Required skills and attitudes for sexual health education: insights from Finnish health education teachers Open Access

Adolescent SH continues to be threatened by many factors. According to WHO’s (2024) report, condom use among young people has significantly decreased between 2014 and 2022, increasing the risk of contracting sexually transmitted infections (STIs) and unintended pregnancies. According to the Finnish School Health Promotion Study in 2023, up to 30% of Finnish youth reported experiencing sexual harassment. Additionally, the diversity of different sexual and gender identities has increased significantly (THL, 2023).

SHE includes developmentally appropriate, curriculum-based, and comprehensive content designed to promote healthy sexual development and informed decision-making (UNESCO, 2018). In 2018, UNESCO established international guidance for SHE, aiming to empower adolescents with the knowledge, skills, attitudes, and values necessary for maintaining good SH (UNESCO, 2018). Still, SHE varies globally in terms of implementation approaches, with some nations having long-standing programs while others are recent adopters. Despite disparities and occasional setbacks, numerous countries have made significant strides in implementing SHE. Nevertheless, several countries still lack legislation or policies addressing SHE (UNESCO, 2021).

The role of teachers in school-based SHE is significant (Vincent and Krishnakumar, 2022; Szucs et al., 2022), and the competence of teachers profoundly impacts adolescent SH promotion (WHO and BzgA, 2010). Teachers’ education and competence levels vary worldwide. According to UNESCO (2021), many teachers are not sufficiently trained in sex education, despite the demand for appropriately trained teachers to deliver SHE (UNESCO, 2018). Poorly educated teachers can harm SHE by conveying inaccurate information or perpetuating values (UNESCO, 2021).

In Finland, SHE is an integral component of the HE subject (terveystieto), a subject that has existed as a standalone discipline since 2003 (Kontula, 2011). Currently, HE is incorporated into the curriculum of both lower secondary schools and general upper secondary education (EDUFI, 2014,2019), with the primary objective of fostering health literacy among pupils and students (EDUFI, 2014, 2019). Finnish legislation governing the qualifications of teaching staff (Decree on Qualification Requirements for Teaching Staff, 1998/986) stipulates that individuals are eligible to teach HE in Finland if they possess a master’s degree, a minimum of 60–120 credits in HE studies, and at least 60 credits in pedagogical studies.

The competence of HE teachers can be categorized into knowledge, skills, and attitudes (WHO and BzgA, 2017; Moynihan et al., 2015). These components overlap and cannot be entirely separated (Moynihan et al., 2015). This study focuses on the SHE skills and attitudes of HE teachers, while the knowledge component is addressed in another paper (Jämiä et al. 2024). As stated before, the competence and education levels of these teachers vary globally, making international comparisons difficult. Since there are no previous Finnish studies on this phenomenon, the studies below aim to gather research from contexts or cultures similar to Finland.

According to WHO and BzgA (2017), sexuality educators’ skills should include the ability to create a safe atmosphere and learning environment, skills in delivering different teaching methods, and effective communication. Previous study has focused on the self-reported skills of teachers and based on these, SHE skills of teachers seem to vary, especially considering topics such as pornography and sexual and gender diversity. Some teachers feel adequately equipped with the required skills and confidence, while others do not (Cummings et al., 2021; Burns et al., 2023; Cumper et al., 2024). In a study conducted by Burns et al. (2023), the majority of teachers felt confident handling sexual and gender diversity issues, but some still lacked confidence. According to the study by Cumper et al. (2024), teachers expressed uncertainty regarding the instruction of the subject, including the use of lesbian, gay, bisexual, transgender, intersex, queer and asexual (LGBTIQA+) terminology.

Teachers also believe they currently lack the necessary skills to effectively address subjects considering sexting and pornography without proper preparation (Oliver and Flicker, 2024). Teachers recognize the importance of communicating with adolescents but face challenges with immature students or those who don’t take issues seriously (Cummings et al., 2021). Confidence in providing SHE among teachers usually depends on experience or the content discussed, with lower confidence reported in areas like sexual identity and gender (Walker et al., 2021).

The attitudes of sexuality educators should include a commitment to SHE, an appreciation for integrity, an understanding of different boundaries, open-mindedness and appreciation for other people (WHO and BZgA, 2017). Based on previous international research, teachers’ attitudes towards SHE seem mainly positive. Teachers consider SHE important (Depauli and Plaute, 2018) and are motivated in delivering SHE (Walker et al., 2022). In addition, teachers express concern that not all teachers have sufficient expertise to teach the subject (Cumper et al., 2024). In studies conducted by Burns et al. (2023) and Cumper et al. (2024), teachers demonstrated positive attitudes toward the LGBTIQA+ community and related issues. On the other hand, teachers with more interest in SHE tend to have more positive attitudes (Walker et al., 2022) compared to those who address the subject less frequently (Depauli and Plaute, 2018).

