Recently, the importance of sex education at an early age has been increasingly emphasized in the literature due to the ongoing acceleration of elementary school students’ physical and mental growth. A study of sixth graders in elementary school showed that more than 30 % of male and female students already had dating experience and that initial engagement in sexual intercourse was being conducted as early as elementary school; this is a surprising finding, but one with unavoidable implications for our society [1]. In addition, the availability of smartphones in elementary schools was found to have reached 37.2% for primary grade students and 74.2% for high school students, providing a medium through which some elementary school students are exposed to indiscriminate sex-related content. According to a comprehensive survey on contact and exposure throughout the youth environment, most teenagers first experienced adult videos in elementary school, and the most popular form of media delivery was mobile phones [2]. In a study by Kim [3], elementary school students were not only able to easily access inappropriate content through smartphones, but they also acted as first-person media creators who produced their own content that contained sensitive and provocative content to gain social popularity. Additionally, media images produced by elementary school students themselves show that they can spread misinterpretations about sexual awareness and sexual orientation to peer groups. Therefore, appropriate education is necessary before elementary school students are exposed to material that they may not fully understand. However, the current sex education standards of the Government Ministry of Health Welfare in South Korea are somewhat ineffective because although they do address practical sex education (such as content regarding gender discrimination), they have failed to devise fundamental measures to manage the discrepancy between the material and current sex-related problems [4].

Sex education is essential during childhood to establish proper values and attitudes toward sex, especially because these formative years are a potential turning point in reasonable decision-making and rapid changes in physical development [5]. Schools are required to devote 10 hours per year to sex education and to have materials that are developmentally appropriate. However, this content is limited to addressing physical changes based on secondary sexual characteristics, the prevention of sexual violence, and individual efforts to escape the damage of sexual violence. Also, the educational programming is delivered to groups of students in class, rather than in small groups, which is considered to be less effective than small group education [6]. In order for school-aged children to acquire the appropriate sexual knowledge and to maintain desirable gender role attitudes and values, comprehensive sex education should be provided that also includes respect for others (emphasizing egalitarian attitudes), changes encountered during sexual development, and methods to cope with various sexual problems [6].

According to a survey of sixth-graders regarding perceptions of their experiences with sex education, 99% of boys and girls had previously received some sex education [1]. The majority of sex education offered by schools was conducted by health teachers (47.3%), homeroom teachers (21.7%), religious representatives (19.5%), parents (6.8%), external lecturers (4.5%), and it was found that sex education was rarely done at home [1].

Parental teaching at home is one of the most important external environments affecting student’s learning activities [7]. As parents often serve as role models and are most aware of their children’s specific development [8], sex education has been shown to be very effective when parents and children discuss sex-related issues together [9]. However, parents have frequently reported feeling uncomfortable or embarrassed when talking about sex with their children [9]. Jin’s [10] study found that parents reported that providing sex education to their children was difficult due to a lack of knowledge of how to teach and provide guidance on sex-related content; therefore, diverse resources should be provided to improve parents’ knowledge. As such, parents’ levels of sex-related knowledge and sexuality have very strong influences on the formation of sound sex-related values in children. Therefore, it is a prerequisite for parents to have accurate knowledge and desirable attitudes toward participating in their children’s sex education at home [6].

Some studies have found that group education can be effective in improving knowledge related to sex and the sexual attitudes of students, but others have shown that little to no change in the sexual attitudes of upper-grade students was achieved. In group education, there are limitations in the content available, and when students ask questions, answers may not be sufficiently conveyed in consideration of others [11,12]. Most agree that it is important to provide formal sex education in school, but it is also important for parents to provide natural and ongoing sexual guidance. Most previous studies were conducted among upper-age school students, such as fourth-to sixth-graders [1,12], were cognitive program studies only for lower-grade school parents [6,13], or investigated the effectiveness of sex education programs [6,11,12]. In addition, most previous studies were conducted before smartphone devices became widely available to elementary school students. Therefore, the purpose of this study was to explore sexual knowledge, sexual attitudes, and the perceptions and actualities of sex education among parents with elementary school children. We also expect that the findings of this study could be used as baseline data to develop effective sex education programs for parents.

This study was conducted to investigate sexual knowledge and sexual attitudes among parents of elementary school students. The average sexual knowledge score was 31.54, and knowledge about sexual health, including sexually transmitted diseases, was highest among the subcategories of sexual knowledge. The other three subcategory scores had similar average scores. The average sexual attitudes score was 52.15 out of 68. Of the four subcategories, attitudes toward sexual etiquette and sexual violence had the highest scores. This fact reflects parental concerns regarding sexual violence based on the increase in the number of cases of sexual violence against young children.

