title: Sexuality after stroke: an exploration of current professional approaches, barriers to providing support and future directions.
abstract: Purpose Sexual difficulties post-stroke are common, yet frequently neglected within rehabilitation. This study aimed to explore the process by which healthcare professionals approach and work with the topic of sexuality within stroke rehabilitation. Method Ten participants were recruited from 5 community and inpatient multi-disciplinary stroke rehabilitation teams. Semi-structured interviews were carried out and data were analysed using grounded theory methodology. Results The authors developed a theoretical model of how professionals engage with sexual concerns. Professionals' own personal level of comfort with the topic of sexuality interacted with a series of barriers to limit opportunities for engagement. These barriers included factors relating to the context and workplace environment of stroke rehabilitation, professionals' perceptions that they did not have adequate skills in this area and unhelpful attitudes towards stroke survivors and sexuality. Although the majority of participants rarely engaged with sexual issues, they adopted both direct and indirect strategies for engaging with their service users' sexual concerns. Concerns were usually addressed through the provision of information and supportive conversations. Conclusions The findings suggest that sexuality is not a legitimised topic within stroke rehabilitation, and current work practises limit professionals' abilities to address service-users' concerns. Implications for developing effective training and staff support are discussed. Implications for rehabilitation Professionals working within stroke rehabilitation rarely directly bring up sexuality with patients, but an indirect method of approaching the topic is more common. Addressing sexual concerns often does not require expertise. Training should show professionals how to use transferable knowledge to address sexual issues and also enhance communication skills. Sexuality should be incorporated within local stroke policy and procedures, to support professionals in addressing the concerns of their patients and motivate them to act.
authors.affiliation: a Department of Applied Psychology , Canterbury Christ Church University , Tunbridge Wells , UK ;
authors.forename: Alexandra
authors.initials: A
authors.lastname: Richards
authors.affiliation: b Lishman Unit, South London and Maudsley NHS Foundation Trust , London , UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dean
authors.affiliation: a Department of Applied Psychology , Canterbury Christ Church University , Tunbridge Wells , UK ;
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Burgess
authors.affiliation: a Department of Applied Psychology , Canterbury Christ Church University , Tunbridge Wells , UK ;
authors.forename: Helen
authors.initials: H
authors.lastname: Caird
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D005260:Female; D066296:Grounded Theory; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D036301:Qualitative Research; D012735:Sexual Dysfunction, Physiological / Q000523:psychology / Q000534:rehabilitation; D019529:Sexuality / Q000502:physiology / Q000523:psychology; D012938:Social Perception; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation / Q000379:methods / Q000523:psychology; D006113:United Kingdom
keywords: Acquired brain injury; neurorehabilitation; sexual dysfunction; sexual functioning; staff training