In summary, adolescent SH continues to be threatened by many factors, such as STIs (WHO, 2024) and sexual harassment (THL, 2023). Additionally, the diversity of different sexual and gender identities is growing (THL, 2023), which requires more information and resources for adolescents. At the same time, it is observed that the competence of teachers providing SHE is not given enough attention (Sato et al., 2022), and SHE should be even more comprehensive (WHO, 2024). A recent WHO report calls for professionals providing SHE to be well-trained (WHO, 2024) and UNESCO (2022) demands qualitative studies on teacher preparedness. To the best of our knowledge, there is no previous research on this phenomenon in this context. This study aims to address this gap.

The purpose of this research is to explore the SHE skills and attitudes required of HE teachers in Finland. This understanding can be applied in shaping the assessment of HE teachers’ competence and help guide teacher training and professional development initiatives.

The research questions guiding this study are as follows:

The study employed a qualitative exploratory approach with the aim of gaining a deeper understanding of the SHE skills and attitudes required of HE teachers (Moser and Korstjens, 2017). The choice of a qualitative design was motivated by the absence of prior research into this particular phenomenon (Kyngäs et al., 2020).

The target group for this study comprised of Finnish HE teachers. The recruitment process was facilitated with the assistance of a physical and health education teachers organization, which disseminated the recruitment letter to its members through social media and email in March 2023. The letter provided comprehensive details about the study’s objectives and methodologies. Interested individuals or those with queries were encouraged to reach out to the researcher via email.

A total of 15 participants, all of whom were Finnish HE teachers actively engaged in teaching either at the high school level or within grades 7–9 of comprehensive schools, were included in the study. All the participants held a master’s degree as their highest level of education. The characteristics of the participants are outlined in Table 1.

Data for this study were gathered through a combination of semi-structured interviews and electronic forms (e-forms) containing open-ended questions (Bengtsson, 2016; Kallio et al., 2016). Participants were given the autonomy to choose which data collection method they participated in. The thematic focus was rooted in established frameworks, including the Health Education Teacher Competency Framework (Szucs et al., 2021), Core Competencies of Health Education Teachers (Moynihan et al., 2015), and the Framework for Core Competencies of Sexuality Educators (WHO and BZgA, 2017). The identified themes included both skills and attitudes. Skills encompassed: (1) communication skills, (2) creating a safe atmosphere and learning environment, (3) reflection and ethical thinking skills, (4) planning and implementation. Attitudes encompassed: (1) attitude towards curricula, (2) comfort teaching the subject, (3) commitment to SHE, (4) openness and respect for others. The same themes were addressed both in the interview and e-form streams. In addition to addressing the research questions, background information about the participants was collected at the outset of the data collection process.

The individual interviews were conducted using Microsoft Teams, while the e-forms were administered via Microsoft Forms. Eight teachers participated in the interviews, and seven teachers completed the e-forms in March and April 2023. The interview durations varied from 60 to 90 min. Recordings of the interviews were transcribed into text, and the e-form responses were saved for subsequent analysis.

The data analysis was undertaken by the first author utilizing an inductive content analysis approach. Throughout the entire research process, ongoing discussions within the research group informed the analysis. The analytical process commenced with a comprehensive reading of the entire research material. The analysis was conducted separately for each research question (Bengtsson, 2016). Subsequently, original phrases that directly addressed the research questions were identified and then distilled into reductions (skills n = 318, attitudes n = 260). These reductions were systematically compared, focusing on discerning both differences and similarities among them. Similar reductions were amalgamated to form sub-categories, categories, and overarching main categories, each named in accordance with its content (Elo and Kyngäs, 2008; Bengtsson, 2016).

Actions were made to ensure the trustworthiness of this study. Credibility was improved through clear documentation and the inclusion of verbatim quotations. Confirmability was achieved by maintaining thorough records, allowing for replication. Ongoing critical reflection on potential biases was addressed to maintain reflexivity, and transferability was strengthened by detailing key participant characteristics (Elo and Kyngäs, 2008.).

