{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:47:42Z","timestamp":1782841662605,"version":"3.54.5"},"reference-count":56,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Res Protoc"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Holistic health care includes sexuality. For people with mental illness, sexuality is an essential element of recovery. However, sexuality is often overlooked in mental health settings in Japan and elsewhere. Therefore, practitioners need to recognize sexuality as a legitimate area of care and acquire the skills and attitude\n s<\/jats:bold>\n required to provide appropriate support. To address this gap, we developed a training program for practitioners through coproduction among peers with mental illness, researchers, and practitioners.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This randomized controlled trial (RCT) in Japan compares an intervention group that participates in the program with a control group that does not and evaluates the program\u2019s effectiveness in improving practitioners\u2019 knowledge, attitudes, and confidence in providing sexuality-related support to clients with mental illnesses.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The study participants are qualified practitioners aged 18 years or older who provide community-based support to people with mental illness. This 4-hour program combines comprehensive sexuality education with content specific to mental illness and deepens participants\u2019 knowledge and skills through textbooks and case studies. The program is delivered in small groups of up to 8 participants by 2 facilitators: a practitioner and a peer with mental illness. Peer facilitators have experience facilitating sexuality-related group programs. The study design is a 2-arm parallel group RCT. After a baseline assessment, participants will be randomly assigned to an intervention or control group. Participants in the intervention group will complete an online questionnaire at baseline (T1), immediately after the program (T2), and 1 month after the program (T3). Participants in the control group will not receive the program during the study period and will complete the same 3 assessments (T1 to T3). Outcomes focus on participant competence rather than client condition. The primary outcome is confidence in providing sexuality-related support, measured using the self-assessment scale (lack of quality for sexuality education). Secondary outcomes include attitudes regarding sexuality (Attitudes Toward Sexuality Scale), knowledge of sexuality education, and knowledge of preconception care for people with mental illness. The target sample size is 76.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Funding was awarded in April 2023. Recruitment began in June 2025, and as of March 12, 2026, 57 participants had enrolled, 46 of whom had completed the final assessment. Analysis has not yet been conducted, and final data collection is anticipated by December 2026.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n To our knowledge, this will be the first RCT on a sexuality support training program for mental health practitioners. If effective, the program may help practitioners provide better support to people with mental illness and, in the long term, contribute to their recovery.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/86419","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T20:43:57Z","timestamp":1779223437000},"page":"e86419-e86419","source":"Crossref","is-referenced-by-count":0,"title":["Co-Design of a Sexuality Support Training Program for Practitioners Supporting People With Mental Illness (RIKASEKU-SAPOPRO): Protocol for a Randomized Controlled Trial"],"prefix":"10.2196","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1221-7763","authenticated-orcid":false,"given":"Masako","family":"Kageyama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6419-6219","authenticated-orcid":false,"given":"Momoko","family":"Kusaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1312-0689","authenticated-orcid":false,"given":"Keiko","family":"Yokoyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7180-0589","authenticated-orcid":false,"given":"Taizo","family":"Shiraishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8807-2512","authenticated-orcid":false,"given":"Kazutaka","family":"Nishio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6874-9640","authenticated-orcid":false,"given":"Shintaro","family":"Noma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4261-0335","authenticated-orcid":false,"given":"Toshifumi","family":"Nemoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8725-2701","authenticated-orcid":false,"given":"Sohei","family":"Yogoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0389-2617","authenticated-orcid":false,"given":"Kayo","family":"Ichihashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0597-3413","authenticated-orcid":false,"given":"Emiko","family":"Nishioka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9082-8300","authenticated-orcid":false,"given":"Nobuhiro","family":"Hara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7162-9275","authenticated-orcid":false,"given":"Sachiko","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"issue":"S2","key":"R1","doi-asserted-by":"publisher","first-page":"66","DOI":"10.22514\/SV112.062016.14","article-title":"Holistic and team approach in health