Sexual activity (re-)engagement following spinal cord injury: Identifying behavior change targets for intervention development.

Abstract

Objectives: This study used the behavior change wheel to identify the priority behavioral factors for a tailored intervention to support (re-)engagement in sexual activity following a spinal cord injury (SCI). Research Method/Design: Forty-eight semistructured interviews were conducted with participants from three outpatient/carer/clinician populations in the United Kingdom: people living with SCI, their partners/spouses, and healthcare professionals working in SCI rehabilitation. To identify potential strategies to facilitate (re-)engagement in sexual activity, the behavior change wheel (BCW) and behavior change technique taxonomy Version 1 were applied to code behavior change techniques (BCTs) present in interview transcripts. Results: Six intervention functions, three policy categories, and 21 BCTs were identified as primary targets for interventions to support sexual (re-)engagement post-SCI. Increasing physical-related skills and training would promote physical capability, while sex-related knowledge and the understanding of sexrelated health consequences would elevate psychological capability. A supportive healthcare team, alongside peer support and targeted environmental resources about sexual activity/well-being facilitate physical and social opportunities for sex. Motivation to (re-)engage in sexual activity comprised goal-driven reflective motivation to enhance beliefs about capabilities, and automatic motivation via emotional support and reward-based reinforcement. Conclusions: This study outlines the key BCW and theoretically-derived intervention targets which now provide the foundation for innovative future interventions in SCI and sexual activity. Targeting these highly specific BCTs increases the likelihood that sexual satisfaction can become universally accessible after SCI. Impact and ImplicationsResults of this study demonstrated the significant strength of combining the capability, opportunity, motivation for behavior model and behavior change technique taxonomy in order to offer a practical and structured framework for formulating sexual activity interventions. The priority domains of the behavior change wheel were physical and psychological capability, physical and social opportunity, reflective and automatic motivation. Future interventions for sexual (re-)engagement post-spinal cord injury (SCI) must first target these domains. Theoretically informed interventions optimize the implementation and acceptability of sexual well-being and sexual satisfaction interventions for people with SCI, their partners, and the healthcare professionals delivering the intervention. Twenty-one key behavior change techniques (BCTs) were identified, specifically pertaining to sexual well-being and sexual satisfaction after SCI: Without including all of these BCTs, future interventions risk weaker psychosocial and behavioral outcomes.