Journal of Rehabilitation Medicine 51-5 | Page 46

362 J. K. Vikan et al. 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.