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The Effectiveness of Virtual Patient Simulation Versus Peer Simulation in Providing Sexual Counseling During Pregnancy: A Randomized Controlled Trial

Neslihan Yilmaz Sezer, Menekşe Nazlı Aker, Pinar Kullu, Rana Tuncer, Gael Lucero-palacios, Roghayeh Leila Barmaki

arXiv:2609.06662v1cs.HC

TL;DR

Professionals’ knowledge and skills are identified as factors in difficulty providing sexual-health counseling, while education may inadequately prepare candidates. This study examines counseling and learning outcomes across simulation methods; the methods reduced negative attitudes and beliefs without significant differences between them.

  • Problem

    Insufficient knowledge, skills, and educational preparation are identified as reasons healthcare professionals have difficulty providing sexual-health counseling.

    Source: §1 · p. 4

  • Method

    The study assessed sexual beliefs, counseling skills, learning satisfaction, and self-confidence using mixed repeated-measures ANOVA.

    Source: Data Evaluation · p. 11

  • Results

    Different simulation methods reduced students’ negative attitudes and beliefs, with no significant differences between methods in attitudes, skills, satisfaction, or self-confidence.

    Source: Conclusion · p. 15

  • Takeaways & Limitations

    Different simulation methods provided similar educational outcomes for sexual counseling education during pregnancy.

    Source: Conclusion · p. 15

    Peer simulation requires intensive preparation, and differences in students’ learning pace and knowledge may complicate learning.

    Source: §1 · p. 4

Abstract

from arXiv · show

Although sexual health counseling is one of the important responsibilities of healthcare professionals, effective educational methods are needed to develop students' counseling skills in this field. The aim of this study was to compare the effectiveness of virtual patient simulation and peer simulation methods in developing sexual counseling skills during pregnancy among nursing faculty students. This randomized controlled trial included 51 participants assigned to one of three groups: virtual patient simulation, peer simulation in a virtual environment, or face-to-face peer simulation. In the study, all groups received face-to-face theoretical instruction on sexual counseling during pregnancy. Following the theoretical training, students participated in virtual patient simulation, peer simulation in a virtual environment, or face-to-face peer simulation practices according to the groups to which they were assigned by randomization. Outcome measures included the Sexual Attitudes and Beliefs Scale, the Student Satisfaction and Self-Confidence in Learning Scale, and the Sexual Counseling Skills Evaluation Form. It was determined that the participants' SABS scores decreased significantly after the intervention. According to the results of the mixed repeated-measures ANOVA, the effect of time was statistically significant. However, the group effect and the group x time interaction were not significant. There was no difference between the groups in terms of Satisfaction in learning, Self-confidence in learning, and Skill scores. This study showed that different simulation methods used in sexual counseling education during pregnancy were effective in reducing students' negative attitudes and beliefs and provided similar educational outcomes. Therefore, virtual patient and peer simulations may be recommended as feasible approaches for improving sexual counseling skills.

(4) Data Availability Statement

The introduction motivates sexual-health counseling education by noting professionals’ difficulties discussing the topic and gaps in training. The study compares simulation approaches for pregnancy counseling; study data are not publicly available.

(4) Data Availability Statement

1. INTRODUCTION

  • Insufficient knowledge, skills, and educational preparation are identified as reasons professionals struggle to provide sexual-health counseling.Source: §1 · p. 4
  • Peer simulation supports collaborative learning and communication, but preparation demands and differences in pace and knowledge may complicate learning.Source: §1 · p. 4
  • The study compares virtual-patient and peer simulations for developing nursing students’ sexual counseling skills during pregnancy.Source: §1 · p. 5
  • Pregnancy is a relevant counseling context because physiological changes and misconceptions may affect couples’ sexual lives.Source: §1 · p. 5

2. METHOD Aim of the Study

The study aims to compare simulation methods for developing pregnancy-related sexual counseling skills among nursing students. It uses a single-center, parallel-group randomized controlled design.

