discussion of some scenarios, and minimal explicit talk. Such a focus left out or kept to a minimum a larger social context of sexuality, including ways to communicate in intimate relationships, the social norms around sexual behaviors, definitions of consent within sexual relationships, options for safer sex, and resources for locating other information.

In addition, the majority of participants indicated that their sex education experience was hindered by failures to accommodate their visual impairments. This suggests that in-school teaching of sex education is limited in focus and inappropriately presented for the needs of students with visual impairments.

These limitations, however, did not prevent respondents from learning about sex. Instead, they learned quite a bit of information about sex in ways available to them outside of the sanctioned school curriculum. Participants reported learning more outside of the school curriculum about the majority of topics listed in the survey from friends, significant others, family members, and the Internet. These prevalent sources could lead to misinformation and therefore point to a clear need for more reliable education and information sources.

However, a lack of reliable information did not prevent sexual activity. Participants reported that they engaged in sexual behaviors during their school years. However, several articulated negative consequences, both emotional and physical, of their sexual behavior. This suggests that more education and more appropriate education are needed.

Given that our findings indicate a need for a broader range of sex education content, more accommodating pedagogical approaches for students with visual impairments, and more reliable and informed resources, it is worth considering the types of curricula, pedagogy, and materials these participants stated would be ideal. There is a need for information on the physical and physiological processes of sex. But more information about the physical and emotional consequences of sexual activity needs to be taught. This includes social information such as decision making, confidence building, and flirting. Educators should employ ways of teaching that would allow students a greater degree of access to the sex education curriculum presented to them in school. Specific methods include realistic, anatomically-correct three-dimensional models used in combination with frank, direct language (i.e., explicit talk). Both of these methods have been recommended by other researchers (Kapperman & Kelly, 2013; Kelly & Kapperman 2012; Krupa & Esmail, 2010) but have yet to make their way into the sex education experience provided in most schools and classrooms. In addition, demonstrations and role-playing should also be incorporated. The data firmly state that these sorts of changes in pedagogical approaches would support access to an ideal sex education curriculum for students with visual impairments.  

While most respondents suggested that sex education should be taught in schools, particularly in health classes, science classes, or even an entire class focused on sex education, many respondents viewed ideal sex education as happening outside the classroom as well. Participants also suggested that this curriculum be taught to students within a specific range of grade levels (generally middle school) or times in a child’s life (e.g., puberty). Regardless of details such as the location or age at which sex education is provided to students, it needs to be taught. A specific curriculum for students with visual impairments should be developed to support education in any setting, with any sex educator, and targeted for a variety of ages. It is important to note that outliers did exist in the data that could not be reported due to IRB restrictions. We did not get 100% agreement on all questions posed to respondents. The reporting of the data reflect group consensus among the respondents and cannot be generalized to the entire population. Therefore, the data from this study suggest that while there are points of wide agreement among respondents, such as the kinds of information to be presented, methods of teaching, the desire to be taught in the sex education class using accessible pedagogies, and participant preference concerning their sex education, there remains a diversity of opinions about which schools and curriculum developers will need to negotiate.

However, these recommendations reflect only the first examination of the data collected. Future examination of this data will include examination of variables presented in the data. These examinations of the data will allow the current researchers to examine more closely the sex education needs of diverse students with visual impairments as expressed by the adult participants in this research.

Limitations

This study used a convenience sample of adults with visual impairments. The subjects were identified based on their affiliation with the National Federation of the Blind. The results of studies using convenience samples cannot be projected to the wider population. However, it should be noted that the demographics of the participant sample shows that, while not statistically even, this study included a rather wide cross-section of respondents along several different axes from which this data was gathered, increasing the study’s generalizability. A further limitation of the present study is that all data were self-reported. While reliance on self-reports can present limitations to research, self-reported data is considered a reliable source of information in most circumstances that deal with critical issues (Rutherford, Cacciola, Alterman, McKay, & Cook, 2000).

