Sexuality, sexual health and older people: A systematic review of research on the knowledge and attitudes of health professionals

Physiotherapists' attitudes, practice and barriers to sexual issues among stroke survivors in South-East Nigeria

BACKGROUND

Sexual issues post-stroke are common and can include difficulties related to arousal, orgasm, and decreased sexual desire, and satisfaction.

AIM

To determine the attitudes, practices, and barriers experienced by physiotherapists in addressing sexual issues among stroke survivors.

METHODS

This cross-sectional survey involved 72 practicing physiotherapists purposively recruited from selected tertiary hospitals in southeast Nigeria. Modified Physiotherapists' Attitudes on sexual issues, Physiotherapists' Performance Questionnaire in dealing with sexual issues, and Barriers to Discussing Sexual Issues Questionnaires were used to collect data that were analyzed using Statistical Package for Social Science (SPSS).

RESULTS

The results showed a significant association (p < 0.05) between the attitude and practice of physiotherapists in dealing with sexual issues of stroke survivors. Although most of the physiotherapists expressed confidence in their understanding of the need to address sexual issues of stroke survivors, only a quarter of them often or always assessed the patients' sexual function as well as included therapy for erectile dysfunction in their plan of care for stroke survivors. Patients' discomfort (88.9%) and insufficient knowledge and training (70.8%) were the most reported barriers. The majority (95.8%) indicated the need for a training program on the sexual issues, despite their area of specialization.

CONCLUSION

Although the studied physiotherapists understand the need to address these issues, the practical application remains limited due to varying barriers. There is a need for structured training programs focused on sexual health to bridge the gap between knowledge and practice, thereby enhancing the overall care and quality of life for stroke survivors.

Geographic Patterns of Human Immunodeficiency Virus (HIV) Risk Behaviors Among Older Adults: A Strategy for Identifying Space as a Risk Exposure

OBJECTIVES

This study examined geographical patterns of HIV risk among adults aged 60 and older.

METHODS

The 2019 Behavioral Risk Factor Surveillance System (BRFSS) weighted data was used to analyze self-reported participation in HIV risk behaviors among older adults (n = 62,852). Logistic regression models were used on a dichotomous HIV risk variable to map the distribution of HIV risk behaviors across both census regions and divisions.

RESULTS

The weighted model revealed significance across regions. Across all regions, identifying as female, identifying as Hispanic, and reporting not having depression were protective from participating in HIV risk behaviors.

DISCUSSION

The geographic heterogeneity in patterns of high-risk behaviors among older adults are discussed, along with the implications of partner access (marital status) and emotional health (depression) that need further examination. Recommendations for additional geographic analysis are made.

"It doesn't Always Have to Be an Expert": Professionals' Perceptions of Practical Aspects of the Existential Dimension of Care for People Approaching Death

'Existential' can be seen as a broad term for issues surrounding people's experiences and way of thinking about life. This study examined availability of existential care and found that many different staff categories performed existential care. Existential care is associated with conversations and experienced as both easy and difficult; several factors were cited, e.g. insufficient time, stress and the difficulty of addressing existential questions for oneself. Respondents reported need for education, guidance and reflection around existential issues and care. Existential care is described as a natural part of patient care that all professional categories have a responsibility to offer.

Older patients want to talk about sexual health in Australian primary care

Background Maintaining sexual health and function is important to many older adults. Although older patients are regular users of primary care, opportunities to address sexual health concerns are missed. Building on interview studies, this research aimed to collect a larger number of older adults' perspectives to deepen understanding of sexual healthcare needs and formulate recommendations for the Australian primary care context. Methods As part of the SHAPE2 Survey of older adults' sexual health information-seeking behaviours, participants (aged ≥60years and living in Australia) were asked what sexual health issues were most important to them, and the barriers they experienced in managing their sexual health. Data were collected in 2021 in the form of free-text comments. The sub-set of comments that related to healthcare experiences were analysed using qualitative content analysis. Results Out of 1470 survey participants, 864 responded to the relevant questions, and of these 107 wrote about healthcare experiences. Some comments described positive experiences seeking sexual health care; however, the majority outlined barriers to accessing support. Barriers were categorised into seven categories: patient embarrassment, barriers to rapport, uncertainty about finding solutions, ageism, barriers unique to minorities, needing general practitioners to initiate conversations and structural barriers. Conclusions Older patients want general practitioners to initiate sexual health conversations as part of routine care, and, crucially, sexual issues raised by the patient should be legitimised and treated with due attention. Although challenges, such as time, embarrassment and pressing health concerns, may hamper sexual health discussions, it is important that this area of holistic care is given more attention.

