Journal of Rehabilitation Medicine 51-5 | Page 42

358 M. McGrath et al. 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) www.medicaljournals.se/jrm • Geriatrician 3. Low; Low to Intermediate