Identifying the social determinants of marginalized women’s quality of sexual life based on the WHO approach: path analysis

Abstract

Introduction: Suburban women are often recognized as a vulnerable group in terms of health and access to related services. This study aimed to design and test a model of social determinants of health affecting the sexual quality of life (SQOL) of marginalized women, based on the World Health Organization (WHO) framework. Methods: This descriptive-analytical study was conducted in two phases. In the first phase, a conceptual model was developed using literature review and expert consensus. In the second phase, the model was tested in a cross-sectional study involving 560 randomly selected married women of reproductive age from marginalized areas of Kermanshah, Iran (2021–2023). The data were collected using the demographic questionnaire, the Sexual Quality of Life-Female (SQOL-F), the Socioeconomic Status Scale, the Mental Health, Domestic Violence, the Unhealthy Behavior Checklist, the General Health Questionnaire (GHQ), the Female Sexual Function Index (FSFI), Enrich Marital Satisfaction Scale (EMS), the Perceived Social Support Scale (PSSS), the Spiritual Health (SH), the Self-Esteem Scale, the Genital Self-Image Scale, the Access to Health Questionnaire, and the International Physical Activity Questionnaires (IPAQ). The data were analyzed in SPSS and LISREL 8. Results: Based on the results of the path analysis and the presented model, among the structural factors of the socio-economic status (β = 0.46), among the intermediate factors is the self-esteem (β = 0.52) and among the contextual factors, duration of marriage (β=-0.22) had the strongest overall causal and significant relationship with the quality of sexual life in marginalized women. Conclusions: The designed model highlights the current status of quality of sexual life of marginalized women and reveals the related gaps and challenges. Therefore, policy makers can utilize these results as a guide for future planning. In addition, the results can help researchers to design appropriate clinical trials to improve the quality of sexual life of the target population.