Introduction

Sexuality is an inherent part of the human being; it is present during all stages of life, so the enjoyment of sexuality is essential for physical, mental and social well-being. An essential part of sexuality is sexual health, defined by the World Health Organization (WHO) as a state of complete physical, mental and social well-being in relation to sexuality ¹, which is not limited to the absence of disease, dysfunction or discomfort ^2,3, but is the harmonious development of sexual capacities, pleasure, communication and affection, leaving aside procreation ⁴.

In order for sexual health to be practiced, access to information, comprehensive education and health services, as well as the elimination of any discrimination, abuse, coercion or violence related to sexuality, are indispensable, so that the guarantee of sexual rights is basic ^4-8. Therefore, sexual health in young adult women is a state of personal, family and social well-being, manifested by the free exercise of sexuality, the practice of safe sex and assertiveness in making decisions that limit health risks, obtaining benefits in the general state of the person such as increased sexual desire, improved bladder control, maintenance of low blood pressure levels; it is part of physical activity and improves cardiovascular health, the immune system, sleep and stress management ⁹. On the other hand, the lack of sexual and reproductive health generates problems such as unplanned pregnancies, adolescent pregnancy, high morbidity of cervical cancer and breast cancer, sexually transmitted infections (STIs), human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), high maternal and infant mortality ¹⁰, and domestic and sexual violence ⁴, so for this review, as well as to know the important aspects of sexual health in young adult women, the aforementioned issues were considered.

It is important to highlight that the onset of sexual life begins at increasingly younger ages, which increases the number of sexual partners and exposure to sexually transmitted infections ^11-14, given that the onset of sexual life originates under risky behaviors such as inconsistent use of contraceptive and barrier methods, the result is sexually transmitted infections, unwanted pregnancies, and health, family, partner, and even social problems ^15-18. With regard to HIV/AIDS, around 6,000 cases are registered every week in women between 15 and 24 years of age ¹⁹, due to the fact that women are two to four times more vulnerable than men ²⁰, there is an increase in the feminization of this epidemic ²¹; this is similar to sexually transmitted infections, since each year there are 20 million new cases in the United States alone, about half of which occur in people between 15 and 24 years of age, with women being at greater risk of damage due to their biological and anatomical constitution ^22,23. In turn, breast cancer is one of the most common diseases with the highest number of deaths ²⁴; likewise, cervical cancer is the third most common malignant neoplasm ²⁵ and the second leading cause of death worldwide ²⁶. Therefore, in view of the epidemiological records mentioned above, it is important to point out the commitment that the nursing professional has in relation to the search, design and implementation of care strategies with the correct scientific evidence to improve the sexual health of young adult women, since the role of nursing in education is essential ^27,28. Likewise, the literature shows that sexual health has been addressed with positive results through educational talks and/or workshops based on health promotion, but the results are not lasting, so it is proposed to review the Motivational Interviewing, whose application has been successful in changing risk behaviors.

Motivational Interviewing is defined as a therapeutic style that focuses on the person who is ambivalent about change ²⁹, so its objective is to explore and resolve ambivalence with the person by creating a bond that helps to resolve the contradictions of unhealthy behaviors and achieve change in favor of health ^30-35. As a result of the analysis of sexual health in women with the application of Motivational Interviewing by the nursing professional, this question arose: What scientific evidence exists on the application of Motivational Interviewing in women regarding sexual health by the nursing professional? Therefore, the objective was established to investigate how Motivational Interviewing is applied in nursing care for sexual health care.

Methodology

The systematic review was used under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, defined as a research publication guide, created to improve the integrity and quality of systematic reviews, consisting of 7 domains (title, abstract, introduction, methods, results, discussion and financing) distributed in 27 items ³⁶.

The search was carried out in electronic databases such as PubMed, Biblioteca Virtual en Salud, Lilacs, Trip Database, Science Direct, EBSCOhost, Cochrane Library, Redalyc.org, Latindex, Elsevier Scopus, Web of Science, SciELO and Dialnet; articles published during the period from 2017 to 2020 were searched. The descriptors used as a search strategy were: Motivational interviewing, Sexual health, Nursing and Woman. Regarding the inclusion criteria, we considered studies of randomized clinical trials, systematic reviews, quantitative and qualitative studies, published in Spanish, English and Portuguese, that addressed as intervention the Motivational Interviewing in the care of young adult women on sexual health by nursing professionals, available in open access, full text and place of implementation unspecified.

The search performed in the electronic databases of the health area resulted in 2,123 articles; subsequently, those articles that did not meet the eligibility criteria and those that were repeated were eliminated. From the 414 articles remaining from the literature search after critical reading of the documents, a total of 2 articles were accepted (Figure 1).

Source: prepared by the authors.

Figure 1: Article selection process, 2019. 

