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Background: Lack of information in marital relationships can be an important factor in sexual dysfunction and dissatisfaction. Many marital problems are caused by dissatisfaction with sex. The lack of awareness in this area is due to marriage in adolescence age and regarding sex as a taboo in religious, cultural and social matters. In such cases, it may be appropriate to take advantage of modern teaching methods. Due to the increase in technology, the present study was designed and conducted to determine the role of multimedia education on sexual satisfaction in Afghan refugees’ adolescent women.
Methods: The present study is a quasi-experimental educational intervention in which Afghan adolescent women referred to selected charity centers in Mashhad were selected as the intervention (n = 34) and control (n = 34) using sortation method. Sampling was convenience and women with inclusion criteria brought in the study. Inclusion criteria were Afghan adolescents aged 10-24 years, having ability to communicate in Persian (reading and writing), formal marriage, first marriage and single marriage, residing in Mashhad, Marriage duration of at least one year, no formal and comprehensive sex education, no underlying medical conditions (diabetes, thyroid dysfunction, liver and kidney disease), non-addicted and non-psychiatric couples, lack of stress experiences in the last 3 months, no pregnancy, abortion, or delivery in the last 3 months, living with spouse in a shared home at the time of research, having sex with spouse, accessing a computer or CD player, and knowing how to use these devices or having access to the person helping the participant to use them. First, the participants completed the demographic characteristics Questionnaire and Sexual Satisfaction Questionnaire. The second questionnaire had 25 questions (13 negative and 12 positive answers) which were answered by likert scale of 1 to 7. The overall scores` range was from 25 to 175 and it categorized sexual satisfaction in three level: low level (score between 25 and 67), moderate level (score between 67 and 100) and high level (score above 100). To assess the validity of the questionnaire, face validity was approved by a survey of 6 midwifery experts and then the content validity was evaluated by 14 experts to assess the simplicity, clarity, necessity, relevance and importance. The results of the data analysis indicated that all the questions were simple and clear. The index for the whole instrument was 0.91, indicating that the instrument was content valid. By calculating the CVR index for each item, the lowest value was 0.57, and according to the Lauvche table, the allowable value for this index was 0.51, and all the questions were sufficiently valid. Test-retest method was used to evaluate the reliability of the tool. The questionnaires were given to 20 members of the study population who were not present in the study sample and after two weeks the questionnaires were again completed by the subjects; correlation coefficients were 0.79. The intervention program consisted of 4 sessions (every session was 60-minute) and 4 CDs provided to the intervention group every week to be observed during the week. Delivering subsequent educational content to participants was based on the researcher's assurance of viewing previous educational content and it was proved by asking a few questions about those contents. All educational contents were first collected by the researcher from various books about sexual subject and finally approved by a qualified professor in this field from the viewpoint of psychology. Control group participants received routine charity programs. The sexual satisfaction questionnaire was completed again at the end of training (4 weeks) and 8 weeks after the beginning of the study. After checking the data normality for data analysis and descriptive statistics such as adjusting frequency distribution tables, calculating numerical indices and inferential statistics of chi-square, independent t-test, paired t-test, One-way analysis of variance was used.
Results: The mean ± SD of the intervention group age was 22.88 ±1.200 and for the control group was 22.44 ± 1.637. 15 and 12 participants in the intervention and control group, respectively, had undergraduate education. 20 and 22 participants had high school diploma or higher. Before the intervention, sexual satisfaction was not significantly different between two groups (P = 0.729), while it increased significantly at week 4 (P = 0.013) namely 8 weeks after the intervention (P <0.001). In the intervention group, the mean of sexual satisfaction was 130.11 ± 24.54 which subsequently increased to 140.50 ±20.51 after intervention and 148.35 ± 18.88     8 weeks after intervention which in turn indicates the persistence of information. There was also an increase in scores of participants. In the control group, the mean sexual satisfaction was 128.82 ± 19.88 in the first week, 128.26 ± 19.57 in the fourth week and 128.41 ±19.65 in the 8^th week which showed no significant difference.
Conclusions: Due to the nature of sex education which is associated with shame, using multimedia method was more effective and cost-effective. This method also does not need face-to-face visits and improved the sexual satisfaction of adolescent Afghan refugee women therefore it can be used in sex education for Afghan couples.

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