Early childhood is a vital period for children's development and identity formation, laying the groundwork for future sexual wellbeing and social adaptation (Li, 2022). Without proper guidance, children undergoing early physical, emotional, and sexual development may face risks such as sexual abuse, gender stereotyping, and inequality, which can hinder their overall wellbeing and potential [Raising Children Network, 2025; UNESCO, 2018]. In response, comprehensive sexuality education (CSE) has been recognized globally as a key strategy to support children's holistic growth [UNFPA, 2021; Global Education Monitoring Report Team, 2019; UNESCO et al., 2018].

According to the international guidance, CSE should offer evidence-based, age-appropriate, and culturally sensitive education that helps individuals understand their bodies, enhance self-protection, foster healthy relationships, and promote gender equality and respect for diversity (UNESCO et al., 2018). Through CSE, children can develop informed sexuality values, improve decision-making skills, and achieve healthy, well-rounded development (UNESCO et al., 2018).

Individuals' understanding of sexuality and the formation of values are not accomplished in isolation but are gradually constructed under the interplay of multiple factors involving family, schooling, peer interactions, and social culture (Gouvernement du Québec, 2025; Maasoumi et al., 2024; UNESCO et al., 2018). As a major source of formal knowledge about sexuality, schools shoulder the important responsibility of guiding children to form healthy sexual concepts, value judgments, and behavioral patterns (Gouvernement du Québec, 2025; Noh and Bakar, 2023; Kurtuncu et al., 2015). Numerous studies showed the significant positive impact of school-based sexuality education in fostering childhood wellbeing and sexuality development (Mehrolia et al., 2023; UNESCO et al., 2018; UNESCO and UNFPA, 2018; Goldfarb and Lieberman, 2021). Sciencebased and well-organized sexuality education not only raises the awareness of physical development and gender identity but also plays an irreplaceable value in nurturing their consciousness of gender equality, self-protection and tolerance of others' differences growth (UNFPA, 2021; UNESCO et al., 2018).

As the primary responsibility of school-based sexuality education, teachers' function in educational practice is much more than knowledge transmitters but also value-oriented leaders and shapers of the school climate (Maasoumi et al., 2024; Xiong et al., 2019). Teachers' knowledge, attitudinal stance and teaching confidence directly influence the quality of education and the effectiveness of childhood development (Binu et al., 2018; Fisher and Cummings, 2015). Given this context, the professional preparedness of pre-service teachers, as the future implementers of sexuality education, is linked directly to the sustainability and high quality of sexuality education in schools. As such, it is important to ensure that pre-service teachers are equipped with systematic and solid knowledge, open and respectful attitudinal stance, and teaching confidence at the teacher education stage to facilitate the sound development of children's sexuality and the successful implementation of school sexuality education in the future (Bourke et al., 2024; Hendriks et al., 2024; Barr et al., 2014).

Knowledge of sexuality education among teachers, which typically encompasses multiple dimensions including reproductive health, gender equality, sexual identity, the prevention of child sexual abuse, etc., whose sufficiency is the foundation of teaching readiness and confidence (Bourke et al., 2024; Cheung et al., 2021; Kapella and Brockschmidt, 2017). Deficiencies in specialized knowledge may cause misinformation, avoidance of students' questions, and/or even persistence of stereotypes and gender bias in schools. International studies indicate a more professional delivery of sexuality education programs among teachers who have received systematic education to proactively introduce interactive, critical and contextualized instructional strategies (Maasoumi et al., 2024; Szucs et al., 2020). For example, studies in countries like the Netherlands and Ireland, where training for teachers in sexuality education at preschool and primary levels has been institutionalized, found generally high knowledge levels among teachers (Bourke et al., 2024; de Looze et al., 2024).