Sexual Expression in Long-Term Care Institutions: Are We Ready for the Baby Boomer Generation?

Baby boomers were at the forefront of profound social changes in sexual attitudes and many have expressed a desire to remain sexually active throughout their life course. The purpose of this survey study was to assess the perceived preparedness of Ontario's long-term care (LTC) homes to meet the changing sexuality needs and expectations of LTC residents. We examined sexuality-related attitudes, including in the context of dementia, among 150 LTC administrators. Participants also completed a questionnaire assessing their experiences and perceptions regarding existing and anticipated supports, barriers, and priorities. Most participants demonstrated positive sexual attitudes; however, multiple challenges to meeting residents' sexuality needs were noted, including assessing capacity to consent, limited privacy, staff training, conflicting attitudes, and a lack of adequate policy and guidelines. Challenges are broad and significant and considerable attention is required to meet the expectations of the next generation of LTC residents, including gender and sexual minority elders.

Including personal boundaries scale: development and psychometric properties of a measurement for nurses' self-efficacy toward intimate and sexual behavior in dementia care

Background

Person-centered nursing home care recognizes the intimate and sexual needs of residents with dementia but lacks guidance for nurses to address them while effectively respecting their personal boundaries. The Including Personal Boundaries (IPB) scale was developed to complement clinical and scientific efforts to support both nurse and resident wellbeing.

Methods

Through a co-creative process, theoretical principles, day-to-day experiences, and expert knowledge were integrated into an initial nineteen-item version of the IPB scale. The pilot sample comprised 297 Dutch (vocational) nurses in dementia nursing care.

Results

After Principal Component Analysis, nine items with strong factor loadings (>0.6) were retained. Internal reliability measures supported the item selection, such as high internal consistency (α = 0.866) and adequate corrected item-total correlations (0.532-0.781).

Conclusion

The presented IPB scale, a nine-item scale, is a short, robust measure to assess nurses' self-efficacy in their capabilities to include personal boundaries (physical and emotional) when confronted with the intimate and sexual behaviors of residents with dementia. Further validation is recommended. The IPB scale could provide valuable insights for research, clinical practice, and education.

The barriers and enablers to accessing sexual health and sexual well-being services for midlife women (aged 40-65 years) in high-income countries: A mixed-methods systematic review

Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives, when hormonal and physical changes are often accompanied by psychological and social evolution. Access to sexual health and sexual well-being (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high-income countries. A systematic review of the enablers and barriers to women (including trans-gender and non-binary people) aged 40-65 years accessing SHSW services in high-income countries was undertaken. Four databases (PubMed, PsycINFO, Web of Science and Google Scholar) were searched for peer-reviewed publications. Findings were thematically extracted and reported in a narrative synthesis. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their healthcare professionals (HCPs), and the over-arching effect of stigma, social connections and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities and financial incentives to access services for under-served groups. Efforts are needed to enhance education about SHSW and related services among midlife women and their healthcare providers. This increased education should be leveraged to improve research, public health messaging, interventions, policy development and access to comprehensive services, especially for midlife women from underserved groups.

Effectiveness of a Sexual Health Care Training to Enhance Psychiatric Nurses' Knowledge, Attitude, and Self-Efficacy: A Quasi-Experimental Study in Southern Taiwan

BACKGROUND

Sexual health is a taboo issue in some societies. Limited assessments were conducted during nursing care in mental health services. It is unknown whether psychiatric nurses' competencies would be enhanced through short training courses.

AIMS

The present study employed a quasi-experimental design to evaluate the effectiveness of an 8-hour sexual health care training for psychiatric nurses to improve sexual health knowledge, attitude, and self-efficacy in a teaching psychiatric hospital in southern Taiwan.

METHOD

Volunteered psychiatric nurses were randomly assigned to the experimental or control group. The 8-hour training program contained sexual health knowledge and attitudes, case discussion, role play, and sexual identity or harassment issues. Each nurse received a pretest and a posttest in the 1-month period between August and September 2019. Descriptive and multivariate statistical analyses were used to evaluate the effects.