care","volume":"11","author":"Huljev","journal-title":"Signa Vitae"},{"issue":"5","key":"R2","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1188\/07.CJON.671-675","article-title":"Sexuality assessment: 10 strategies for improvement","volume":"11","author":"Mick","journal-title":"Clin J Oncol Nurs"},{"key":"R3","unstructured":"Sexual and reproductive health and research (SRH). World Health Organization. URL: https:\/\/www.who.int\/teams\/sexual-and-reproductive-health-and-research\/key-areas-of-work\/sexual-health\/defining-sexual-health [Accessed 24-03-2026]"},{"issue":"7","key":"R4","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17072186","article-title":"Medical and health care professionals\u2019 sexuality education: state of the art and recommendations","volume":"17","author":"Verrastro","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-023-04901-1","article-title":"Gaps in sexual health content of healthcare professional curriculum: a systematic review of educational interventions","volume":"23","author":"Prize","journal-title":"BMC Med Educ"},{"key":"R6","unstructured":"International technical guidance on sexuality education: an evidence-informed approach for schools, teachers and health educators. United Nations Educational, Scientific and Cultural Organization (UNESCO); 2018. URL: https:\/\/unesdoc.unesco.org\/ark:\/48223\/pf0000183281 [Accessed 21-04-2026]"},{"key":"R7","unstructured":"International technical guidance on sexuality education: an evidence-informed approach [Report in Japanese]. United Nations Educational, Scientific and Cultural Organization (UNESCO); 2018. URL: https:\/\/unesdoc.unesco.org\/ark:\/48223\/pf0000374167 [Accessed 21-04-2026]"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-022-01504-9","article-title":"Factors influencing the integration of comprehensive sexuality education into educational systems in low- and middle-income countries: a systematic review","volume":"19","author":"Chavula","journal-title":"Reprod Health"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1080\/14681994.2024.2331439","article-title":"Systematic literature review on comprehensive sexuality education intervention","volume":"40","author":"R","journal-title":"Sex Relation Ther"},{"issue":"1","key":"R10","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1007\/s13178-021-00674-8","article-title":"Comprehensive sex education addressing gender and power: a systematic review to investigate implementation and mechanisms of impact","volume":"20","author":"Sell","journal-title":"Sex Res Soc Policy"},{"issue":"2","key":"R11","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1265\/jjh.73.178","article-title":"Historical transition of sexuality education in Japan and outline of reproductive health\/rights [Article in Japanese]","volume":"73","author":"Nishioka","journal-title":"Nihon Eiseigaku Zasshi"},{"issue":"8","key":"R12","doi-asserted-by":"publisher","first-page":"827","DOI":"10.34433\/og.0000000334","article-title":"The history, current state, and challenges of sex education in Japan","volume":"90","author":"Kitamura","journal-title":"Obstet gynecol"},{"issue":"2","key":"R13","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1080\/14681811.2024.2320399","article-title":"Comprehensive horizons: examining Japan\u2019s national and regional sexuality education curricula","volume":"25","author":"Harel","journal-title":"Sex Educ"},{"issue":"5","key":"R14","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1080\/14681811.2024.2368022","article-title":"Initiation and delivery of comprehensive sexuality education in Japanese schools","volume":"25","author":"Noguchi","journal-title":"Sex Educ"},{"issue":"1","key":"R15","first-page":"157","volume":"42","author":"Nishioka","journal-title":"Adolescentology"},{"key":"R16","doi-asserted-by":"crossref","unstructured":"Tamagawa M . The Japanese LGBTQ+ community and the world. In: The Japanese LGBTQ+ Community in the World The COVID-19 Pandemic, Challenges, and the Prospects for the Future. Routledge; 2022:55-79. [doi: 10.4324\/9781003289968-2]","DOI":"10.4324\/9781003289968-2"},{"key":"R17","unstructured":"Kamano S et al. Report of the National Survey of Family, Gender\/Sexuality, and Diversity [Report in Japanese]. SOGI Research Institute, Waseda University; 2025. URL: https:\/\/www.zenkoku-chosa.jp\/documents\/2023NationalSOGISurveyReport.pdf [Accessed 24-03-2026]"},{"issue":"4","key":"R18","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1002\/jgf2.70012","article-title":"Healthcare professionals\u2019 experiences related LGBTQ+ patients and colleagues at their workplace: descriptive research in Japan","volume":"26","author":"Mizumoto","journal-title":"J Gen Fam Med"},{"issue":"1","key":"R19","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1037\/prj0000409","article-title":"Romantic relationships, sexuality, and psychotic disorders: a systematic review of recent findings","volume":"44","author":"Cloutier","journal-title":"Psychiatr Rehabil J"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1111\/jpm.12700","article-title":"Sexuality in people living with a serious mental illness: a meta-synthesis of qualitative evidence","volume":"29","author":"Hortal-Mas","journal-title":"J Psychiatr Ment Health Nurs"},{"issue":"3","key":"R21","first-page":"168","volume":"6","author":"Kessler","journal-title":"World