354
M. McGrath et al.
we completed a systematic review and meta-synthesis of qua-
litative research regarding experiences of stroke survivors and
their partners in relation to post-stroke sexuality (1). Secondly,
a content review of existing sexual rehabilitation programmes
for adults following acquired disability was completed. Thirdly,
we examined the curricula of published interventions, which
addressed sexuality after stroke (16–18). A list of potential
content was then organized into the 6 broad categories listed
above and presented to participants in the first Delphi survey.
For the first Delphi survey, participants were initially asked
to rate the value of each content area in relation to sexual reha-
bilitation programmes, using a 5-point-Likert scale. Secondly,
participants were asked to identify and rank the 10 content areas
they deemed to be most important for inclusion in a sexual
rehabilitation programme, from 1 (highest) to 10 (lowest) in
importance. Next, participants were asked to propose additional
content not covered in the survey, responding to an open-ended
question. The same process was completed for timing of a sexual
rehabilitation programme, method of programme delivery and
involvement of specific disciplines.
For participants with self-reported communication difficul-
ties, the aphasia-friendly version was modified using aphasia-
friendly principles (24) with pictographic support, simplified
language, bolding and larger font. Pictographic supports for
sexuality were used with permission from the Aphasia Institute
Canada (27). Three participants required the modified version,
with the remainder (n = 5) completing the online survey with
support from the speech pathologist as required. The online
survey was formatted so that participants could return and
complete it later; some people with mild self-reported com-
munication difficulties reported that this was helpful, as they
could complete the survey more slowly with breaks.
Round 2. In round 2, participants were presented with content
areas from round 1, along with a summary of responses obtained
from round 1. Participants were asked to rate the importance
of each content area, preferred methods of delivery, timing of
delivery and discipline using the same 5-point Likert scale.
Finally, participants were asked to reflect on results from round
1 and provide feedback on aggregated responses via a series of
open-ended questions.
Analysis
Analysis was conducted for the overall sample. Descriptive
statistics were used to calculate responses about content area,
timing, methods and disciplines that the overall group deemed
most important. For each content area, the mean importance
score, the 25 th and 75 th percentile and interquartile range were
calculated. To determine the degree of consensus around the
importance score, a score was calculated for each content area
by dividing the interquartile range by 2. Following guidelines
proposed by Burnette and colleagues (28), a consensus score of
< 1 indicated high consensus, a score of 1 indicated moderate
consensus, and a score > 1 indicated low consensus.
Two approaches were used to identify the content areas,
timing, methods and disciplines deemed of highest importance
by respondents. Firstly, we considered the mean priority score
given to each content area. Scores ≤ 2.4 were categorized as low
priority, scores ≥ 2.41 and scores ≤ 2.8 as intermediate priority,
and scores ≥ 2.81 categorized as high priority. Secondly, the
percentage of respondents who included a content area in their
top 10 priorities was calculated. After reviewing the spread of
scores, categories were assigned as follows: > 25% = high prio-
rity, 15–25% = intermediate priority, and < 15% = low priority.
www.medicaljournals.se/jrm
Finally, the 2 priority ratings (mean priority score and per-
centage of respondents including the content area in their top
10 priorities) were synthesized into 1 priority code with 3 tiers.
Tier 1 content, timing, delivery methods and disciplines were
rated as either: (i) high by both rating schemes; or (ii) high by
one rating scheme and intermediate by the second rating scheme.
Tier 2 content were rated as either: (i) intermediate by both
rating schemes or (ii) high by one rating scheme and low by the
second rating scheme. Tier 3 content areas were rated as either:
(i) low by both rating schemes or (ii) low by one rating scheme
and intermediate by the second rating scheme. For example, the
statement “Resuming sexual activity after stroke”’ had a mean
priority score of 3.51 (high priority), with 57.4% of respondents
identifying the statement as a top 10 priority area (> 25%, high
priority), thus was included as a tier 1 content area. On the other
hand, the statement “What is sexuality?” had a mean priority
score of 3.57 (high priority) with 9.6% of respondents identify-
ing the content area as a top 10 priority area (low priority), and
thus was included as a tier 2 statement. A summary matrix was
compiled to display the content, timing, delivery methods and
disciplines according to consensus and priority. See supplemental
Tables SI 1 , SII 1 , SIII 1 and SIV 1 for full information.
RESULTS
Participants
The final sample size and characteristics are presented
in Table I. Of the 102 participants who completed the
first survey, 49% (n = 50) completed the second survey.
For participants with self-reported communication
difficulties (n = 8), 1 person (male) had a mild activity
limitation on the AusTOMS (26) cognitive-commu-
nication scale, 3 people (2 females and 1 male) had
mild receptive and expressive language limitation on
the AusTOMS language scale (26), and all elected to
complete the online survey. One participant (female)
had a moderate expressive language limitation, a mild
receptive language limitation, and competed the online
survey. Another participant (male) had moderate ex-
pressive and receptive language limitations and chose
to complete the aphasia-friendly survey. Finally, 2 male
participants had moderate/severe language and speech
limitations (apraxia) and completed the aphasia-
friendly version with supported communication. Due
to time constraints associated with data collection the
3 participants who completed the aphasia-friendly
version of the survey were unable to participate in the
second round of data collection.
Content for inclusion in sexual rehabilitation
following stroke: priorities and consensus
During round 1, participants were presented with 47
potential content areas for inclusion in sexual rehabilita-
http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-2548
1