RESULTS

Among the 75 psychiatric nurses, 43 were in the control group and 32 were in the experimental group. The two groups were not significantly different in the working year, gender, education, marriage, and other psychosocial variables. After the training, the overall performance of sexual health care knowledge, attitudes, and self-efficacy of the experimental group improved significantly than the controls.

CONCLUSIONS

The sexual health care training program enhanced psychiatric nurses' confidence and generally improved their sexual knowledge and attitudes. It is suggested that sexual health care needs to be highlighted during in-job training to augment the well-being and life quality of psychiatric patients.

Analysis of Inclusive Gender, Sexuality and Sexual Orientation Data Elements in Academic Electronic Health Records

Findings from an analysis of three vended academic electronic health records used in health science education are presented in this article. The quality assurance project examined the lexical and semantic fit and content coverage of gender, sexuality, and sexual orientation data elements within the academic electronic health records. A semantic comparative content analysis using a cognitive walkthrough was conducted as a means of comparing the ideal set of gender, sexuality, and sexual orientation data elements with those found in the three vended academic electronic health records. The results indicated a need for alignment to the research literature, expert consensus, and technical standards similar to what is expected for electronic health records used in clinical practice because of a lack of ideal state data elements. The findings align with ongoing issues with bias and disparities seen in the care of the lesbian, gay, bisexual, and transgender population and a lack of diverse, inclusive media and teaching technologies in health science education. The quality project and findings can inform academic electronic health record vendors on how they can create more inclusive systems and bring awareness to healthcare educators about the potential for implicit and explicit bias in their teaching technologies.

Promoting sexual health in older adults: Findings from two rapid reviews

BACKGROUND

Sexual health throughout the life course is increasingly recognised as important to maintaining one's overall health, wellbeing, and relationships. We aimed to provide an overview of the evidence on sexual health needs and sexual health promotion in later life.

METHODS

We undertook two rapid reviews, drawing on systematic review evidence. Searches were conducted in Epistemonikos. Studies were eligible if they reported evidence about the sexual health needs of, or sexual health promotion interventions for, people aged 50+ years. Evidence was quality assessed and summarised in a narrative synthesis.

RESULTS

Fifteen systematic reviews were included in Review 1 (sexual health needs) and 12 in Review 2 (interventions). Key concerns and needs of older adults included the impacts of cultural stigma/misperceptions, barriers to sexual expression, and a need for tailored support in a welcoming environment. Key concerns and needs of health and social care professionals included mixed attitudes towards and knowledge of later-life sexuality and a need for more training and education. Approaches to promoting sexual health in later life included training and workshops for care home professionals, education for older people at risk of/living with HIV, and interventions to address sexual health-related symptoms of menopause. Gaps in the evidence from current reviews and methodological issues in primary studies were identified.

CONCLUSION

Older people have specific needs relating to their sexual health. Health and social care professionals working with older people may benefit from education/training around sexuality in later life. Evidence on effective interventions and strategies is limited.

Trends and projections in sexually transmitted infections in people aged 45 years and older in England: analysis of national surveillance data

AIMS

We describe the epidemiology of sexually transmitted infections (STIs) and HIV in people aged ⩾45 years in England and provide future projections about the burden of STIs in this age group.

METHODS

Analysis of national surveillance data in England from 2014 to 2019 for chlamydia, gonorrhoea, herpes, syphilis, anogenital warts and HIV was carried out. Time trends were assessed by the Poisson regression and reported using incidence rate ratios (IRRs). Two scenarios were modelled to predict the number of new STI diagnoses and associated costs in 2040.

RESULTS

In 2019, there were 37,692 new STI diagnoses in people ⩾45 years in England. Between 2014 and 2019, there was a significant increase in the rate of new STI diagnoses in men (IRR = 1.05, p = .05) and those aged 45-64 years (IRR = 1.04, p = .05). Absolute numbers of new STI diagnoses in men who have sex with men increased by 76% between 2014 and 2019 (IRR = 1.15, p < .001). In adults aged ⩾50 years, the number of episodes of care for HIV increased over time (age = 50-64 years, IRR = 1.10; age = 65+ years, IRR = 1.13; p <.001). The modelled scenarios predicted an increase in STI diagnoses and costs in older people by 2040.