Teachers' attitudes are key predictors of their willingness and behavior to provide instruction (Zhuravleva and Helmer, 2024; Mkumbo, 2012). As interpreted based on Bandura's Social Cognitive Theory (SCT; Bandura, 1986, 1997), the attitudes and values that teachers possess toward sexuality education—including their recognition of the importance of sexuality education, their determinations of social acceptability, and their understanding of pupils' needs—would directly influence their willingness to participation and selection of pedagogy. With an open and tolerant attitude, teachers are more likely to introduce an interactive and value-oriented mode of teaching, whereas they may display evasive, restrictive, or negative teaching behaviors (Mike and Hartal, 2025; Ding et al., 2025; Kahveci, 2023). Research has indicated there are differences in teachers' attitudes toward sexuality education in various areas owing to the socio-cultural context. In countries where sexuality education has been systematically promoted, such as Netherlands and Ireland, the attitudes of educators are more positive (Bourke et al., 2024; de Looze et al., 2024); while in culturally conservative societies, such as China and India, teachers are constrained by societal expectations and traditional concepts which make them express more negative or avoidant attitudes (Bibina et al., 2023; Smith and Harrison, 2013).

Bandura's concept of self-efficacy highlights that individuals' beliefs in their ability to perform specific tasks influence their motivation, emotional regulation, and persistence (Bandura, 1997). In education, this translates to teachers' confidence in addressing sensitive topics, managing student inquiries, and maintaining classroom dynamics (Castillo Nuñez et al., 2019). Higher self-efficacy is linked to sustained engagement and effective performance, while lower self-efficacy may lead to avoidance or anxiety (Fisher and Cummings, 2015). Under Bandura's Social Cognitive Theory (SCT), behavior results from the interaction between cognitive processes, emotional factors, and social environments (Bandura, 1986, 1997). The theory underscores observational learning and the role of external factors—such as social norms, role models, and cultural expectations—in shaping knowledge and attitudes (Bandura, 1977). Drawing on SCT, this study proposed a mediation model where knowledge of sexuality education influences teaching self-efficacy through attitudes, forming a cognitive–attitudinal–behavioral pathway. Gender, as a socially constructed identity, may moderate this process through societal expectations, educational interactions, and role identification, justifying its inclusion in the model and offering valuable insight for research on gendered dimensions in sexuality education preparation.

In China, there are obvious political shortcomings and cultural resistance to the promotion of sexuality education (Qin and Zhang, 2023). Though national policy has specifically stated in law the necessity of bringing sexuality education into the pre-school and elementary education phases, the absence of supporting enforcement guidelines, mandatory requirements and monitoring systems makes it generally unsatisfactory to encourage school-based programs (Cai, 2023; Chen et al., 2022; The Central People's Government of the People's Republic of China, 2020; UNESCO, 2019). Meanwhile, owing to the far-reaching impact of traditional Chinese culture, the subject of sexuality has long been regarded as taboo, making it quite challenging to discuss it openly and guide it scientifically under the conditions (Qin and Zhang, 2023; Jiang, 2023; Huang, 2021; Leung et al., 2019). Such cultural patterns have not only undermined the accountability and responsibility of introducing sexuality education to young children but also limited the breadth and depth of the educational content. Some educators have realized the significance of childhood sexuality education in contributing to the individual's health and social adaptability, yet the teaching and learning activities remain limited for children and mainly concentrated on basic knowledge such as biological structure and personal safety protection, with rare coverage of critical topics concerning gender equality, relationships, sexual identity, and personal rights (Zhang and Yuan, 2023; UNFPA, 2021; UNESCO, 2019; Xiong et al., 2019). Moreover, Chinese education programs generally fail to provide a systematic curriculum framework and a sustainable supporting strategy for pedagogy, with teachers missing the necessary professional training on teaching skills and knowledge development, rendering it hard for them to respond to young children's actual needs (Hu et al., 2023; Qin and Zhang, 2023; UNESCO and UNFPA, 2018). The absence of standardized curricula and associated resources may cause individuals to form misconceptions, prejudices and stereotypes about sexuality, which in turn may affect their future perspectives in sexuality education as educators (Shibuya et al., 2023). Overall, Chinese school-based sex education remains at the preliminary stage of development, with the urgent need to improve the systematic development of policy and to localize curricula and professionalize teachers in practice.

