Addressing Sexuality Among People Living With Chronic Disease and Disability: A Systematic Mixed Methods Review of Knowledge, Attitudes, and Practices of Health Care Professionals

McGrath, Margaret; Low, Michelle Anne; Power, Emma; McCluskey, Annie; Lever, Susan Z.

doi:10.1016/j.apmr.2020.09.379

Cited by 19 publications

(13 citation statements)

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“…Our participants argued that creating the space to openly discussing sexual desires, health, experiences, and boundaries with clients is needed to eliminate taboos about sexuality in mental health and disability care organizations. Previous research has shown that sexuality and sexual health needs of clients are inadequately addressed in mental health [ 36 – 38 ] and disability care settings [ 39 ]. While many healthcare professionals acknowledge the importance of addressing sexuality and intimacy as part of holistic, recovery-oriented care, they may feel unprepared, uncomfortable and not have sufficient training to deal with these issues [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous research has shown that sexuality and sexual health needs of clients are inadequately addressed in mental health [ 36 – 38 ] and disability care settings [ 39 ]. While many healthcare professionals acknowledge the importance of addressing sexuality and intimacy as part of holistic, recovery-oriented care, they may feel unprepared, uncomfortable and not have sufficient training to deal with these issues [ 39 , 40 ]. Professionals’ personal experiences with SBV may further contribute to how sexuality is approached in a care relationship [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

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Combining rules and dialogue: exploring stakeholder perspectives on preventing sexual boundary violations in mental health and disability care organizations

et al. 2022

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Background Sexual boundary violations (SBV) in healthcare are harmful and exploitative sexual transgressions in the professional–client relationship. Persons with mental health issues or intellectual disabilities, especially those living in residential settings, are especially vulnerable to SBV because they often receive long-term intimate care. Promoting good sexual health and preventing SBV in these care contexts is a moral and practical challenge for healthcare organizations. Methods We carried out a qualitative interview study with 16 Dutch policy advisors, regulators, healthcare professionals and other relevant experts to explore their perspectives on preventing SBV in mental health and disability care organizations. We used inductive thematic analysis to interpret our data. Results We found three main themes on how healthcare organizations can prevent SBV in mental health and disability care: (1) setting rules and regulations, (2) engaging in dialogue about sexuality, and (3) addressing systemic and organizational dimensions. Conclusion Our findings suggest that preventing SBV in mental health and disability care organizations necessitates setting suitable rules and regulations and facilitating dialogue about positive aspects of sexuality and intimacy, as well as about boundaries, and inappropriate behaviors or feelings. Combining both further requires organizational policies and practices that promote transparency and reflection, and focus on creating a safe environment. Our findings will help prevent SBV and promote sexual health in mental health and disability care organizations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Combining rules and dialogue: exploring stakeholder perspectives on preventing sexual boundary violations in mental health and disability care organizations

et al. 2022

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“…However, few persons with stroke get the opportunity to address sexuality during their rehabilitation ( 16 , 17 ) even though past studies showed that a lack of access to sexuality-related services could put them at risk of depression and poor quality of life ( 14 , 18 ). There are interrelated factors, both individual and organizational, that contribute to this situation ( 19 , 20 ). The perceived lack of knowledge and skills of clinicians, as well as personal discomfort and misconceptions related to sexuality are among the most reported barriers ( 16 , 21 , 22 ).…”

Section: Introductionmentioning

confidence: 99%

Co-designing a Program to Improve Post-stroke Sexual Rehabilitation: The Promise of Innovative Methods

Auger

Allegue

Morales

et al. 2022

Front. Rehabilit. Sci.