Ethical approval for this study was sought and obtained on March 2, 2023 (22/2023) from the Ethics Committee for Human Sciences of Tampere Area. The entire research process adhered to the Finnish Ethical Principles of Research with Human Participants and Ethical Review in the Human Sciences in Finland (TENK, 2019). Ensuring the ethical treatment of participants was of paramount importance, and the following measures were implemented: (1) Voluntary Participation: In accordance with ethical guidelines (TENK, 2019), participation in the study was entirely voluntary, and participants were not under any obligation to take part; (2) Anonymity Assurance: The anonymity of participants was safeguarded throughout the research process (TENK, 2023), and any information that could potentially identify participants was handled with the utmost confidentiality; (3) Informed Consent: Prior to their involvement in the study, informed consent was actively sought from each participant (TENK, 2019), and participants were provided with comprehensive information about the study’s purpose, methods, and potential implications, allowing them to make an informed decision about their participation. By adhering to these ethical principles, the research aimed to uphold the rights and well-being of the participants, ensuring the integrity and ethical soundness of the study.

Three major skill areas emerged from the data analyses: (1) diverse professional management, (2) comprehensive SH topic engagement, and (3) educational engagement for adolescents (Table 2).

Tailored instructional flexibility (Table 2). Participants described that teachers should have the necessary skills to create interesting teaching. It is crucial to present the material in a manner that resonates with adolescents, especially when addressing topics related to sexuality. Adolescents often express interest in SH, and the teacher should leverage this curiosity. Simultaneously, teachers should have proficiency in information filtering for adolescents. They should be adept at filtering media and handling potentially disturbing news, such as reports on sexual offenses.

Participants underscored the importance of a teacher possessing the significant skill of adapting teaching to student groups. A teacher should be adept at creating suitable groups within the classroom and be willing to adjust their methods when necessary. Observational skills are crucial, enabling the teacher to assess the group’s existing knowledge, preferred discussion topics, and the emotional dynamics within each student group.

Participants also highlighted the necessity of adapting teaching to age groups. Given the potential for a wide age range in classrooms where teachers work across different education levels, it becomes vital to employ language and instructional methods that resonate with the specific age group. Teachers are urged to plan lessons, choose perspectives, and employ methods that align with the cognitive and emotional development of the students.

The teachers should be proficient in responsive teaching applications. Flexibility is key, as teachers should be capable of modifying lesson plans on the fly and addressing topics that emerge from the students. Additionally, participants stressed the importance of a teacher’s ability to prioritize and limit teaching activities in the face of resource constraints. Teachers should be skilled at determining which themes are most essential and directing their focus accordingly when resources are limited.

Versatile teaching method management (Table 2). Participants underscored the necessity of teaching method dexterity. Teachers must be adept at employing a variety of teaching techniques beyond traditional lecturing, ensuring engagement and adaptability. They should demonstrate proficiency in collaborative methods, utilizing introductory games and diverse instructional tools to facilitate discussions, such as incorporating articles and task stations. Additionally, teachers should encourage ethical contemplation and use comics to address sensitive topics, fostering a dynamic and enriching learning environment.

Moreover, participants highlighted digital teaching method proficiency such as Padlets, Kahoots, videos, and series in teaching. Videos and series were perceived as foundational tools for fostering conversation, while Kahoots were considered effective in assessing the knowledge adolescents already possess or what they have learned.

Participants emphasized the importance of optimized teaching planning. They highlighted the significance of scheduling SHE during a school year when ample resources are available to ensure comprehensive delivery. They also stressed the value of integrating SH with other subjects. Participants considered skills in diverse thinking and the ability to consider issues from multiple perspectives as essential. Besides good planning, the participants also highlighted quality teaching implementation. Consistency in lesson structure is important. Establishing a conducive learning environment through various arrangements is crucial, as is breaking down the material into manageable segments. Proficiency in lesson delivery is imperative, including the ability to convey safety skills.

Competence self-management (Table 2). Participants emphasized that teachers should possess the skill of continuous learning. It is necessary for an HE teacher to stay current with new, reliable information. It is crucial for an HE teacher to be well-informed and possess the skills to seek additional information, particularly in the context of understanding and broadening their perspectives on topics related to LGBTIQA + issues. Teachers should also be adept at staying informed about current events in adolescents’ lives and critically evaluating the multitude of information sources.

Furthermore, teachers should have competence awareness. They should be conscious of the limits of their competence, acknowledge gaps in their knowledge, and seek assistance when needed. In situations where resources may be insufficient, teachers should be equipped to address challenges effectively. Participants also emphasized that, when faced with unfamiliar information, teachers should be capable of determining how and where to access accurate and relevant information.

