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of being comfortable addressing sexuality with patients
and their partners (Table V). The entire model was
statistically significant: χ 2 (7, n = 289) = 74.6, p < 0.001.
DISCUSSION
Lack of sexual health policy: A barrier to addressing
sexuality
These results indicate that a lack of sexual health policy
represents a barrier to evidence-based practice in this
area during stroke rehabilitation. A considerable varia-
tion in sexual health policies was found between the 9
participating centres; being completely absent in some
cases and sparse in most. At centres with high policy
score, HCPs’ responses were consistently more positive
about having routines and resources concerning sexual
health at their workplace than at low-scoring centres.
Thus, responses from HCPs are in accordance with the
responses given by administrative leaders regarding
their stroke rehabilitation unit’s sexual health policy.
These findings suggest that lack of sexual health po-
licy leaves HCPs without guidance and with undefined
roles and responsibilities when addressing sexuality in
clinical practice, allowing disclaim of responsibility
among members of the rehabilitation team. The Austra-
lian SOX study produced similar results, showing that
employees were uncertain about their responsibility,
underpinning the need for an interdisciplinary approach
to addressing sexuality after stroke (24, 28). Based on
their recent review of the literature, Grenier-Genest
and colleagues recommended an interdisciplinary
approach to sexuality in stroke rehabilitation to meet
the complex impact of stroke on sexual wellbeing (8).
However, results from the present study indicate a lack
of interdisciplinary approach to sexuality in the majority
of participants, as only one-fifth of HCPs indicated that
addressing sexuality should be a mutual responsibility
of the interdisciplinary team, and less than one-tenth
reported such practice at their workplace.
The fact that healthcare services, to a large extent,
do not follow recommendations on implementing
sexual health in standard care (1–6) is concerning.
One possible explanation for these recommendations
not being followed may be the lack of specific advice
in guideline documents and the sparsity of studies on
how to manage practice and clinical care with respect
to sexual health. Stroke guidelines recommend that pa-
tients and/or partners should be offered education and
the opportunity to discuss sexuality with a healthcare
provider, but they are not specific in defining roles or
responsibility, and are limited regarding stroke-specific
interventions for sexual problems or dysfunctions.
Not having access to practical guidelines, educa-
tion and training can also influence HCPs’ ability to
www.medicaljournals.se/jrm
address sexuality at an individual level. The present
study shows that HCPs working at centres with high
sexual health policy scores felt more comfortable with
and more knowledgeable about sexual health issues
than personnel at low-scoring centres. These findings
are consistent with findings from qualitative studies
of stroke and sexuality that describe a lack of policy
as a barrier to HCPs initiating sexuality-related com-
munication (20, 21). Policies on sexual health should
therefore be designed in a proper way to be successful
for use in clinical practice. This means taking into ac-
count needs at an organizational and individual level
to facilitate having this topic raised and handled in
accordance with evidence-based practice. The po-
licies should provide specific recommendations for
information and interventions on sexual rehabilitation
after stroke to guide clinicians. Cooperation with user
organizations, user consultants and other stakeholders
is a key to ensure patient experiences and involvement
in development of recommendations. The capacity and
ability of hospitals or organizations to prioritize sexual
health may also be a question of economy and hospital
facilities as well as staff resources. Policies on sexual
health therefore need to be rooted in health authorities
for successful sexual health promotion.
Perceived low level of knowledge: A barrier to be
overcome
Importantly, more than three-quarters of HCPs in this
study reported having little or no knowledge about
working with sexual health after stroke. Similar findings
have been reported by others (8, 17, 20, 21) as one of the
major barriers to provide information about sexuality to
patients and their partners. Most HCPs expressed a need
for knowledge within several areas of sexual medicine/
sexology and preferred an interdisciplinary model for
sexological education and training. It has been suggested
that expertise may not be necessary when addressing
sexuality, but emphasized the importance of strengthen
ing communication skills (21). Results from the present
study indicate that sexual health education is desired
in order to support knowledge and comfort in HCPs.
Given the complexity of the impact of stroke and the
diversity of sexual problems, we believe that expertise
should be available in the interdisciplinary team. The
need for training and education in sexual health among
all professions is emphasized by others (8). Perceived
lack of knowledge is a barrier that can be overcome by
supporting the correct education and training in sexual
health. However, the ability and opportunity to change
practice is more complex, being influenced by multi-
ple interacting factors, including hospital policies as
described, as well as social and cultural circumstances
and personal level of comfort (12, 21).