With the continuous promotion of sexuality education globally, numerous studies have focused on the components and effectiveness of sexuality education in schools. Yet, since the relevant studies are mostly based on Western sociocultural contexts, its applicability in diverse cultural settings requires further validation. Moreover, due to the unique culture and concepts of sexuality in China, sexuality education has long been constrained by conservative notions, inadequate policy support, and practical barriers in its development locally, particularly at the early childhood stage where such education tends to be marginalized. While attention to sexuality education has gradually grown over the past decades, compared to the extensive concern for in-service teachers, the existing literature lacks sufficient research on pre-service teachers, who are the backbone of the teaching force, causing a certain gap in the teacher education program regarding sexuality education. Hence, it is necessary to thoroughly explore the perspectives and competencies of pre-service teachers on early childhood sexuality education starting from the roots of teacher education development.

According to the social cognitive theory posits that knowledge could shape one's attitudes by influencing individuals' expectations of behavioral outcomes, while attitudes, as motivational cognitive factors, exert a certain influence on self-efficacy, this study proposes an extended model based on the theory, suggesting that knowledge influences self-efficacy through the mediating pathway of attitude. Also considering the marked differences exist between males and females in knowledge processing, attitude formation mechanisms, and the psychological processes involved in establishing self-efficacy suggested by gender socialization and gender role orientation research, this study, therefore, seeks to construct a mediation model that includes moderating effects to investigate the mediating role of pre-service teachers' attitudes toward early childhood sexuality education between their knowledge and teaching self-efficacy, and to further analyze the moderating effects of pre-service teachers' gender in this mediating mechanism. To be specific, the hypothesis of this study are: (1) H₁: pre-service teachers' attitudes mediate the relationship between their knowledge of sexuality education and teaching self-efficacy; (2) H₂: gender moderates the mediation pathway between knowledge of sexuality education and teaching self-efficacy via attitudes.

In the present study, there were 497 pre-service teachers who successfully completed the questionnaire. Of these, 39 were dropped due to poor response (e.g., choosing the same option for all questions on the same scale). Eventually, a valid sample of 458 was accepted for statistical analysis. The mean age of the participants enrolled was 19.5 years old, of which 426 were female. Participants were from two cities, with 177 data from Ganzhou City and 281 data from Dandong City. Regarding the distribution of years of study, the majority of the respondents were sophomores representing 58.95%, followed by freshmen and juniors with 23.58% and 13.97%, respectively, while senior students occupied a minimal percentage of 3.49%. Nine different ethnic groups were covered in this study, with Han Chinese comprising the majority at 385, followed by Zang (28) and Zhuang (24).

The details are presented in Table 2.

Adopting a PLS-SEM approach, the study sought to explore the structural relationships among pre-service teachers' knowledge of sexuality education, their attitudes toward it, and their teaching self-efficacy, with a specific attention to analyzing the mediating role attitudes in the relationship between knowledge and self-efficacy, as well as the moderating effect of gender on this mediating pathway. Before testing the structural model, the reliability and validity of the measurement model was first assessed. Results indicated that the Cronbach's alpha coefficients and the composite reliability (CR) of each variable exceeded 0.70, and the average variance extracted (AVE) were all above 0.50, suggesting that the instrument possessed satisfactory internal consistency and convergent validity (Hair et al., 2021; Fornell and Larcker, 1981). Moreover, discriminant validity was confirmed through the Fornell-Larcker criterion and the heterotrait-monotrait ratio (HTMT) of correlations, ensuring the adequacy of the measurement model for subsequent structural analysis (Fornell and Larcker, 1981; Henseler et al., 2015).

Regarding model fit, the coefficients of determination (R²) for the key endogenous variables showed R² values of all dimensions within the range of 0.5–0.8, demonstrating a moderate to strong explanatory power of the model for each variable (Hair et al., 2019). Additionally, the predictive relevance indicator, Q², also indicated that the model had good predictive relevance, with the Q² values for knowledge, attitude and self-efficacy being greater than 0, which is consistent with the criterion (Hair et al., 2019). Collectively, these indicators revealed the adequacy of the model's fit and predictive performance, thereby validating the interpretation of the hypothesized structural relationships and moderated mediation effects.

