Design and procedure
This study was designed as a correlational descriptive study, using a cross-sectional online survey to explore the factors that influence the SH experience of male nurses. The subjects of this study were male nurses who had worked for at least 6 months in general hospitals. Convenience sampling was conducted of those who voluntarily agreed to complete the questionnaire. An online survey link was provided to the subjects through recruitment posts distributed through Korean hospitals, or on social media channels that many Koreans use and access. To ensure the representativeness of the study sample, snowballing recruitment procedures were applied. We were eventually able to collect final samples that were fairly geographically balanced across the country, and between metropolitan and non-metropolitan areas (metropolitan areas included Seoul, Incheon, and Gyeonggi Province, whereas non-metropolitan areas included Busan, Daejeon, Gangwon Province, South Chungcheong Province, North Gyeongsang Province, South Gyeongsang Province, and Jeju Province). This study received ethical approval from the Institutional Review Board of the institution where the author was affiliated (IRB no.: 2019–228-01). Data were collected from May 31, 2019, to July 26, 2020. The online questionnaire included written consent for providing and utilizing personal information. The questionnaire was distributed to a total of 246 people, and the final sample used for analysis was 155 people. Ninety-one people were excluded for the following reasons: 39 due to disagreement with participation, 17 because there was no response regarding SH experiences, 30 due to missing values, 4 because of duplications, and 1 because the respondent was not qualified (not currently working as a nurse).
Variables and instruments
Dependent variable: sexual harassment
The Sexual Harassment Questionnaire–Department of Defense short version (SEQ-DoD-s), developed by Stark and colleagues [29], was used to measure experiences of SH in this study. The authors obtained permission from the developer and performed translation from English to Korean and back-translation. This tool included four subfactors with a total of 16 items: sexist behavior (4 items), crude/offensive behavior (4 items), unwanted sexual attention (4 items), and sexual coercion (4 items). In the study by Stark et al. [29], Cronbach’s alpha was .92, while in this study, Cronbach’s alpha was .92, ranging from .78 to .87 in all subfactors. Each item of the SEQ-DoD-s was measured on a 5-point response scale (coded as 0 = never, 1 = once or twice, 2 = sometimes, 3 = often, 4 = many times). The instrument comprised questions on SH exposure during the past 6 months. The total SEQ-DoD-s score and frequency of SH were calculated by totaling the scores of each polytomous item. High scores indicated high levels of exposure to SH. The survey questions on the SEQ items used in the present study can be found in Table 2. Additional questions were included to investigate the coping responses of those who were sexually harassed. The additional items included information on the perpetrator, coping responses, whether the incident was reported, and the reasons for not reporting the incident.
Independent variable: perceived nursing work environment
To measure the perceived nursing work environment, we used the Korean translation of the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire [30], which Lake [27] originally developed. With a total of 29 items, this tool consists of 5 subfactors: nurse participation in hospital affairs (9 items); nursing foundations for quality of care (9 items); nurse managers’ ability, leadership, and support of nurses (4 items), adequacy of staffing and resources (4 items); and collegial nurse-physician relations (3 items). Cronbach’s alpha from Cho et al. [30] was .93, and Cronbach’s alpha for this study was .92, ranging from .80 to .84 in all subfactors. Each item of the PES-NWI was measured on a 4-point Likert scale (coded as 1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree). High scores corresponded to high positive perceptions of the nursing work environment.
Independent variable: general characteristics
Data on general characteristics were divided into the individual, hospital, and unit levels. Individual-level variables included age (coded as 1 = 20–29 years, 2 = 30–39 years, 3 = 40+ years), marital status (coded as 1 = married, 2 = unmarried), and education level (coded as 1 = associate degree, 2 = bachelor’s degree, 3 = master’s or higher), and years of clinical experience (coded as 1 = < 1 year, 2 = 1- < 3 years, 3 = 3- < 5 years, 4 = 5+ years). Hospital-level variables included location (coded as 1 = metropolitan area, 2 = non-metropolitan area) and number of hospital beds (coded as 1 = < 500, 2 = 500–999, 3 = 1000+). Unit level variables included job position (coded as 1 = charge nurse or head nurse, 2 = staff nurse), type of unit (coded as 1 = medical or surgical ward, 2 = special unit such as the emergency room, intensive care unit, operating room, outpatient department, administration department, physician’s assistant or others), years of current unit experience (coded as 1 = < 1 year, 2 = 1- < 3 years, 3 = 3- < 5 years, 4 = 5+ years), shift pattern (coded as 1 = non-shift work, 2 = shift work), and perceived nursing work environment (continuous).
Data analysis
Descriptive statistics were utilized for general characteristics and SH experiences. The significance level for all hypothesis tests was a p-value < 0.05. Since the data of the total SEQ-DoD-s score had a positively skewed distribution and overdispersion, data were treated as count variables. To analyze factors associated with SH, we performed a non-negative binomial regression analysis including all independent variables.