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Health Organization (WHO) report states that the way
in which sexual health is and can be addressed within
different countries is largely culturally determined,
being bound by gender constructs and religion, and
reinforced by politics (22). According to the WHO
(23), the disconnect between patients’ wishes to discuss
sexual concerns and the services actually provided by
HCPs highlights that communication on intimate issues
is an area requiring urgent attention.
The extent to which sexual health is addressed in
hospital stroke policies (meaning clinical practice pro-
cedures and routines) is unknown. The perspectives of
HCPs addressing sexual health in stroke rehabilitation
has been explored only to a limited degree, while fac-
tors associated with HCPs’ perceived discomfort when
communicating about sexuality have been explored to
a lesser extent.
Objectives
The objectives of this study were to identify and ex-
plore sexual health policies at stroke units at different
specialized rehabilitation centres in relation to: (i)
HCPs’ experiences and perspectives on workplace
practices concerning sexual health after stroke, and
(ii) HCPs’ perceived level of knowledge and comfort
working with sexual health and educational needs.
METHODS
Participants
This descriptive cross-sectional study explored sexual health po-
licies at stroke units and the perspectives of HCPs; thus it inclu-
ded participants at an organizational and individual level. Stroke
units at 9 specialized rehabilitation centres from 7 countries in
different parts of the world were included: Alamal Rehabilita-
tion Centre, Islamic University (Gaza, Palestine); Bethlehem
Arab Society for Rehabilitation (Bethlehem, Palestine); Sheba
Medical Center (Tel Aviv, Israel); Bayi Rehabilitation Center
(Chengdu, China); Polyclinica nr.2, Respublikanskaja Bol’nica
imeni Baranova (Petrozavodsk, Russia); Rusk Rehabilitation,
NYU Lagone Health (New York, USA); Sahlgrenska Univer-
sity Hospital (Gothenburg, Sweden); Stockholm’s Sjukhem
(Stockholm, Sweden); and Sunnaas Rehabilitation Hospital
(Oslo, Norway). Eight of these belong to a well-established
research network, described elsewhere, and where specialized
rehabilitation standards have been found to be comparable
(10). One collaborating Swedish centre was added (Stockholm
Sjukhem) in the present study. Participants were recruited from
each centre. Inclusion criteria were: HCP, all professionals, in
clinical positions working with specialized stroke rehabilitation.
Data collection procedures
Data were collected from each specialized rehabilitation centre,
with administrative leaders and contact persons responsible for
reporting data concerning stroke unit sexual health policy to
the research group.
www.medicaljournals.se/jrm
Data from participating HCPs from the 9 centres were col-
lected anonymously using a web-survey. Contact persons at
each site provided oral and written information to staff members
about the survey. An information letter was translated into the
preferred languages of participating centres and e-mailed to
employees. The letter contained brief information and a re-
quest to complete the anonymous web-survey via an attached
survey link.
The methodology was the same at all participating centres.
In order to ensure identical procedures and optimal responses
an English-speaking contact person was selected at each centre
and the research group communicated with the contact persons
and administrative leaders.
Measurements
Two structured questionnaires were used:
• An organizational-audit tool developed by the Australian
Research Centre in Sex, Health & Society at La Trobe Univer-
sity in collaboration with the Victorian Stroke Network (24).
The audit was developed to determine the capacity of orga-
nizations to provide patients and partners with information
on sexuality after stroke. The audit consist of 10 statements
covering policies and practice concerning providing informa-
tion to patients and partners, education to staff, assessment
and documentation of sexuality after stroke, and stakeholder
involvement. Items are based on the WHO’s principles for
successful sexual health programmes (22, 25). Each statement
was rated as not met (0 points), partly met (1 point) or met
(2 points). The total score range was 0–20. A positive score
(“partly met”/”met”) on 5 or more of the 10 statements was
categorized by us as “high score”, and less than 5 as “low
score”. This cut-off was set based on an understanding that
having routines within at least 5 of these items would have
an effect on clinical practice.
• A HCP questionnaire of 33 questions (32 multiple choice and
1 open-ended) was developed with the purpose of exploring
the perspectives and experiences of HCPs working with sexual
health in stroke rehabilitation. The questionnaire included 9
questions modified from a Norwegian survey on “rehabilitation
and sexuality” (26) and 5 from the Australian “Sexuality after
stroke” (SOX) staff survey (24). The selected questions were
chosen based on scientific and clinical literature and tested
among professionals working with stroke rehabilitation and a
user consultant to ensure that questions were understandable
and relevant. In the present study, a total of 20 of the 33 ques-
tions were selected in order to capture: (i) socio-demographic
variables: workplace, age, gender, profession, years of work
experience and sexological education; (ii) HCPs’ clinical ex-
periences and perspective on sexual health in stroke rehabilita-
tion: experiences of workplace prioritizing giving information
on sexuality to patients and providing sexological education
to staff, having access to guidelines or procedures concerning
sexual health and stroke, educational/training preferences,
responsibility for addressing sexuality in current practice and
opinion on who should be responsible for addressing sexuality,
experiences of patients addressing sexuality, perceived level
of knowledge when working with sexual health (categories
high, middle, low and none were dichotomized into high/
middle and low/none), being comfortable addressing sexuality
(categories very comfortable, comfortable, uncomfortable and
very uncomfortable were dichotomized into comfortable and
uncomfortable); and the impact of patient age, gender and
marital status on level of comfort.