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IntroductionMost people who sustain a stroke are likely to experience sexual difficulties during their recovery. However, few people get the opportunity to address sexuality during their rehabilitation because of factors related to the organization (e.g., culture), managers (e.g., lack of resources), clinicians (e.g., perceived lack of knowledge, skills, and comfort), and clients (e.g., taboo). A multifactorial program tailored to stakeholders' needs with various complementary interventions is needed to lead to a change of practice in post-stroke sexual rehabilitation.ObjectiveTo co-design with stakeholders (i.e., people with stroke, partners, clinicians, managers and researchers) a theory-driven multifactorial program to improve post-stroke sexual rehabilitation services.MethodsThis qualitative study will be conducted in four steps using an Intervention Mapping approach and a co-design methodology divided into four phases: (1) exploration; (2) co-design; (3) validation; and (4) development. Persons with stroke, partners, clinicians and managers from five distinct stroke rehabilitation centres in the province of Quebec (Canada), and researchers will be recruited to either participate in an advisory committee or working groups throughout the study. A combination of contributions from three different types of groups (advisory group, Lego® groups, work groups) will be used for data collection. Qualitative data analysis will first be realized by two independent reviewers using the Theoretical Domains Framework, and preliminary results of analysis will be validated with the advisory and working groups.ConclusionThis study will lead to the co-design of the first theory-driven program intended to optimize post-stroke sexual rehabilitation services.

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“…In general, sexuality poststroke is poorly addressed in stroke rehabilitation, and several barriers that prevent patients and partners from receiving adequate sexual rehabilitation have been identified. 9 , 10 , 11 The scarcity of a biopsychosocial approach in clinical practice and research investigating sexuality poststroke represents one such barrier. Thus, evidence-based studies to guide clinical practice after stroke from a biopsychosocial perspective are called for to meet the diverse sexual rehabilitation needs, 12 , 13 , 14 , 15 also in stroke patients with cognitive impairments.…”

Section: Introductionmentioning

confidence: 99%

Sexual Satisfaction and Associated Biopsychosocial Factors in Stroke Patients Admitted to Specialized Cognitive Rehabilitation

et al. 2021

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Introduction: The consequences of stroke on sexual life in stroke patients in need of specialized cognitive rehabilitation have been limited explored. A biopsychosocial perspective in post-stroke sexuality studies is warranted to capture the complex picture of stroke consequences and sexual life after stroke and sexual satisfaction is an important outcome measure when exploring such multifactorial associations. Aim: To explore sexual satisfaction and associated biopsychosocial factors in stroke patients admitted to specialized cognitive rehabilitation. Methods: A cross-sectional study was performed including 91 consecutive stroke patients admitted to specialized cognitive rehabilitation. Data were collected from medical records and by face-to-face interviews using a structured interview guide and questionnaires. Descriptive and inferential statistics were applied. Main outcome measures: A wide range of biopsychosocial variables including medical and sociodemographic characteristics, social support, sexual complaints, aspects of sexual life, psychological distress and life satisfaction were analyzed in relation to the main outcome "Satisfaction with sexual life." Results: Only 33 % were satisfied with sexual life. Prevalence of sexual complaints was high, more frequent in women (84%) than in men (64%). Three-quarters were less sexually active than before stroke. Multivariable analyses showed that anxiety, sleep problems, manifested sexual complaint, decrease in sexual activity and fear of partner rejection were significantly associated with low odds of sexual satisfaction, while affectionate support and partnership satisfaction were significant for sexual satisfaction. When combined in a biopsychosocial multivariable model only fear of partner rejection (OR 0.07; 95 % CI: 0.01−0.42) and decrease in sexual activity (OR 0.11; 95 % CI: 0.02−0.58) showed significant contribution to sexual satisfaction. Conclusion:The variety of predictors for sexual satisfaction indicates that therapeutic actions need to be individualized and points towards a broad assessment and interventional approach to meet the sexual rehabilitation needs of stroke patients with cognitive impairments in need of specialized rehabilitation. Vikan JK, Snekkevik H, Nilsson MI, et al. Sexual Satisfaction and Associated Biopsychosocial Factors in Stroke Patients Admitted to Specialized Cognitive Rehabilitation. Sex Med 2021;XX:XXXXXX.

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Addressing Sexuality Among People Living With Chronic Disease and Disability: A Systematic Mixed Methods Review of Knowledge, Attitudes, and Practices of Health Care Professionals

Cited by 19 publications

References 100 publications

Combining rules and dialogue: exploring stakeholder perspectives on preventing sexual boundary violations in mental health and disability care organizations

Combining rules and dialogue: exploring stakeholder perspectives on preventing sexual boundary violations in mental health and disability care organizations

Co-designing a Program to Improve Post-stroke Sexual Rehabilitation: The Promise of Innovative Methods

Sexual Satisfaction and Associated Biopsychosocial Factors in Stroke Patients Admitted to Specialized Cognitive Rehabilitation

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