CONCLUSION

STI rates in England are increasing in people aged ⩾45 years. The population is ageing and older people will contribute an increasing burden to STI costs if this trend continues. The reasons for this trend are not fully understood and further longitudinal epidemiological research is needed. Sexual health promotion campaigns and healthcare interventions targeted at older people should be prioritised.

The impact of rurality on vulvodynia diagnosis and management: Primary care provider and patient perspectives

Objective

The objective of this study was to better understand how rurality impacts the knowledge, diagnosis and management of vulvodynia by primary care providers (PCPs) practising in the geographically disparate province of Newfoundland and Labrador, Canada.

Design

This was a qualitative case study using questionnaires and semi-structured interviews with PCPs, compared with semi-structured focus groups and interviews with vulvodynia patients conducted in a previous study phase.

Results

Ten family physicians and 6 nurse practitioners participated. Over half had baseline knowledge that vulvodynia has a relatively high prevalence, but most underestimated the likelihood they would see a patient with vulvodynia in their practice. Three barriers to discussing and managing vulvodynia emerged: (1) discomfort initiating sexual/vulvar health conversations; (2) concerns about protecting patient privacy and confidentiality; and (3) time constraints and building therapeutic relationships. These issues were largely corroborated by previous findings with vulvodynia patients. Rural-informed solutions might include: (1) supporting increased education in vulvodynia and sexual health more broadly, including funding to attend continuing professional education and developing more clinical tools; (2) following practice guidelines regarding standardised initiation of sexual health conversations; (3) incentivising retention of rural providers and extending appointment times by reconsidering fee-for-service structures; and (4) researching a tailored vulvodynia toolkit and the potential advantage of mobile health units.

Conclusion

Rurality exacerbates common concerns in the identification and management of vulvodynia. Acting on recommended solutions may address the impact of rurality on the provision of timely care for those experiencing vulvodynia and other sexual health concerns.

Mediating effects of ageism and knowledge on the relationship between contact with older adults and attitudes toward older adults' sexuality among nursing students

BACKGROUND

Healthcare professionals often ignore sexuality in aging and avoid discussing related topics, especially in China. Nursing students, as future professionals, can address the sexuality of older adults encountered in clinical practice by establishing positive attitudes toward aging sexuality. Previous studies have demonstrated that contact has positive impacts on nursing students' attitudes toward aging sexuality. However, little is known about the mechanism underlying this relationship between contact and attitudes.

OBJECTIVES

To explore the mediating effects of ageism and knowledge on the relationship between contact and nursing students' attitudes toward aging sexuality.

DESIGN

This was a cross-sectional study.

SETTINGS

The study was conducted at a nursing school in Hefei city, China.

PARTICIPANTS AND METHODS

614 nursing students completed online-administered questionnaires measuring the level of contact with older adults, ageism, knowledge, and attitudes toward aging sexuality. Data were analyzed using SPSS and AMOS.

RESULTS

The mean scores for knowledge and attitudes toward aging sexuality were 85.70 (SD = 16.39) and 104.91 (SD = 14.88), respectively. Overall, our findings confirmed that these hypotheses were accepted. Ageism (β = -0.079, P = 0.007) and knowledge (β = -0.070, P < 0.001) mediated the relationship between contact and attitude.

CONCLUSION

Given the mediating role of ageism and knowledge in the relationship between contact and attitude, reducing ageism and enhancing knowledge are vital to changing students' attitudes, including integrating ageism and aging sexuality knowledge learning into the nursing curriculum and creating opportunities for contact with older adults. The frequency and quality of contact between nursing students and older adults can be improved by rationalizing the internship duration, tasks, and assessment objectives of placements on geriatric wards and by the role of clinical faculty role models in cultivating positive attitudes toward aging sexuality.

Do Sexual Expectations Matter for Older Men and Women? Anticipated Sexual Futures and Late-Life Sexuality Over Two Decades

BACKGROUND AND OBJECTIVES

Expectations across a variety of life domains appear to shape the aging process, giving weight to the role of self-fulfilling prophecies in later life. Sexuality is one area where the power of expectations is not well-understood. We investigated whether 10-year sexual expectations were associated with sexual satisfaction and sexual frequency a decade on among older heterosexual coupled adults. We further examined whether sexual expectations could offset the sex-constraining impact of functional limitation onset.

