Journal of Rehabilitation Medicine 51-5 | Page 45

J Rehabil Med 2019; 51: 361–368 ORIGINAL REPORT SEXUAL HEALTH POLICIES IN STROKE REHABILITATION: A MULTINATIONAL STUDY Jannike K. VIKAN, MSW 1,2 , Marie I. NILSSON, PhD 2,3 , Tamara BUSHNIK, PhD 4 , Wanying DENG, MD 5 , Khamis ELESSI, MD, PhD 6 , Yael FROST-BAREKET, MSc 7 , Elena KOVRIGINA, MD 8 , Jeries SHAHWAN, Psych 9 , Hildegun SNEKKEVIK, MD 1, Elisabet ÅKESSON, MD, PhD 2,10 , Johan K. STANGHELLE, MD, PhD 1,11 and Kerstin S. FUGL-MEYER, PhD 1–3,10 From the 1 Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway, 2 Department of Neurobiology, Care Science and Society, Karolinska Institutet, 3 Function Area Social Work in Health, Karolinska University Hospital, Stockholm, Sweden, 4 Rusk Rehabilitation, NYU Lagone Health, New York, USA, 5 Bayi Rehabilitation Center, Chengdu, China, 6 Faculty of Medicine, Islamic University, Gaza, Palestine, 7 Sheba Medical Center, Tel Aviv, Israel, 8 Rehabilitation Medicine, Policlinica nr 2, Petrozavodsk, Russia, 9 Bethlehem Arab Society for Rehabilitation, Bethlehem, Palestine, 10 The R&D Unit, Stockholms Sjukhem, Stockholm, Sweden and 11 Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway Objective: To identify and explore sexual health po- licies at specialized stroke rehabilitation centres in relation to the perspectives of healthcare personnel concerning sexual health. Design: Cross-sectional study. Subjects: Nine specialized rehabilitation centres re- presenting 7 countries, and healthcare personnel (n  = 323) working with stroke rehabilitation at the 9 centres were included in the study. Methods: Two structured questionnaires were used: (i) an organizational-audit on sexual health policies; (ii) an anonymous web-questionnaire assessing the perspectives of healthcare personnel concerning sexual health. Results: Of the 9 centres, 5 scored high on having sex- ual health policy in stroke rehabilitation and 4 scored low. Healthcare personnel working at centres with high scores reported higher levels of knowledge and comfort in working with sexual health, and looked more positively on the workplace sexual health po- licies, than personnel working at centres scoring low on these factors. Most personnel expressed a need for knowledge on the topic. Being comfortable about addressing sexuality was significantly associated with higher levels of knowledge about sexuality and working at centres having sexual health policies. Conclusion: A lack of sexual health policy represents a barrier to evidence-based practice in stroke reha- bilitation. Such protocols need to be implemented in standard care in order to meet the sexual rehabilita- tion needs of stroke patients and partners. Key words: stroke rehabilitation; sexual health; healthcare personnel; stroke policy. Accepted Mar 22, 2019; Epub ahead of print Apr 2, 2019 J Rehabil Med: 2019; 51: 361–368 Correspondence address: Jannike K. Vikan, Research Department, Sunnaas Rehabilitation Hospital, NO-1450 Nesoddtangen, Norway. E- mail: [email protected] I nternational guidelines on stroke recommend that sexual health should be addressed as an integral part of standard stroke care (1–6). There is a high preva- lence of sexual problems and dysfunction among stroke LAY ABSTRACT Stroke survivors and their partners have been found to have unmet sexual rehabilitation needs. Stroke guide- lines recommend that sexual health should be part of standard care, but sexuality is not consistently addres- sed in stroke rehabilitation. This study explored sexual health policies at 9 specialized stroke rehabilitation cen- tres around the world and the perspectives of health­care personnel on working with sexual health. Five centres had routines on sexual health, while 4 had few or none. Personnel working at centres with routines felt more knowledgeable and comfortable working with sexual health, and responded more positively to having rou- tines at their workplace concerning sexual health than did personnel at centres having few or no such routines. Those who felt comfortable more often felt knowledge­ able addressing sexuality and more often worked at a centre having routines on sexual health. Sexual health policies should be implemented in stroke care in order to meet the needs of patients and their partners. survivors and their partners (7–9). A previous multina- tional study, conducted within the same research net- work as the present study, found that patients reported their sexual life to be one of the most dissatisfactory areas in life (10, 11), confirming the need for sexual rehabilitation after stroke. Patients often do not raise questions about sexuality as they feel embarrassed, and those patients may want their healthcare providers to raise the topic (12–15). Healthcare personnel (HCP) should therefore be prepared to initiate conversations about sexuality in order to meet the needs of patients and partners. However, sexuality is not consistently addressed in stroke rehabilitation and is often over- looked by HCP (15–17). Significant barriers to initiating sexuality-related communication have been reported among HCPs, such as lack of training and knowledge, feeling uncomfort­ able, lack of hospital policy and unhelpful attitudes, such as disabled or elderly people being asexual, or that raising the topic would cause distress or embar- rassment in patients (15, 18–21). Cultural aspects can also influence how sexuality is approached. A World This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2552