Implications

This study is unique in that it asked adults with visual impairments to reflect on their experiences with sex education in a variety of educational settings. This study is also the most in-depth in the field of visual impairments, with the largest sample size focused on this topic to date. Quantitative and qualitative data in the current study showed overwhelmingly that the visual impairments of the participants had an impact on the sex education they received. In addition, it was noted that sex education for students with visual impairments needs to be improved in order to the meet the needs of students and prepare them for situations they will face in their lives. These data can help make educators aware of what their students want and need to understand their own bodies and to be prepared for sexual relationships. Accessible materials and models need to be made available for students with visual impairments; they need to be used by teachers who understand effective pedagogical approaches and are willing to speak openly and honestly with students about sexual health. Curricula should not only include the physiology of sex but the emotions and social information associated with making decisions about sex.   

Therefore, it is recommended that educators and researchers develop a sex education instructional tool. The tool should include references for obtaining models and ready-made accessible materials for educators to teach students with visual impairments along with scenarios that can provide social and emotional contexts for explicit talk with students. This tool would (a) address the wider range of knowledge related to sexuality required by students with visual impairments as indicated by the study, (b) be fully accessible, (c) make use of pedagogies employed with students with visual impairments in other content areas, and (d) account for students’ access to sources of (mis)information outside of the classroom.

Future research should continue to examine a range of related topics, including how teachers are teaching sex education to inclusive classes at both public and residential settings, how students with multiple disabilities and visual impairment are accessing sex education, what specific pedagogical practices best meet the needs of which students, and what students experience with an expanded, more accessible sex education curriculum as recommended by this study.           

References

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Foulke, E., & Uhde, T. (1974). Do blind children need sex education? The New Outlook for the Blind, 68(5), 193-200, 209.

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Hicks, S. (1980). Relationship and sexual problems of the visually handicapped. Sexuality and Disability, 3(3)165-176.

Kapperman, G., & Kelly, S. M. (2013). Sex education instruction for students who are visually impaired: Recommendations to guide practitioners. Journal of Visual Impairment & Blindness, 107(3), 226-230.  

Kelly, S. M., & Kapperman, G. (2012). Sexual activity of young adults who are visually impaired and the need for effective sex education. Journal of Visual Impairment & Blindness, 106(9), 519-526.

Kent, D. (2002). Beyond expectations: Being blind and becoming a mother. Sexuality and Disability, 20(1), 81-88.

Krupa, C., & Esmail, S. (2010). Sexual health education for children with visual impairments: Talking about sex is not enough. Journal of Visual Impairment & Blindness, 104(4),327-337.

Kvam, M. H. (2005). Experiences of childhood sexual abuse among visually impaired adults in Norway: Prevalence and characteristics. Journal of Visual Impairment & Blindness, 99(1), 5-14.

Pava, W. S. (1988). Visually impaired persons’ vulnerability to sexual and physical assault. Journal of Visual Impairment & Blindness, 88(2), 103-112.

Rutherford, M. J., Cacciola, J. S., Alterman, A. I., McKay, J. R., & Cook, T. G. (2000). Contrasts between admitters and deniers of drug use. Journal of Substance Abuse Treatment, 18(4), 343-348.

Schuster, C. S. (1986). Sex education of the visually impaired child: The role of parents. Journal of Visual Impairment & Blindness, 80(4), 675-680.

U. S. Department of Health and Human Services, Centers for Disease Control and Prevention (2007). Sexually transmitted disease surveillance. Retrieved from http://www.cdc.gov/std/stats07/Surv2007FINAL.pdf

Vaughan, J., & Vaughan, C. E. (1987). Sex education of blind children re-examined. Journal of Visual Impairment & Blindness, 81(3), 95-99.

Notes

1 In doing so, we draw, in part, on outdated scholarship. We do so because of the dearth of current scholarship in the field.

2 The literature available to be reviewed comes from a range of perspectives on children with visual impairments. This includes specific terminology (“blind” vs. “visually impaired”) as well as perspectives on children’s abilities and potentials.  In this review we have chosen to reflect the terminology and perspectives within the literature as it is currently available, but our own work builds on a strengths-based rather than deficit perspective, values person-first language, and understands that people may self-identify as blind and/or visually impaired for a variety of reasons. We have chosen to use visual impairment to encompass low vision and blindness throughout the rest of this paper.


The Journal of Blindness Innovation and Research is copyright (c) 2014 to the National Federation of the Blind.