It is considered a risk-free research as it is a systematic documentary review without any interaction with individuals. The information collected for each article included authors, year, study design, country and journal of publication. Regarding the intervention, authors, number of sessions, time of intervention, topics addressed and results were considered.

Results

The studies that answered the research question were studies from Brazil, of the randomized clinical trial ³⁷ and quasi-experimental study ³⁸ types in English (Table 1).

In the study by Marques, et al. ³⁷ the study subjects were women with inadequate periodicity in the cytology examination; two groups were formed, one group was given an educational intervention by telephone providing information on knowledge, attitudes and practices on cervical cancer prevention, risks, purpose of the cytology examination, importance of performing it with the appropriate periodicity, pre-examination care, as well as the importance of returning for the results. Among the main findings were an increase in knowledge in both groups, although it was higher in the educational intervention group; both groups presented inadequate attitudes, although the score decreased in the educational group. Finally, practices increased in both groups, although adherence was higher in the behavioral group than in the educational group.

In the study by Oliveira, et al ³⁸, three groups of adult women were formed, in the first group daily assistance was provided, which consisted of collecting the sample and arranging a return date by means of a printed sheet that was given to the person; the second group received daily assistance, which consisted of an educational telephone call and a dialogue according to the principles of Motivational Interviewing; the third group received daily assistance and a behavioral intervention, which consisted of notifying the date and time of the consultation one week in advance; the calls were made by previously trained nursing personnel. All three groups were administered a survey on knowledge, attitudes and practices. The main results were that educational and behavioral interventions are effective in getting women to return for the results, as well as increasing motivation to be interested in health issues, also they perceive an active role in self-care, and ambivalence was eliminated in the Motivational Interviewing group (Table 2).

Discussion

When investigating how Motivational Interviewing is applied to nursing care in sexual health care in young adult women, we found limited information according to the search criteria and inclusion of articles; likewise, it is worth mentioning that the studies ^37,38 showed an increase in knowledge regarding the topic of interest, improved adherence to undergo the colpocitological examination and to come for the results, as well as increased motivation for health issues, participation in self-care and elimination of ambivalence. This is in agreement with Steinberg, who mentions that Motivational Interviewing is considerably useful in the treatment of various health problems and to address addiction problems such as alcohol and other substances; he also showed that its application improved the abandonment of behaviors that put people's lives at risk; most importantly, it can be learned by anyone ³⁵, which supports Oliveira's results, pointing out that it is a simple intervention that requires little time and also few economic resources ³⁷. Likewise, this agrees with what Fernandez mentions, when stating that Motivational Interviewing works on motivation together with the person in order to favor change and eliminate unhealthy behaviors, so it should be used by nursing personnel to work on motivation to change ³⁹.

However, according to the study by Marques ³⁷, adherence to cytological examination was greater in the behavioral group, so he suggests further studies and even a follow-up study to determine the duration of the effect of the intervention provided. Other favorable results of its application are its usefulness as an intervention to improve adherence to pharmacological treatments in people with heart failure ⁴⁰, reduce alcohol consumption ⁴¹, treat obesity and overweight ⁴², increase self-efficacy for breastfeeding ⁴³, among others; therefore, it is an application tool to improve health in collaboration with the person, establishing mutually agreed objectives according to the processes established by the Motivational Interviewing, i.e., linking, focusing, evoking and planning activities, and achieving goals for wellbeing.

Conclusions

The information found from the systematic review based on the application of the Motivational Interviewing to young adult women on aspects of sexual health by the nursing professional was scarce. In turn, the studies found address aspects such as inadequate periodicity of the colpocitological examination, as well as the low rate of women who return for the results after the examination; problems that are the result of inefficient sexual health with future complications due to the lack of periodic revisions. However, it is important to point out that there are other aspects that must be addressed as part of the comprehensive care offered by the nursing professional, which is fundamental for the well-being of young adult women, since they are at a higher risk of acquiring infections and their complications.

Regarding the application of Motivational Interviewing as a care tool, it is necessary to expand its application in the context of sexual health, although it is an intervention that has been tested in other issues, there is a lack of evidence to reaffirm whether it is effective in addressing sexual health in young adult women. Studies show that although Motivational Interviewing can be developed through phone calls to improve education on the subject, it is essential to apply its processes such as collaboration, acceptance, evocation and compassion, which are essential aspects when dealing with a sensitive subject such as sexual health, because some societies may consider it as a taboo subject and show resistance to be treated.

This review shows an opportunity for the nursing professional to consider the importance of Motivational Interviewing in sexual health care, addressing its different aspects, as well as the social problems that the health professional can improve for disease prevention, and in turn, promote sexual health to avoid health risks, for which it is necessary to develop strategies that modify sexual risk behaviors to healthy sexual behaviors.

Conflict of Interest

The authors of this review declare that they have no conflicts of interest.

Funding

This review was funded by Conacyt because one of the authors is currently enrolled in the PhD program in Nursing Sciences.