RESEARCH DESIGN AND METHODS

We used 3 waves of the Midlife Development in the United States study (1995, 2005, 2014), a nationally representative panel survey. Analyses consider adults aged 45+ in 1995 who had a spouse or romantic partner at 2 consecutive waves. Associations between sexual expectations and eventual sexual satisfaction and frequency were estimated with multivariable generalized estimating equations. Moderation analyses examined whether between-wave onset of functional limitations had less influence on sexuality outcomes when combined with a high initial level of sexual expectations.

RESULTS

Sexually optimistic participants reported more sexual satisfaction and higher sexual frequency a decade later. Though the onset of functional limitations tended to suppress sexual frequency for women, the probability of having weekly sex was significantly higher among such women if they had high rather than low sexual expectations.

DISCUSSION AND IMPLICATIONS

Results suggest that, similar to other life domains, expectations shape the sexual experience of older adults. Clinicians and care providers may consider ways to help foster realistic optimism about sexuality among older men and women.

Sexuality, quality of life and psychological well-being in older adults: A correlational study

Objective

This study aimed at analyzing the relationship between general health status, quality of life, and sexual life among older adults.

Study design

This descriptive-correlational design study was conducted with the participation of 323 (169 female and 154 male) older people at the age of 65 + . The participants were clients of the outpatient services in a general hospital in Istanbul. Data were collected with the General Health Questionnaire, Arizona Sexual Experiences Scale, and Quality of Life Scale.

Results

Psychological well-being had no association with sexuality scores whereas quality of life had a significant association. Older people with better quality of life had less sexual dysfunctionality. Participants who were up the 75 years old, who have lower education, lower economic status, unemployed, having chronic diseases seemed to experience higher ASEX scores, meaning that higher sexual dysfunction, lower GHQ scores and lower quality of life level.

Conclusions

Sexuality in older people changes over time and continues to hold its importance. Less sexual dysfunction seemed to relate with higher quality of life in older people. Researchers should consider the importance of the quality of life on sexual satisfaction in older people.

Feasibility and acceptability of an education and training e-resource to support the sexuality, intimacy and relationship needs of older care home residents: a mixed methods study

BACKGROUND

sexuality, intimacy and relationship needs are often a neglected aspect of the care of older adults in residential care facilities. Improving awareness, knowledge and improving attitudes about these needs among care staff could enhance quality of care and lead to better outcomes for residents.

OBJECTIVE

to evaluate the feasibility and acceptability of a co-designed education and training e-resource to help care staff support their residents' sexuality, intimacy and relationship needs.

METHODS

we delivered the education and training e-resource to five UK care homes over a 6-month period in a pre-post mixed methods study using surveys, focus groups and individual interviews.

RESULTS

fifty-nine members of staff from participating care homes undertook the education and training e-resource. 18/59 (31%) of participants completed all six modules and the pre-post surveys. Eleven participants participated in focus groups/interviews to explore experiences of using the e-resource. The e-resource was successfully implemented in the study homes and found to be acceptable. We found preliminary evidence of positive changes in staff attitudes. Factors that facilitated implementation included support from the care home manager. Barriers identified included IT infrastructure and technology.

CONCLUSIONS

the findings provide initial evidence that a co-designed education and training e-resource raised awareness of, and improved attitudes towards, older adults' sexuality and intimacy needs. This work provides the foundation for a next phase to establish the effectiveness of the e-resource on staff practice and resident outcomes.

Survey on the experiences, attitudes, and training needs of Australian healthcare professionals related to sexuality and service delivery in individuals with acquired brain injury

Following acquired brain injury (ABI), sexuality, self-esteem and practices are often negatively impacted. Whilst sexuality is recognized as an essential part of a person's life regardless of medical condition, it is poorly understood in the ABI rehabilitation context. This study examined current assessment and treatment practices for sexual health and wellbeing in ABI rehabilitation, including perceived barriers and facilitators to discussing sexuality with individuals after ABI. We also assessed the need for further education and training in this area. Two hundred and thirty-nine Australian healthcare professionals predominantly working with both traumatic brain injury (TBI) and stroke populations completed an online survey comprising thirty-four questions. The 12-item sexuality attitudes and beliefs survey (SABS) was included as an additional objective outcome measure. Findings suggest that healthcare professionals infrequently raise sexuality with individuals with ABI. Inadequate education and training, not knowing whose role it is and when to raise the topic, and the view that individuals with ABI will ask for the information were all identified as key barriers contributing to poor sexuality management after ABI. More education and training opportunities with greater access to resources are needed to facilitate the incorporation of sexuality into routine practice across the continuum of ABI care.