2. METHOD Aim of the Study

  • The study compares virtual-patient and peer simulation for developing nursing students’ sexual counseling skills during pregnancy.Source: §2 · p. 5

Type of Study

Participants

The study enrolled 51 nursing students who met coursework and participation criteria. Students were randomized to three simulation groups, and the study assessed descriptive characteristics and learning outcomes.

Participants

  • The study ran from April to June 2025 and was completed with 51 students enrolled in the Faculty who had completed required clinical coursework related to maternal health care.Source: Participants · p. 6

Randomization

  • Simple randomization assigned students to virtual-patient, virtual-environment peer, or face-to-face peer simulation groups, with an independent researcher drawing sealed-envelope assignments.Source: Randomization · p. 7

Parameters Examined in the Study

Descriptive Characteristics of the Students

Sexual Attitudes and Beliefs

The study used three instruments to assess sexual attitudes and beliefs, learning satisfaction and self-confidence, and counseling skills. The measures differed in timing, scoring, and content.

Sexual Attitudes and Beliefs

  • The 12-item SABS was administered after group allocation and after simulation; scores range from 12 to 72, with higher scores indicating more negative attitudes and beliefs.Source: Sexual Attitudes and Beliefs · p. 7

Satisfaction and Self-Confidence in Learning

Sexual Counseling Skills

  • The counseling-skills form covers the interview from initiation to termination and scores 32 behaviors as 0 or 1, for a total range of 0–32.Source: Sexual Counseling Skills · p. 8

Implementation of the Study

All groups received common theoretical instruction before randomized assignment to one of three sexual-counseling simulation practices. The training used shared scenarios and a standardized observation and feedback process.

Implementation of the Study

  • All groups received theoretical instruction before randomized practice in virtual-patient, virtual-peer, or face-to-face peer simulation.Students were assigned to practice groups by randomization.Source: Implementation of the Study · p. 8

Theoretical Training

  • The standardized theoretical training comprised four 50-minute sessions covering sexuality, pregnancy, counseling processes, communication techniques, and counseling models.Instruction used lectures, PowerPoint presentations, visuals, and models.Source: Theoretical Training · p. 8
  • Four scenarios were developed for pregnancy sexual counseling practice; one described a woman at 16 weeks avoiding sexual intimacy because she feared sexuality could harm herself and her baby.The practice took place in a communication-skills laboratory designed similarly to an outpatient clinic room.Source: Theoretical Training · p. 9
  • Students drew a scenario, conducted and ended a counseling interview, and were observed by the same researcher, who completed the skills form and provided feedback.Students completed post-test forms after feedback.Source: Theoretical Training · p. 9

Virtual Patient Simulation Group

The study compared virtual-patient practice with peer counseling in virtual and face-to-face settings. The peer roles were trained for the same four scenarios.

Virtual Patient Simulation Group

  • In virtual-patient simulation, students counseled a synchronous virtual model structured around four scenarios and positioned in an outpatient clinic room.The model could ask questions and respond verbally to students.Source: Virtual Patient Simulation Group · pp. 9–10

Peer Simulation Group in a Virtual Environment

  • In virtual-environment peer simulation, students counseled a peer online against the same background used for virtual-patient practice.The peer was trained and piloted for the four scenarios; one trained student portrayed all peer roles.Source: Peer Simulation Group in a Virtual… · p. 10

Face-to-Face Peer Simulation Group

  • In face-to-face peer simulation, students counseled a peer in person using the four scenarios, with the same student portraying peer roles as in virtual peer practice.The peer was trained and took part in a pilot practice with the researchers.Source: Face-to-Face Peer Simulation Group · p. 10

Data Evaluation

The analysis used descriptive statistics and tests selected according to variable type and distribution. Mixed repeated-measures ANOVA evaluated change in SABS scores over time and the group–time interaction.

