Sexuality after stroke: Exploring knowledge, attitudes, comfort and behaviours of rehabilitation professionals.

Background: Sexual dysfunction after stroke is common and is associated with poor health and quality of life outcomes. Clinical guidelines for stroke typically recommend that all stroke survivors have access to support relating to sexuality during rehabilitation. However, the extent to which rehabilitation professionals are prepared to address sexuality after stroke is unclear.

Objective: To investigate the knowledge, comfort, approach, attitudes, and practices of rehabilitation professionals toward supporting stroke survivors with their sexuality concerns.

Methods: Cross-sectional analytic survey design. Data were collected by using an electronic questionnaire that contained the Knowledge, Comfort, Approaches, and Attitudes towards Sexuality Scale (KCAASS) and sexuality-related practice questions. Participants were recruited from Australia, New Zealand, the United States, Canada, United Kingdom, Ireland, Singapore, and South Africa. Multiple regression was used to explore KCAASS scores and sexuality-related practices.

Results: A total of 958 multi-disciplinary, stroke rehabilitation professionals participated in the study. Only 23% (n=216) of health professionals' reported directly initiating sexuality discussions with stroke survivors. On regression analysis, professionals' practices, perception of their role in sexuality rehabilitation, sexuality training, education, age and sex predicted their knowledge of sexuality after stroke (r=0.44; p<0.001). Sexuality training, religious affiliation and provision of sexuality-rehabilitation services predicted comfort (r=0.21; p<0.001). Professionals' age and provision of sexuality-rehabilitation services predicted approach-related comfort (r=0.2; p<0.001). Professionals' perception of health professionals' role in sexuality rehabilitation, religious affiliation and geographical location predicted professionals' attitudes toward sexuality (r=0.11; p<0.001). Open-ended responses indicated that participants perceived a need to improve their competency in providing sexuality rehabilitation. The timing of training predicted knowledge (t=3.99; p<0.001), comfort (t=3.47; p<0.001) and the provision of sexuality-rehabilitation services (t=3.68; p<0.001).

Conclusion: Findings confirm that sexuality is neglected in stroke rehabilitation and point to the need for a considered approach to the timing and nature of education.