There were significant differences in sexual knowledge and sexual attitudes depending on the expressed sexual attitudes of the participant (closed or neutral/open). Parents with open sexual perceptions had significantly higher sexual knowledge and sexual attitudes than those with closed or neutral sexual perceptions. In order to provide sex education from home, parents should overcome their fear and bias about sex education and bolster their confidence to openly communicate with their children about sensitive issues [16]. Moreover, several factors have been found to be associated with better communication regarding sex-related issues and the provision of quality guidance, including parents having received sex education from their parents, previous experience providing sex education to their children, the age of parents, higher education levels of parents, higher income levels of parents, and the child’s gender [16,17].

Forty-two percent of the parents reported neutral sexual perceptions, and 40% reported having more open perceptions. This result showed that parents were fairly open regarding sexual attitudes; however, they had generally only received sex education one or two times as a parent. Although their perceptions could be considered open compared to the past, the frequency of the sex education they received was insufficient, indicating an environment similar to the past in that opportunities to receive sex education were minimal.

In this study, 77% of the participants were mothers. The mothers’ sexual knowledge and sexual attitudes scores were higher than those of the fathers, but this trend was not statistically significant. This result is similar to other studies, which found that mothers were more interested in providing sex education for their children and spent more time discussing sex-related issues with them [13]. Further, some intervention studies only included mothers as the providers of sex education for their children [9,17]. This trend is similar to studies in the United States where mothers are predominantly cited in most studies as the primary sex educators at home, and mothers are consistently noted as more proactive in engaging their children in talks related to sex. Mothers were also found to be more comfortable discussing sex than fathers [18]. However, mothers were reported to be most comfortable when talking to their daughters about sexuality. The authors therefore addressed the need for fathers to participate in their sons’ sex education to discuss male issues more effectively [18]. Parents frequently become role models for their children, and the child’s same-gender parent is often best-equipped to affect the child’s ability to accomplish his or her goals; therefore, it is important for fathers to provide sex education for their male children [19].

In the current study, no statistically significant difference was found in sexual knowledge based on employment level, education level, relationship with the child (mother or father), or age. This is because the majority of participants in the study were mothers, and most (88%) reported high education levels (such as college and advanced degrees). In this study, parents with two or more children had higher sexual attitude scores. Those parents might have obtained more experience regarding their children’s sex-related education and issues while raising other children. Almost 40% of parents (35.9%) reported that lower grade elementary school was the best period to commence initial sex education, and one-third of all participants seemed to believe that most parents welcomed the inclusion of sex education for their children in elementary school. This is similar to other studies’ findings [6,13].

Although most parents thought that elementary school was a good time to receive sex education, 60% of the parents had never provided sex education for their children. The average number of times parents had provided some form of sex education was approximately one or two times. This indicates that most parents had never provided sex education even though the majority thought that sex education should be given to elementary school students and that parents should be the primary contributor to that education. Participants’ preferences regarding learning content was evenly distributed, with approximately 20% for both “sexual physiology” and “sexual structure of males and females”. When their children proposed sex-related questions, they most often referred to those two areas. These have always been common topics, as they are important basic information for children [13]. That said, sex education content must be updated. These findings are similar to those of studies in the United States, where predominantly normative sex discussions are generally performed along gender and role expectations, and there has been a steady increase in research investigating more sensitive topics including concerns about sexuality [18]. Interestingly, new content continues to be added each year, including dating, relationship building, and dealing with sexual harassment, with the latter becoming a critical topic to prepare children for the steps to be taken to avoid sexual assault or violence. Based on an integrative literature review related to sex education for Korean elementary school students, sexual violence should be considered as an integral part of sex education, but this topic is rarely covered in elementary school textbooks and materials. Students learn about this topic later through middle school textbooks. In order to potentially prevent sexual violence at an earlier age, this content should be included in the elementary school sex education curriculum [20].

Sex education was deemed necessary by parents for two main reasons, “to foster the proper attitudes of children toward each other and both genders” and “to guide children’s curiosity correctly”. Parents seem like ideal sex educators because they can offer sex education sequentially and provide time-sensitive information as they receive questions from their children [21]. In an Australian study, parents of primary school children answered that sex education was necessary when children are young because they need to know about their bodies and to develop their own sexuality [22]. In particular, girls were considered to need sex education at a young age because their bodies develop more quickly and they could soon become vulnerable to teenage pregnancy and sexual violence [22].