Reflective pedagogical practice was identified as essential for an HE teacher. A teacher should be adept at self-reflection and know how to leverage colleagues when engaging in reflective practices. It is important for a teacher to reflect on daily experiences and consider whether there are valuable lessons to be learned. Ethical thinking skills were also deemed crucial. A teacher should demonstrate an understanding and acceptance of diversity, being able to empathize with the adolescent’s perspective irrespective of their own viewpoints. Moreover, a teacher should possess the ability to facilitate ethical conversations about sensitive topics such as abortion and sexual rights.

Courage in handling SH topics (Table 2). Participants described that teachers should possess pedagogical confidence in teaching. Confidence and trust in one’s teaching skills were highlighted as crucial, where teachers should believe in themselves and convey certainty in their instruction. Adolescents should perceive the teacher as knowledgeable, understanding that they possess more information than shared and that the information delivered is reliable. The ability to confidently demonstrate and discuss contraceptive methods, even using props like wooden models or bananas to illustrate condom use, was considered a necessary skill.

Additionally, participants stressed the importance of facilitating open dialog. Teachers should have the courage to address various SH-related issues. Teachers should be adept at initiating discussions on challenging topics, sharing information with adolescents, and normalizing conversations about sexual taboos, such as sexual pleasure. Participants highlighted that teachers should possess adolescent empowerment skills. They should be encouraging, utilizing positive language to promote contraception use and encouraging students to seek treatment when needed. Furthermore, participants described the importance of responsive SH-topic reception. Teachers should be open to any questions or themes coming from adolescents. A teacher should be prepared to respond to adolescents’ questions and accept all kinds of reactions with readiness and understanding.

Considerate SH topic management (Table 2). Participants stressed the importance of teachers possessing skills in sensitive topic management. Teachers must exercise boundless discretion when discussing sensitive subjects, being cautious with their language and avoiding any accusatory tone towards adolescents. Teachers should refrain from making interpretations and demonstrate an understanding of the adolescents’ perspectives. When addressing sensitive topics, teachers should be attuned to the kind of information and support the adolescents need. They should be vigilant in responding to adolescents’ questions and comments, intervening when necessary to address any potential crossing of limits among students in the classroom.

Moreover, it is crucial for a teacher to have precision in conceptual communication. Teachers should master different terms and concepts related to SH and communicate them directly. Teachers should be proficient in understanding the meanings of various concepts and confidently employ them. The teachers should utilize a generalized communication approach. Topics should be discussed at a general level, avoiding gender-specific language. Discussion in class should remain at a general level, allowing for natural conversation. A teacher’s crucial attribute is the ability to discuss matters without blushing. Messages should not be directed toward a specific group or its members. Delicate subjects should be taught in a general manner, being mindful of the discussion’s context.

Pedagogical interactions with adolescents (Table 2). Teachers should be able to create positive interactions with the adolescents. Participants highlighted that good communication skills are one of the most important skills a teacher should have. Participants emphasized the paramount importance of effective communication skills for teachers. It was underscored that teachers should cultivate a strong connection with adolescents, demonstrating eloquence, adaptability, and a courteous communication style. Genuine engagement with adolescents was also deemed crucial. Confronting adolescents genuinely is deemed essential, with teachers being urged to listen actively, respond appropriately to ensure adolescents feel genuinely heard, and address any potential difficulties they may face.

Participants underscored the importance of teachers possessing the ability to create safe learning environments. Teachers should be equipped with skills to navigate and address challenging topics securely, acting as a safe and supportive figure for adolescents. In instances of classroom bullying, the teacher must promptly intervene, not only addressing the bullying itself but also regulating discussions about others’ sexuality in the classroom. Teachers are required to instill a relaxed and natural atmosphere in the classroom, demonstrating the ability to gauge the atmosphere and adjust their behavior as necessary.

Participants also noted that effective use of humor in teaching is a valuable tool for teachers in certain situations, contributing to the creation of a relaxed atmosphere. However, participants emphasized the need for teachers to discern appropriate situations for humor, recognizing the delicate balance and timing required.

Resourceful guidance for adolescents (Table 2). Participants emphasized that teachers should be adept at facilitating help-seeking and assisting adolescents in seeking help when needed. In discussions addressing issues closely connected to the daily lives of adolescents, they may seek guidance or assistance from the HE teacher. It is crucial for teachers to have the skill to communicate to adolescents that for personal matters, they should contact professionals such as the school nurse or other healthcare providers. Teachers need to discern the limits of what they need to know, recognizing when an issue should be handled by healthcare professionals.

