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discuss in groups although this may be effective later; the-
refore, one-to-one is a much more person-centred, sensitive
and culturally appropriate approach.’
Furthermore, while participants valued the use of
peer-to-peer counselling, they had concerns regarding
the skills and training needed to ensure safe effective
counselling.
‘Peer counselling could be useful however it could be a
disaster depending on the ‘peer’.’
Disciplines involved in delivering sexual rehabilitation
following stroke: priorities and consensus
Participants did not exclude any professional group
from providing sexual rehabilitation following stroke.
Table SIV 1 shows the 11 potential professionals pre-
sented in round 1, with their consensus and priority
scores. Table V shows the final 11 options in a matrix,
categorized by consensus and priority. Rehabilitation
physicians, nurses with specialist knowledge in stroke
and sexuality, psychologists, sexologist/sex educators/
counsellors, nurses working in stroke services (acute
care or rehabilitation), physiotherapists and occupa-
tional therapists were all prioritized as the preferred
professionals to address sexuality, with a high level of
consensus. There was a moderate level of consensus
for prioritising social workers and speech pathologists.
Analysis of responses to open-ended questions in-
dicated that stroke survivors and their partners did not
have a strong preference for any specific profession to
provide sexual rehabilitation. Instead, they suggested
that factors, such as the age, gender and comfort of
a professional when discussing sexuality should be
considered:
‘Difficult to talk to female professionals about this and most
of the male professionals are older than me. Need someone
who is young and male.’
Participants with self-reported communication dif-
ficulties commented on the value of having a speech
pathologist available to support discussions with part-
ners and other health professionals:
‘I need people to help me (in having conversations)’ and
‘Our experience is that the medical fraternity are woefully
ignorant of aphasia, its effects and its treatment, and do not
take the time or care to understand the patient’s needs.’
DISCUSSION
This study used a modified Delphi technique to
determine whether agreement could be reached on
the essential components of sexual rehabilitation
following stroke. Specifically, we sought to identify
what content should be addressed, at what point in
the stroke recovery journey, and which profes-
sional group should deliver interventions, using what
method. There was a high level of consensus that all
18 core content areas should be included in post-stroke
sexual rehabilitation. Participants also identified a
clear preference for sexual rehabilitation services
to commence during the sub-acute phases of stroke
recovery and to be available across the chronic stages
of stroke recovery. Participants prioritized individual
face-to-face services, as well as services delivered
online by professionals, reading material or peer-to-
peer counseling. Rehabilitation physicians, nurses
with specialist knowledge in stroke and sexuality,
psychologists, sexologists/sex educators/counsellors,
nurses and physiotherapists were all prioritized as the
preferred professionals to address sexuality, with a
high level of consensus. There was a moderate level
of consensus for prioritising occupational therapists,
social workers and speech pathologists. The inclusion
of consumer perspectives when designing healthcare
interventions is widely accepted and likely to increase
the quality, relevance and acceptability of interventions
(29, 30). A strength of our research is the inclusion of
people with self-reported communication difficulties as
part of the consumer panel, a group that are typically
excluded from sexuality (1) and stroke rehabilitation
research (31).
Previous studies outlining interventions to address
sexuality following stroke have focused primarily
Table V. Matrix of consensus and priority scores for preferred professionals to provide sexual rehabilitation following stroke
Tiered priority ratings
Consensus 1. High; High to Intermediate 2. Intermediate; High to Low
High (< 1) • Rehabilitation Physician
• Nurse with specialist knowledge in stroke and
sexuality
• Psychologist
• Sexologist/sex educator/counsellor
• Nurse working in stroke services (acute care or
rehabilitation)
• Physiotherapist
• Occupational therapist
• Social worker
• Speech pathologist • Neurologist
Moderate (1)
Low (> 1)
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• Geriatrician
3. Low; Low to Intermediate