Some parents in the current study did not want to provide sexual education for their children; in particular, 16.6% felt they did not know how to teach their children and 11.6% believed that the children were still too young. This result is similar to that of a previous study regarding parents who did not know how to discuss sex-related issues with their children [14]. This finding also aligns with a literature review in the United States, which indicated that several factors affect sex-related communication between parents and children, including insufficient knowledge about sex, their commitment to become more responsible sex educators for their children, the misinterpretation of discussions regarding sex as permission for the children to have sex, and the perception that their children were not old enough to discuss sex [18]. In two other studies conducted in the United States and Australia, parents thought that their children were too young to discuss sex-related issues regardless of their actual age [22,23]. If children were to learn certain information about sex before reaching sexual maturity, many parents felt that early awareness might provoke risky behaviors due to the immaturity of children’s physical and mental development [22].

There was also profound fear from parents about their children’s potential “loss of innocence” as a result of sex education [22]. Based on these results, there are conflicting and controversial opinions about the provision of sex education to children in elementary school. Nevertheless, age-appropriate introductory sex education should be conducted by parents with their children to foster the ongoing dialogue required to deal with any concerns and sex-related issues that will soon follow.

Furthermore, 50% of the parents in the current study wanted to receive sex-related education. This result is similar to the results obtained by Jang [14], who found that more than half of parents wanted to learn more about sex education. It is clear that accurate information regarding sex-education must be available for parents. In our study, we aimed to provide insight into the sexual perceptions, knowledge, and attitudes of parents regarding sex education for their children. Based on this study, we found that parents would like to learn more about sex education and that they maintain open perspectives regarding sex. Many parents would like to provide sex education, but they feel they do not know how to begin. In this study, parents mentioned a preference to receive education from professional organizations or experts. When parents sought sex-related resources, 50% received information from seminars or lectures, and about one-third searched websites from a smartphone app or an Internet browser. This finding is similar to that of a literature review in the United States [18]. There are reliable resources such as the Centers for Disease Control and Prevention (CDC) and the Sexuality Information and Education Council of the United States (SIECUS) that provide research-based information and proper sex education guidelines according to the children’s developmental stage, including the National Sexuality Education Standards [24,25]. However, outside of the classroom, children can often be exposed to unreliable websites. Also, as young children are now technologically proficient, parents must learn how to adjust internet settings to restrict their children’s access to risky websites that may expose them to inappropriate sexual behavior [18]. Furthermore, it is sometimes difficult to judge whether a website contains accurate sex education information.

In previous studies, sex education programs were found to be effective in improving parental efficacy, increasing sexual knowledge, and forming positive sexual attitudes [6,9,14]. These programs were effective in small groups of parents, but we must find ways to include more parents in classes and develop effective methods to provide education through smartphone apps and Internet-based education for those who cannot attend classes in person. Also, we need to include education for nonparental family members such as aunts, uncles, and grandparents who play adult roles in lieu of parents for children who do not live with their biological parents [18].

Based on the findings of this study, we would like to suggest implications for nursing and public health regarding sex education. Continuous and open communication between parents and their children is essential for discussing any sex-related issues. It is important to specifically include fathers as a communicators or educators for their sons regarding sex issues. Some parents fear providing sexual education for their children and do not know how to provide proper education for their children. Parents would like to learn through seminars, schools, or experts. Thus, policymakers and school-teachers need to provide parents resources with up-to-date and accurate information. Furthermore, parents need to know how to set up internet settings to prevent their children from accessing risky websites.

This study had a sufficient sample size, however, it was limited to a descriptive study with the intent of providing data related to the sexual knowledge and sexual attitudes of parents. In order to obtain a deeper understanding of parental perspectives, focus groups and qualitative interviews can be conducted to elicit additional information. It is also worth noting that we used an Internet-based survey that relied on self-reporting. Therefore, the data may not be fully reliable, depending on the sincerity of the respondents’ answers. This self-response bias may also occur in paper-pencil surveys. In order to increase the likelihood of analyzing sincere responses and improve reliability, we checked respondents’ answers and removed surveys with incomplete responses (6% of the total surveys).

This study concluded that many parents maintained open perceptions about sexual attitudes, but had rarely received any formal sex education through schools or experts. They were willing to learn more about sex-related topics to benefit their children. Parents also thought that elementary school is an appropriate time to start the initial phases of sex education. Based on these findings, it is important for parents to learn more about sex education from experts or educators who are better qualified to provide the most accurate and recent information, while training parents to effectively teach sex-related issues to their children at home. The delivery of sex education might include fathers and non-family members, and various methods should be used to effectively convey the material, including methods for those who cannot attend regular in-person sessions.