Data Evaluation

  • Continuous variables were assessed for normality using skewness and kurtosis, with values within ±2 treated as indicative of normal distribution.Continuous data were summarized as mean ± standard deviation and median (minimum–maximum); categorical data as number and percentage.Source: Data Evaluation · p. 10
  • Group comparisons used chi-square tests for categorical variables, one-way ANOVA for normally distributed continuous variables, and Kruskal–Wallis tests otherwise.Descriptive characteristics were compared using one-way ANOVA for continuous variables.Source: Data Evaluation · p. 10
  • Mixed repeated-measures ANOVA evaluated SABS score changes over time and the group–time interaction, with statistical significance set at p < 0.05.Analyses used SPSS version 30.0.Source: Data Evaluation · pp. 10–11

Ethical Considerations of the Study

The study received ethics approval, obtained written permissions and participant consent, and followed the Declaration of Helsinki.

Ethical Considerations of the Study

3. RESULTS

The time effect on SABS scores was significant, but neither group nor group-by-time effects were significant. Groups also did not differ in satisfaction, self-confidence, or counseling skill scores, or in the reported descriptive characteristics.

3. RESULTS

  • No statistically significant group differences were found in age, academic grade point average, economic status, or previous counseling experience (p > 0.05).Table 2 compares groups on descriptive characteristics.Source: §3 · p. 11, Table 2 · p. 11
  • SABS scores showed a significant time effect (F = 113.31, p < 0.001), but group (F = 0.836, p = 0.440) and group × time (F = 0.304, p = 0.739) effects were not significant.The scale-score comparison is presented in Table 3.Source: §3 · pp. 11–12, Table 3 · p. 12
  • Groups did not differ in satisfaction in learning, self-confidence in learning, or skill scores (p > 0.05).These outcomes are compared in Table 3.Source: §3 · p. 12, Table 3 · p. 12

4. DISCUSSION

The discussion considers how the three simulation approaches relate to students’ attitudes, counseling skills, satisfaction, and self-confidence in learning. It characterizes virtual patient simulation as an acceptable and effective approach comparable to peer simulation in supporting self-confidence.

4. DISCUSSION

  • Negative attitudes and beliefs about providing sexual counseling decreased after instruction and simulation in all three groups, with no significant group or group–time differences.The methods were virtual patient simulation, peer simulation in a virtual environment, and face-to-face peer simulation.Source: §4 · p. 12
  • The authors suggest interactive, practice-based approaches may help address sensitive counseling topics, as theoretical instruction alone may not be sufficient to change attitudes and beliefs.This interpretation is linked to the finding that each of the three simulation methods reduced negative attitudes and beliefs.Source: §4 · p. 13
  • Counseling skill scores did not differ significantly between groups; structured virtual patient scenarios may therefore be a feasible alternative to peer simulation for communication skills.The authors describe this as the first study to evaluate virtual patient simulation for sexual counseling.Source: §4 · p. 13
  • Satisfaction in learning scores showed no significant differences between groups, and virtual patient simulation may support satisfaction as an alternative to peer simulation.The discussion suggests online peers or virtual patients may be alternatives when face-to-face practice is not always possible.Source: §4 · p. 14
  • Self-confidence in learning scores did not differ between groups, suggesting virtual patient simulation may promote self-confidence comparably to peer simulation.The discussion also notes that the virtual patient group’s self-confidence scores were similar to those of the peer simulation groups.Source: §4 · pp. 14–15
  • A prior study reported simulation superior to other methods for nursing anxiety, clinical decision-making self-confidence, simulation-based learning, and performance scores.Source: §4 · p. 15
  • Virtual patient simulation may be acceptable and effective at a level comparable to peer simulations in supporting students’ self-confidence in learning.Source: §4 · p. 15

Conclusion

Virtual patient and peer simulation methods reduced students’ negative attitudes and beliefs about sexual counseling, with no significant differences between methods in the reported educational outcomes. The authors recommend these interactive approaches for nursing education, including when face-to-face education is limited.

Conclusion

  • All three simulation formats reduced negative attitudes and beliefs, with no significant differences between methods in attitudes, counseling skills, satisfaction, or self-confidence.Source: Conclusion · p. 15
  • Virtual patient simulation may be a feasible alternative to peer simulation when face-to-face education is unavailable or limited.Source: Conclusion · p. 15
  • The authors recommend expanding interactive simulation methods in nursing programs for communication-focused topics such as sexual counseling during pregnancy.Source: Conclusion · pp. 15–16
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