Conception and development of Sexual Health indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Abstract

Context: Although spinal cord injury or disease (SCI/D) results in complex biological and psychosocial impairments that adversely impact an individual's overall quality of sexual life, sexual health is poorly integrated into the current rehabilitation processes. Therefore, it is vital to promote sexual health as a rehabilitation priority. Herein, we describe the selection of Sexual Health structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. Methods: Experts in sexual health and the SCI-High team identified key factors that influence the sexual health outcomes of rehabilitation interventions to inform Driver diagram development. This diagram informed the selection and development of indicators to promote a permissive environment for discussion of sexual health issues among regulated health care professionals (HCPs). A review of literature and psychometric properties of measurement tools facilitated final indicators selection. Results: The structure indicator is the proportion of rehabilitation HCPs who have completed annual preliminary sexual health training. The process indicator is the proportion of SCI/D inpatients that have a documented introduction to available local sexual health resources. The outcome indicator is a sexual health patient questionnaire used to assess sexual health patient outcomes and sexual health information/educational needs. Rapid-cycle piloting verified that the indicator tools developed are feasible for implementation. Conclusion: Successful implementation of the Sexual Health structure, process and outcome indicators will promote a permissive environment to enable open discussion, and lead to provision of equitable and optimal care related to sexual health following SCI/D. This will ultimately advance sexual health rehabilitation across the nation.

Supporting Sexual Functioning and Satisfaction During Rehabilitation after Spinal Cord Injury: Barriers and Facilitators Identified by Healthcare Professionals

“…The importance of prioritizing support around sexual functioning/satisfaction within SCI rehabilitation was collectively highlighted in this study as a crucial area in overall rehabilitation, consistent with wider findings ( 23 ). The current results demonstrated that HCPs felt sexual wellbeing was poorly integrated into SCI rehabilitation and a vital area of priority for review and further development ( 17 ). Wider research has found the inclusion of sexual functioning/satisfaction as part of SCI rehabilitation is often overlooked or ignored ( 24 ), echoing findings from this study, whereby sexual health was thought to be sidestepped or avoided throughout both inpatient and long-term phases of SCI rehabilitation.…”

“…To explore barriers and facilitators associated with HCP provisions for sexual wellbeing within SCI rehabilitation, a 9-item semi-structured interview schedule was developed (see Table II ). Key areas for consideration were identified by topical qualitative elicitation interviews with people with SCI, and through consultation of existing psychosexual literature aiding the development of the interview schedule; training and resources ( 17 ), clinician competency and communication, ( 12 ) and personal autonomy ( 13 ).…”

Improving practice through collaboration: Early experiences from the multi-site Spinal Cord Injury Implementation and Evaluation Quality Care Consortium

“… 17 Proportion of SCI/D inpatients having a documented introduction to available local sexual health resources, and who complete the SCI-High Sexual Health Questionnaire. 18 Proportion of SCI/D rehabilitation inpatients with inappropriate antibiotic prescription. 19 Proportion of individuals with SCI/D who completed a daily head to toe skin check.…”

Collaborative networks to achieve innovations in care

“…Building off the work of the SCI-High Project 1 and the National SCI Knowledge Mobilization Network, 2 the SCI IEQCC was established to implement indicators of SCI rehabilitation excellence, with a focus on the following domains: emotional well-being, 6 sexual health, 7 walking mobility, 8 wheeled mobility, 9 tissue integrity, 10 and urinary tract infections. 11 Further domains and indicators will be added as the Consortium work continues in 2021, including the implementation of the community participation domain.…”