Psychiatry"},{"issue":"6","key":"R22","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1001\/archpsyc.62.6.593","article-title":"Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication","volume":"62","author":"Kessler","journal-title":"Arch Gen Psychiatry"},{"issue":"8","key":"R23","doi-asserted-by":"publisher","DOI":"10.3390\/medicina57080771","article-title":"The impact of bipolar disorder on couple functioning: implications for care and treatment. A systematic review","volume":"57","author":"Azorin","journal-title":"Medicina (Kaunas)"},{"issue":"1","key":"R24","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-022-04452-1","article-title":"Psychiatric vulnerability and the risk for unintended pregnancies, a systematic review and meta-analysis","volume":"22","author":"Schonewille","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"R25","doi-asserted-by":"publisher","first-page":"74","DOI":"10.11124\/JBISRIR-2017-003824","article-title":"Sexuality and intimacy among people with serious mental illness: a qualitative systematic review","volume":"17","author":"McCann","journal-title":"JBI Database System Rev Implement Rep"},{"issue":"2","key":"R26","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1093\/schbul\/sbw172","article-title":"Psychosis as a barrier to the expression of sexuality and intimacy: an environmental risk?","volume":"43","author":"de Jager","journal-title":"Schizophr Bull"},{"issue":"2","key":"R27","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1111\/inm.12795","article-title":"Consumers living with psychosis: perspectives on sexuality","volume":"30","author":"Evans","journal-title":"Int J Ment Health Nurs"},{"issue":"5","key":"R28","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1016\/j.apmr.2020.09.379","article-title":"Addressing sexuality among people living with chronic disease and disability: a systematic mixed methods review of knowledge, attitudes, and practices of health care professionals","volume":"102","author":"McGrath","journal-title":"Arch Phys Med Rehabil"},{"issue":"17-18","key":"R29","doi-asserted-by":"publisher","first-page":"3065","DOI":"10.1111\/jocn.14900","article-title":"Discussing sexuality in health care: a systematic review","volume":"28","author":"Fennell","journal-title":"J Clin Nurs"},{"issue":"2","key":"R30","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1037\/prj0000506","article-title":"Addressing sexuality and intimate relations in community mental health services for people with serious mental illness: a qualitative study of mental health practitioners\u2019 experiences","volume":"45","author":"Berger-Merom","journal-title":"Psychiatr Rehabil J"},{"issue":"4","key":"R31","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1007\/s11195-022-09757-9","article-title":"Healthcare professionals\u2019 perspectives on integrating reproductive and acute mental healthcare","volume":"40","author":"Cahn","journal-title":"Sex Disabil"},{"issue":"5-6","key":"R32","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1111\/jocn.14085","article-title":"When holistic care is not holistic enough: the role of sexual health in mental health settings","volume":"27","author":"Hendry","journal-title":"J Clin Nurs"},{"issue":"5","key":"R33","doi-asserted-by":"publisher","first-page":"1522","DOI":"10.1111\/inm.12452","article-title":"Understanding the current sexual health service provision for mental health consumers by nurses in mental health settings: findings from a survey in Australia and England","volume":"27","author":"Quinn","journal-title":"Int J Ment Health Nurs"},{"issue":"5","key":"R34","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-058428","article-title":"Coproduction and mental health service provision: a protocol for a scoping review","volume":"12","author":"Norton","journal-title":"BMJ Open"},{"issue":"6","key":"R35","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1111\/jpm.12945","article-title":"An exploration of loneliness experienced by people living with mental illness and the impact on their recovery journey: an integrative review","volume":"30","author":"Caple","journal-title":"J Psychiatr Ment Health Nurs"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.5630\/jans.44.763","article-title":"Sexual and reproductive realities of individuals with mental disorders","volume":"44","author":"Kageyama","journal-title":"J Jpn Acad Nurs Sci"},{"issue":"1","key":"R37","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1111\/inm.13234","article-title":"Approaches for improving sexuality and sexual health care in mental health settings: a qualitative study exploring clinicians\u2019 own perspectives","volume":"33","author":"Urry","journal-title":"Int J Ment Health Nurs"},{"issue":"2","key":"R38","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1111\/j.1447-0349.2011.00783.x","article-title":"Getting BETTER: breaking the ice and warming to the inclusion of sexuality in mental health nursing care","volume":"21","author":"Quinn","journal-title":"Int J Ment Health Nurs"},{"issue":"1","key":"R39","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1177\/10783903211045733","article-title":"Effectiveness of a sexual health care training to enhance psychiatric nurses\u2019 knowledge, attitude, and self-efficacy: a quasi-experimental study in southern Taiwan","volume":"30","author":"Lu","journal-title":"J Am Psychiatr Nurses Assoc"},{"issue":"3","key":"R40","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1111\/jpm.12989","article-title":"Nurses\u2019 and