Sexual health policies in stroke rehabilitation
Translation, editing and proofreading of the HCP questionn-
aire was provided by Mapi Language Services (27). Language
versions were in Norwegian, Swedish, English (US), Hebrew,
Chinese and Russian. In addition, contact persons carefully
revised the questionnaire to ensure it was adaptable and under-
standable in the specific context. The topic “sexuality” was also
discussed among HCP from each site at network seminars to
gain an understanding of possible cultural differences and how
this survey could be conducted in the best possible way cross-
culturally. Some of the topics discussed were the appropriateness
of addressing sexuality with unmarried patients, older patients
and with patients of opposite gender. However, since these ques-
tions were to be surveyed only among staff, and not patients,
the questions were found adequate among network members.
Statistical analysis
Descriptive data are presented as frequencies, percentages,
standard deviations (SD), medians and ranges. χ 2 or Fisher’s
exact test and Student’s t-test were applied for the comparison
of independent groups as appropriate. Logistic regression ana-
lyses were performed in order to estimate crude and adjusted
odds ratio (OR) with 95% confidence intervals (95% CI) for the
association between HCP’s comfort with addressing sexuality
(dependent variable) and explanatory variables theoretically
relevant for the outcome. Testing for multicollinearity was
carried out by building separate models with covariates. Years
of work experience were correlated with age and was therefore
not included in the regression model. Gender, age, profession,
level of knowledge and workplace categorized by sexual health
policy score were all associated with the outcome in crude
analyses and were included in the direct multivariable logistic
regression model. Statistical significance was set to p < 0.05.
Statistical analyses were performed using SPSS (IBM Corp
Released 2014, Version 23.0).
Ethics
Each participating centre approved and consented for the study
to be conducted according to local ethical regulations. The study
363
was, in addition, approved by the Norwegian Data Protection
Officer (Oslo University Hospital) and the Regional Ethical
Committee (REK Sør-Øst 2018/1988 A), confirming that the
study collects anonymous non-sensitive and non-health-related
data voluntarily from employees.
RESULTS
The organizational-audit tool was completed at all
9 participating centres. Table I shows the number of
centres responding to each response-category of the
10 statements in the organizational audit. The total
score on the organizational audit varied from 0 to 17
points. Only one centre responded positively to all
statements. Two centres responded as not meeting any
of the statements.
Five of 9 centres responded positively (partly met
or met) to 5 or more statements and were categorized
as having a high policy score. Four centres responded
positively to less than 5 statements and were catego-
rized as having low policy score. The 9 centres were
dichotomized ad hoc into groups labelled “high policy
score centres” and “low policy score centres” based on
their scores in the organizational audit. Table II shows
the categorization of each centre and the number of
respondents and response rate of HCPs on the HCP
questionnaire.
A majority of the 323 clinical employees answering
the HCP questionnaire were female, aged between 30
to 49 years, and allied professionals (Table III). At
centres with high policy scores there were more male
respondents (p < 0.001), aged over 30 years (p < 0.001)
and allied professionals (p = 0.004) and fewer nurses
(p = 0.004) than at centres with low scores. HCPs at
Table I. Responses from the 9 participating centres on the organizational audit tool*
Response
Question Not met Part met Met
1 Our service/unit provides all stroke survivors, and their partners, with information on sexuality after stroke. 4
5
0
If yes list evidence to substantiate. If no list action to rectify.
2 Our service/unit invites all stroke survivors to discuss sexuality with staff. 4 3 2
If yes list evidence to substantiate. If no list action to rectify.
3 Our service/unit has a policy outlining how information on sexuality after stroke will be provided to stroke survivors and their partners. 6 2 1
If yes list evidence to substantiate. If no list action to rectify.
4 Our service/unit has a guide for assessment and documentation of sexuality after stroke. 5 4 0
If yes list evidence to substantiate. If no list action to rectify.
5 Our service/unit has documented the roles of all disciplines in the provision of information on sexuality after stroke to stroke survivors. 5 3 1
If yes list evidence to substantiate. If no list action to rectify.
6 Our service/unit has a systematic strategy for interdisciplinary communication relating to sexuality after stroke. 5 3 1
If yes list evidence to substantiate. If no list action to rectify.
7 Our service/unit has consulted stroke survivors to design and review strategies for providing information on sexuality after stroke. 5 3 1
If yes list evidence to substantiate. If no list action to rectify.
8 Our service/unit assesses the knowledge, values and beliefs of staff relating to sexuality after stroke. 6 3 0
If yes list evidence to substantiate. If no list action to rectify.
9 Our service/unit ensures that information and education is valuing and inclusive of diversity of sexual orientation and gender identity. 4
10 Our service/unit has a systematic process for providing staff education relating to sexuality after stroke.
6 3
2 2
1
If yes list evidence to substantiate. If no list action to rectify.
*Reference: Barrett C, Whyte C. Sexuality after stroke: a report on the 2013 sexuality after stroke project. Australian Research Centre in Sex, Health and Society.
La Trobe University. Melbourne Australia 2014. Permission to use and publish given by Dr Catherine Barrett, Chief investigator of the SOX-program.
Number of centres responding to each response category (not met, part met, met) of 10 statements is reported.
J Rehabil Med 51, 2019