Teachers should also be proficient in directing students to reliable information sources. They should guide students on where to find reliable information and encourage them to explore further. In instances where teachers may not possess all the necessary knowledge or answers to adolescents’ questions, they should adeptly guide them toward obtaining accurate information from trustworthy sources.

Three major attitude areas arose from the data analyses: A) holistic attitude towards professionality, B) supportive approach to adolescent interaction, and C) broadmindedness towards sexuality (Table 3).

Equitable curricular approach (Table 3). The participants emphasized the importance of curricular emphasis. They suggested that teachers should view the curriculum as a crucial tool for instruction, ensuring a fair and comprehensive coverage of SH-related subjects, while refraining from expressing personal views. Participants highlighted the curriculum’s role in guiding teaching practices, stressing that teachers have an obligation to adhere to its guidelines. It is essential for teachers to be familiar with the curriculum content, fostering a positive attitude toward implementing lessons based on the curriculum.

Participants emphasized the necessity of an equitable treatment of SH topics. Teachers must avoid favoritism towards some topics and should not downplay the significance of others. It is crucial to disseminate information about all SH-related matters to the entire group, ensuring that everyone, regardless of gender, is informed about aspects such as menstruation. Participants stressed the importance of taking sufficient time to cover these topics comprehensively, viewing them as integral components of SH for humanity as a whole, rather than isolated aspects. Additionally, participants highlighted the importance of teachers maintaining professional neutrality. While teachers should be open-minded, acknowledging diverse perspectives, they should refrain from expressing any negative attitudes, ensuring a supportive environment for adolescents. Teachers should also avoid sharing personal experiences as examples or discussing matters related to their own sexuality.

Considering SHE meaningful (Table 3). The participants underscored the necessity of a dedication to SHE. Teachers should exhibit a willingness to teach SH-related issues and demonstrate their commitment to SHE instruction. According to the participants, the quality of teaching is enhanced through this commitment. Teachers’ attitudes should also include recognizing SHE significance. It was emphasized that teachers should not only consider SHE as important but also believe that SH is integral to the overall development of adolescents. Teachers should find SHE interesting, fostering enthusiasm for the subject. The participants also pointed out that for example, the continued prevalence of STIs and adolescent abortions does not undermine the effectiveness of school-based SHE. Participants also considered that valuing HE as an essential subject is important, suggesting that teachers should take pride in their discipline. Moreover, participants highlighted the need for HE teachers to advocate for the subject, and to maintain a positive attitude towards all aspects of HE.

Collaborative spirit (Table 3). Participants emphasized the significance of collegial appreciation. They stressed the importance of expressing appreciation for colleagues. Additionally, participants highlighted the importance of teachers relying on the assumption that colleagues from other subjects or previous education levels have followed the curriculum, ensuring that adolescents receive the necessary knowledge. Encouraging teachers to maintain a positive attitude toward utilizing the expertise of other teachers, such as religion, psychology, and biology teachers, is important. Participants noted that leveraging the competence of teachers from various subjects could contribute to a more comprehensive SHE for adolescents. However, participants also expressed the view that it is not acceptable to completely delegate certain aspects of SHE to other subjects.

The teachers should also be open to valuing professional collaboration. Participants stressed the importance of teachers maintaining a positive attitude towards utilizing other professionals. Utilizing experts, including HE and healthcare professionals, greatly bolsters teaching efforts. Seeking assistance from a school nurse and directing individuals to the family counseling center’s website are integral parts of supporting teaching initiatives. Furthermore, participants highlighted family involvement recognition. The attitude should be inclusive of parents, fostering their involvement and collaboration. It’s vital to engage parents and consider their perspectives, especially concerning multicultural students. Being prepared to accommodate parental reactions is essential for effective cooperation and fostering a family-centric approach.

Commitment to self-development (Table 3). Participants emphasized a willingness towards proactive information seeking. They described the willingness to search for more information as crucial for a teacher. Being open to receiving new information, regularly updating knowledge, and having an attitude of willingness to find out if there’s something unknown were seen as important qualities for a teacher. Participants also highlighted that an HE teacher should delve deeper into SH-related issues and maintain a positive attitude towards staying informed by following the news.