This study used bootstrap approach to test the mediating effect, the results showed that the mediating effect of attitude was significant. Specifically, the results of the paths were illustrated as follows: (1) Knowledge → Attitude → Self-efficacy: the total effect coefficient of this pathway was 0.383, the 95% confidence interval was [0.299, 0.465], and the T-value was 9.027, which indicated that the total effect of pre-service teachers' sexuality knowledge on their self-efficacy teaching of it was significant; (2) Knowledge → Self-efficacy: it had a direct effect coefficient of 0.217, a 95% confidence interval of [0.140, 0.298], and a T-value of 5.401, suggesting that sexuality knowledge of the respondents has a significant positive direct effect on their teaching self-efficacy; (3) Knowledge → Attitude → Self-efficacy: the indirect effect coefficient of pre-service teacher's sexuality knowledge on their teaching self-efficacy was 0.166, with a 95% confidence interval of [0.120, 0.214], and a T-value of 6.916, which showed that their attitude toward sexuality education had a significant mediating effect on the relationship between knowledge and self-efficacy (Table 3). It is therefore evident that attitude as a mediating variable not only directly affects individual self-efficacy, but also indirectly affects the role of one's knowledge on one's personal self-efficacy. This suggests that attitude plays a partly mediating role in this mechanism, that is, individuals with greater knowledge tend to hold more positive attitudes toward sexuality education, and these attitudes in turn enhance their confidence in teaching sexuality education.

Prior to conducting multiple group analyses, preliminary path estimates were examined to clarify the fundamental relationships among the key variables. The results revealed that knowledge was positively associated with both attitudes (O = 0.358, p < 0.001) and self-efficacy (O = 0.217, p < 0.001), and attitude was positively correlated with self-efficacy (O = 0.462, p < 0.001). To further examine the moderating role of gender in mediating pathways, multiple group analysis was applied to analyse the structural pathway coefficients comparing male and female pre-service teachers. Results showed that the indirect effect of pre-service teachers' knowledge of sexuality education affecting their sense of teaching self-efficacy through their own attitudes was more significant among female counterparts (Difference = −0.169, p = 0.002). The MGA test for path differences yielded a p value of < 0.05, indicating a statistically significant difference between the two groups for the effect. That is, gender markedly moderated the strength of the mediation path, showing a moderated mediation effect in the model, of which the mediation effect of female teachers in the knowledge → attitude → self-efficacy path was significantly more powerful than that of the males, thus confirming the research hypothesis. The finding highlights the importance of gender as a factor contributing to the development of positive attitudes and self-confidence in taking actions during the process of raising the professional competence of pre-service teachers in sexuality education, which deserves more attention in the relevant training programs and intervention strategies.

This study, through the lens of pre-service teachers, examined how their attitudes toward early childhood sexuality education mediate the relationship between their knowledge and teaching self-efficacy, while also validating the moderating role of gender. Results indicated that attitudes play a crucial mediating role, with stronger effects observed among female participants. These findings reinforce the theoretical relevance of the knowledge–attitude–self-efficacy model in teacher education and contribute to a deeper understanding of pre-service teacher development in sexuality education. The study highlights the importance of structured training that not only enhances knowledge but also cultivates positive attitudes and confidence, particularly by addressing gender based differences and fostering supportive learning environments. While limitations such as the cross-sectional design, reliance on self-reported data, and limited regional scope may affect the generalizability of findings, the study still provides valuable insights for educators and policymakers. To strengthen future research, it is recommended to expand the sample size, diversify the variables, and apply longitudinal or mixed-method approaches. Such efforts can help refine strategies for equipping pre-service teachers with the professional competence needed to deliver effective, value driven sexuality education in early childhood settings.