auxiliary nurses\u2019 beliefs and attitudes regarding the sexual health of patients with severe mental illness: a qualitative study","volume":"31","author":"Martinez","journal-title":"J Psychiatr Ment Health Nurs"},{"issue":"1","key":"R41","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1007\/s10508-022-02430-4","article-title":"Guidelines, policies, and recommendations regarding the sexuality of individuals with severe mental disorders in psychiatric units, institutions, and supported housing across Europe: a systematic review","volume":"52","author":"Anex","journal-title":"Arch Sex Behav"},{"key":"R42","unstructured":"Act on mental health and welfare for persons with mental disorders [Report in Japanese]. Ministry of Health, Labour and Welfare of Japan; Apr 2024. URL: https:\/\/www.mhlw.go.jp\/content\/001081036.pdf [Accessed 24-03-2026]"},{"key":"R43","unstructured":"Overview of the survey of social welfare facilities [Report in Japanese]. Ministry of Health, Labour and Welfare of Japan; 2024. URL: https:\/\/www.mhlw.go.jp\/toukei\/saikin\/hw\/fukushi\/24\/dl\/gaikyo.pdf [Accessed 24-03-2026]"},{"key":"R44","unstructured":"Hashimoto A . Support for romantic and sexual issues faced by men with schizophrenia living in the community [Report in Japanese]. Japan Society for the Promotion of Science (JSPS) \/ KAKEN (NII Japan); 2023. URL: https:\/\/kaken.nii.ac.jp\/en\/file\/KAKENHI-PROJECT-20K10809\/20K10809seika.pdf [Accessed 24-03-2026]"},{"issue":"2","key":"R45","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1007\/s11113-025-09943-5","article-title":"Residential segregation in Japan: ethnic stratification in a global new destination","volume":"44","author":"Liang","journal-title":"Popul Res Policy Rev"},{"issue":"1","key":"R46","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-023-05254-1","article-title":"A peer-led learning program about intimate and romantic relationships for persons with mental disorders (AIRIKI): co-creation pilot feasibility study","volume":"23","author":"Kageyama","journal-title":"BMC Psychiatry"},{"issue":"3","key":"R47","doi-asserted-by":"publisher","DOI":"10.1002\/fcsr.70050","article-title":"Family planning decision-making process among Japanese women with mental disorders","volume":"54","author":"Kageyama","journal-title":"Family & Consum Sci Res J"},{"issue":"1","key":"R48","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-024-06063-w","article-title":"Effects of an online program about intimate and romantic relationships for people with mental disorders (AIRIKI): a study protocol for a randomized controlled trial","volume":"24","author":"Kusaka","journal-title":"BMC Psychiatry"},{"key":"R49","unstructured":"Main revisions in the FY2024 revision of remuneration for disability welfare services [Report in Japanese]. Ministry of Health, Labour and Welfare of Japan; 2024. URL: https:\/\/www.mhlw.go.jp\/content\/001216034.pdf [Accessed 24-03-2026]"},{"issue":"1","key":"R50","doi-asserted-by":"publisher","DOI":"10.1002\/pcn5.70280","article-title":"Relationally specific sexual identity concealment and loneliness among sexual and gender minority women in Japan: a culturally situated analysis","volume":"5","author":"Hayakawa","journal-title":"PCN Rep"},{"issue":"6","key":"R51","doi-asserted-by":"publisher","first-page":"549","DOI":"10.20812\/jpnjschhealth.53.6_549","article-title":"Promoting and inhibiting factors in sexuality education by guardians at home: Results from surveys conducted on mothers of 6th grade elementary schoolchildren in Sapporo-City [Article in Japanese]","volume":"53","author":"Horibe","journal-title":"Jpn J Sch Health"},{"key":"R52","volume":"17","author":"Asakura","journal-title":"Jpn J Health Behav Sci"},{"issue":"6","key":"R53","doi-asserted-by":"publisher","first-page":"509","DOI":"10.11477\/mf.1681100223","article-title":"Factors affected nursing professionals\u2019 attitudes toward sexuality [Article in Japanese]","volume":"36","author":"Asakura","journal-title":"Jpn J Nurs Res"},{"key":"R54","unstructured":"Japanese Society of Psychiatry and NeurologyJapan Society of Obstetrics and Gynecology. Clinical guide for women with mental health problems during perinatal period [Report in Japanese]. Ministry of Health, Labour and Welfare; 2020. URL: https:\/\/fa.kyorin.co.jp\/jspn\/guideline\/sALL_s.pdf [Accessed 24-03-2026]"},{"key":"R55","unstructured":"Defining the role of authors and contributors. International Committee of Medical Journal Editors (ICMJE). 2019. URL: https:\/\/www.icmje.org\/recommendations\/browse\/roles-and-responsibilities\/defining-the-role-of-authors-and-contributors.html [Accessed 24-03-2026]"},{"key":"R56","unstructured":"Survey report on the current status and utilization of peer support in psychiatric healthcare institutions [Report in Japanese]. Hamagin Research Institute; Mar 2022. URL: https:\/\/www.yokohama-ri.co.jp\/shogai_bunya2021\/pdf\/hokoku.pdf [Accessed 24-03-2026]"}],"container-title":["JMIR Research Protocols"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e86419","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:14:18Z","timestamp":1782839658000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e86419"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":56,"URL":"https:\/\/doi.org\/10.2196\/86419","relation":{},"ISSN":["1929-0748"],"issn-type":[{"value":"1929-0748","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]},"article-number":"v15iS2e86419"}}