Commitment to professional growth was deemed crucial. Participants highlighted the importance of teachers having a positive attitude towards enhancing their competence through ongoing training. Additionally, participants expressed the view that HE teachers should be open to obtaining the qualification of an HE teacher. They emphasized the significance of following the curriculum while also expecting teachers to possess knowledge beyond what the curriculum demands.

Appreciation for adolescents (Table 3). Participants underscored the importance of an approving attitude towards adolescents. Participants underscored that teachers should exhibit approving attitudes, especially on the sensitive topic of SH. Teachers should refrain from being dismissive, judgmental, or making assumptions about adolescents. Regardless of the adolescents’ gender or sexual orientation, teachers should accept them as they are, treating them with respect and openness. Teachers are encouraged to approach adolescents with curiosity, free from prejudice, and avoid having a narrow view of diversity. In SH lessons, teachers highlight a voluntary participation perspective. Active involvement is voluntary, and the teacher should refrain from pressuring adolescents to share personal experiences or to respond to uncomfortable questions. Participants highlighted that in SH lessons, adolescents have the option to simply listen if they prefer and can choose to participate actively or share information only when they feel comfortable doing so.

Teachers should respect the adolescents’ right to accessible information. This entails a willingness to adapt teaching methods based on the specific adolescent group. Teachers should be committed to delivering SHE in a format that fosters the development of adolescents and is appropriate for their understanding.

Willingness to be accessible (Table 3). Participants emphasized their willingness to be approachable. Teachers should foster an attitude that encourages adolescents to approach them with any questions, making time for discussions after lessons or in private. HE teachers are expected to be reliable adults for adolescents, understanding that they don’t need to have all the answers. Participants stressed the significance of understanding personal limits in teaching. Teachers should acknowledge that it’s okay not to know everything and maintain a positive attitude when adolescents share new information. However, it’s crucial for teachers to be willing to find out and address any gaps in their knowledge.

Participants emphasized allowing personality expression in teaching. Teachers are allowed to let their own personalities shine through in lessons. They described the importance of teachers being familiar with both themselves and the subject matter to effectively convey the material. An emphasis was placed on self-awareness, as being familiar with oneself enables the teacher to deliver lessons with their own personality.

Positive engagement with adolescents (Table 3). Teachers emphasized the paramount importance of having a genuine interest in adolescent wellbeing. Caring about adolescents and being attuned to their lives is a core value for teachers. It is crucial for adolescents to feel that the teacher is supportive. The teacher should possess the ability to engage with students effectively and show genuine interest in their well-being. Openness towards adolescents was also deemed important. An open and approachable attitude is crucial, creating an open atmosphere in the classroom. Additionally, the teacher should exhibit curiosity, fostering a positive and dynamic learning environment. Participants also highlighted the need for kindness towards adolescents. A kind, tolerant and empathetic approach to SHE is essential, and participants further emphasized the importance of teachers being positive and encouraging towards adolescents.

Unprejudiced attitude towards sexuality (Table 3). Participants emphasized the importance of LGBTIQA+ inclusivity. Teachers are encouraged to maintain open-minded attitudes towards LGBTIQA+ individuals, understanding sexual and gender diversity and appreciating various orientations. It is essential for teachers to recognize that traditional boy or girl systems are evolving. They should cultivate open-mindedness towards themselves and others, understanding the diversity of people around them. Teachers are encouraged to adopt an attitude that promotes acceptance and allows everyone to be themselves.

Participants emphasized multicultural acknowledgment. If there are adolescents from diverse cultures or religions who choose not to participate due to their background, the teacher should respect their decision. Teachers should be open to understanding and embracing adolescents’ diverse backgrounds, including different cultures and religions.

Unaffected attitude towards sexuality (Table 3). Participants emphasized the importance of adopting a natural approach to sexuality. Teachers should exhibit a natural attitude when addressing SH-related issues, without feelings of shame or fear. It is essential for teachers to recognize sexuality as a natural and positive aspect of personality. To effectively teach SH-related topics, teachers should have a good understanding of themselves. Participants further described that teachers should maintain neutrality towards sexuality, embracing gender diversity and fostering a normalizing attitude. The discussion of SH issues should be approached with neutrality, creating an environment where sexuality is not considered as mysterious, and discussions are conducted in a non-aggressive, neutral manner.

The purpose of this study was to explore the essential SHE skills and attitudes required of HE teachers. The primary skill areas identified include diverse professional management, comprehensive SH topic engagement and educational engagement for adolescents. In a broader context, the findings predominantly highlighted the general skills necessary for all teachers, including effective communication and versatile pedagogical abilities. However, the study also identified specific perspectives crucial within the context of SHE. Previous research indicates variability in teachers’ proficiency in delivering SHE (Walker et al., 2022; Burns et al., 2023; Cumper et al., 2024; Oliver and Flicker, 2024). The findings of this study partially adapt the skills required from sexuality educators based on a previous framework (WHO and BzgA, 2017).

In this study, participants emphasized the importance of teachers employing various teaching methods adeptly and engaging in continuous professional development. Previous study also underscores the importance of mastering new teaching methods and highlight teachers’ perspectives on professional development and growth (Sato et al., 2022). Teachers who have not received the required training to deliver SHE describe teaching sensitive issues as challenging (Ram and Mohammadezhad, 2020). The lack of time and the extensive range of topics present significant barriers for teachers in engaging in continuous professional development (Cummings et al., 2021). In order to provide diverse and comprehensive SHE for adolescents, teachers require constant access to reliable information and ongoing in-service training, especially given the rapid development of the world and technology. However, this cannot be achieved without allocating sufficient time for teachers to engage in these activities. Overall, the findings underscore the importance of teachers being adaptable and proactive in their teaching practices.

The findings of this study underscore the crucial importance of courage and sensitivity when addressing this topic. According to previous international research, teachers’ skills considering confidence with LGBTIQA+ issues vary, some teachers feel confident, and others lack the confidence (Cummings et al., 2021; Burns et al., 2023; Cumper et al., 2024). Teachers in previous studies have also described a lack of skills to effectively address subjects considering sexting and pornography (Oliver and Flicker, 2024). The results of this study underline the need to have the skills to be pedagogically confident and have the sensitivity to address difficult issues, as SHE in schools should address sex and sexuality as versatile and healthy matters (Goldfarb and Lieberman, 2021; Cummings et al., 2021). In turn, previous studies indicate that these goals are not consistently adopted by teachers.

The participants of this study underscored the importance of pedagogical interactions with adolescents. Previous studies have indicated that adolescents themselves perceive the classroom atmosphere as equally important to learning as the subject matter (Laverty et al., 2021; Unis and Sällström, 2020). Teachers recognize the importance of communication with adolescents; however, some describe encountering challenges when interacting with immature students or in situations where students do not take these issues seriously (Cummings et al., 2021). For teachers addressing sensitive SH issues, the ability to engage comprehensively with adolescents is crucial. Teachers are expected to cultivate a supportive and engaging environment that enhances student learning experiences, even if students are not always receptive to the teaching.

The primary attitude areas identified through the analysis include a holistic attitude towards professionalism, supportive approach to adolescent interaction, and broadmindedness towards sexuality. Participants highlighted the importance of maintaining positive attitudes towards professionalism. Teachers are expected to embrace positive attitudes towards adhering to curricula and recognizing the meaningfulness of SHE. This aligns with previous literature, where teachers are acknowledged for recognizing the importance of SH and emphasizing the significance of using suitable teaching methods and materials (Depauli and Plaute, 2018). Teachers consider SHE important (Depauli and Plaute, 2018) and are motivated in delivering SHE (Walker et al., 2022).

The findings of this study underscore the importance of appreciation for adolescents and broadminded attitudes towards SHE. In accordance with the recommendations from the WHO and BzgA (2017), the attitudes expected from a sex educator encompass understanding different boundaries and open-mindedness. Previous study also describes teachers having mainly positive attitudes towards LGBTIQA+ community and issues (Burns et al., 2023; Cumper et al., 2024). This alignment with established literature indicates the consistency and validity of the study’s findings. However, existing research (Cummings et al., 2021) suggests a potential discrepancy, implying that SHE in schools tends to emphasize the risks of sexual behavior more than the positive aspects of sexual development. This discrepancy points to an inconsistency between the attitudes advocated for HE teachers and the actual emphasis given in classrooms.

It is worth noting that all of the participants in this study were HE teachers who volunteered to take part in the research. Previous research has shown varied attitudes among teachers towards SHE. Teachers who demonstrate more interest in SHE tend to have more positive attitudes (Walker et al., 2022) compared to those who address the subject less frequently (Depauli and Plaute, 2018). Being willing volunteers, the participants of this study likely possessed a genuine interest in SHE, and this may contribute to their positive attitudes about the research phenomenon, suggesting a potential bias in the sample’s perspectives. But given the varied attitudes towards SHE seen among teachers in previous research, it’s crucial to encourage teachers to show interest in SHE and address it consistently with students.

A recent WHO (2024) report emphasizes the need for teachers providing sexual education to be adequately trained. In turn, the findings of this study underscore the necessity for HE teachers to possess a diverse range of SHE skills and attitudes. Teachers are required to exhibit the ability to effectively address adolescents, demonstrate extensive didactic skills, and cultivate sensitivity, professionalism, respect, and broadmindedness. A previous study expresses concern that not all teachers delivering SHE possess sufficient expertise to teach the subject (Cumper et al., 2024). Ensuring the competence of HE teachers is crucial to providing comprehensive SHE for adolescents. This necessitates improvements in the pre-service education of HE teachers and the provision of accessible in-service training opportunities.

While this study provides valuable insights into the perspectives of HE teachers, some limitations should be acknowledged. The context-specific nature of the study, focusing exclusively on Finnish HE teachers, limits the transferability of the findings to broader international or diverse cultural contexts. The recruitment letter reached potential participants throughout Finland. However, since the survey’s background information did not include a question about the participants’ region, data on the geographical distribution of respondents is not available. Anyhow, the design of this study was exploratory, aiming to gain insights and gather information to help define the phenomenon for further research. This view has not been studied in depth before, which makes this design suitable. Consequently, further research in different settings and countries is essential to validate and extend the applicability of these findings.

Although common in qualitative research (Bengtsson, 2016), the sample size of 15 teachers raises considerations about the representativeness of Finnish HE teachers as a whole. It is plausible that the participants may only offer a partial representation of Finnish HE teachers, emphasizing the need for caution when extrapolating the findings. However, the data could be considered comprehensive, considering the number of reductions identified from the analysis (skills n = 318, attitudes n = 260).

Additionally, the necessity for participants to contact the researcher may have led to some individuals opting out of the study. While this approach was intended to provide participants with direct information and facilitate interview arrangements, it might have inadvertently limited the pool of participants. These limitations highlight the need for cautious interpretation and suggest a need for further research with larger and more diverse samples, encompassing varied cultural and educational contexts.

Policy and societal implications. The exploratory findings of this study are valuable for initiating discussions in both education and health policy regarding the competencies of HE teachers in SHE. By placing greater focus on this issue, policymakers and educators can work together to ensure that teachers are well-prepared to deliver comprehensive and effective SHE. The goal of all this is to achieve better health outcomes for adolescents and a more informed and healthy society overall.

Curriculum development and teacher training. The research highlights the need for curricula that prepare teachers to address sensitive topics such as SH in an unbiased and supportive manner. Teacher trainees should be provided with a more comprehensive education on SH. This comprehensive training should include practical strategies for engaging students, addressing their concerns, and promoting healthy attitudes toward sexuality.

Professional development. To enable teachers to acquire the necessary competencies, comprehensive in-service training should be provided to HE teachers. Additionally, opportunities should be made available for them to undertake these training programs during working hours or study leave.

Future research. Given the exploratory nature of this study, future research should adopt a broader perspective on this phenomenon with larger samples and different contexts. There is also a need to assess the current skills and attitudes of HE teachers, identify areas for improvement, and establish instruments for systematic evaluation. Such efforts would contribute to ensuring that HE teachers are well-equipped to address the evolving landscape of SHE and the diverse needs of adolescents. It is also important to focus on how these identified skills and attitudes are implemented in different educational settings besides classrooms.

This study has contributed new knowledge regarding the SHE skills and attitudes required of HE teachers in Finland, previously unexplored in research. The identified skill areas primarily centered on general teaching skills such as effective communication and versatile pedagogical techniques. However, specific perspectives crucial for SHE were also highlighted, emphasizing the need for courage and sensitivity in addressing SH-related issues. In terms of attitudes, the findings underscored the importance of professionalism, a supportive approach to adolescents and broadmindedness.

In conclusion, this study sheds light on the multifaceted landscape of SHE skills and attitudes required of HE teachers. It is evident that teachers must not only possess a diverse set of skills but also foster multiple positive and encouraging attitudes to be able to deliver comprehensive SHE. In relation to this sensitive matter, professionalism and interaction with adolescents were highlighted, as well as unbiased and unaffected attitudes toward sexuality.

Required Skills and Attitudes for Sexual Health Education: Insights from Finnish Health Education Teachers.

We want to thank the health education teachers who participated in the study and gave us their time.