Aging, sexual intimacy, and challenges in contemporary India: A qualitative study

An individual's life is shaped by age norms practiced in a particular society. In most societies, there is a deadline for every life event. Sexual intimacy is an essential part of every individual. However, sexual intimacy seems appropriate for young individuals, and middle-aged and older are considered asexual. Those who share sexual intimacy at a later age have to face the consequences for this age-inappropriate behavior in society. This study analyses "Badhaai Ho" film to explore the consequences of sharing sexual intimacy by middle-aged heterosexual couples in their 50s as it is forbidden by prevalent social norms. This study also explores the role of family in dealing with the repercussions of actions against the prescribed social norms. Thematic analysis suggests that society has a predefined age-bound box for individuals with different age categories. The middle-aged couple suffers various consequences for breaking the prescribed age-bound box. The role of the family is found to be crucial in mending the box by replacing it with an updated version. There are also gender differences in attitude toward sexual intimacy. Implications of this study can be utilized to explore the pathway of social change in existing social (age) norms in any society.

Competence and Attitude of Family Physicians towards Sexuality Regarding Their Sexual Orientation, Age, or Having a Partner-Survey Study and Validation

BACKGROUND

The main objective of this study was to assess different aspects of family physicians (sex, age, sexual orientation, or having a partner) regarding their competencies, attitudes, and procedures towards their patients' sexuality. We also sought to develop a valid questionnaire to perform this task.

METHODS

A cross-sectional study was performed among family and community medicine physicians in southeast Spain.

RESULTS

A total of 259 family physicians participated. Overall, 69.9% were women, 80.7% were heterosexual, 80.7% had a partner, and 50.6% had not received specific sexology training. Homosexual physicians showed a slightly more positive attitude toward sexuality. Training in sexuality established differences in competencies and procedures, but no differences were found in the attitude regarding whether the physicians had a partner or their training. While younger ages were correlated with a more positive attitude, the global score was positively correlated with the age of the professionals.

CONCLUSIONS

Competences, attitudes, and knowledge of procedures do not depend on whether the professional has a partner, but there may be slight differences regarding attitude when considering the sexual orientation of the physicians. The attitude toward sexuality may not depend on previous training. Albeit younger family physicians have a more positive attitude, all providers become more involved with sexuality as they gain professional experience.

Discomfort in Discussing Sexual Issues: Developing a New Scale for Staff at Long-Term Care Facilities for Older Adults

Interviews reveal that many health professionals working with older adults are uncomfortable discussing sexual issues with those under their care. Nevertheless, to date, discomfort in discussing sexual issues with older adults has not been empirically investigated. To facilitate exploration of this subject, the current study evaluated the psychometric properties of a new measure: The Discomfort in Discussing Sexual Issues (DDSI) with Older Adults scale. The study was conducted via online survey among 127 long-term care staff (e.g., nurses, physicians, physical therapists, social workers, speech therapists, occupational therapists) serving older adults. A confirmatory factor analysis confirmed the DDSI scale's structure as a single, four-item construct. More conservative attitudes regarding sexuality in later life were associated with higher DDSI scores. In addition, DDSI scale scores were negatively correlated with knowledge about sexuality in later life and educational level. Findings indicate that the DDSI has good psychometric properties, as reflected by its high reliability and adequate validity, making it a useful assessment tool for future research. [Journal of Gerontological Nursing, 48(9), 27-37.].

Psychometric Properties of the Danish Version of the Questionnaire Professionals’ Attitudes towards Addressing Sexual Health (PA-SH-D)

Background

Health professionals’ attitudes towards addressing sexual health are important to promote patients’ sexual health. Therefore, measurement of health professionals’ attitudes towards addressing sexual health is essential.

Aim

This study aimed to adapt the questionnaire Students’ Attitudes towards Addressing Sexual Health (SA-SH-D) to health professionals working with rehabilitation in Danish municipalities and evaluated psychometric properties of the adapted questionnaire: The Danish Version of the Professionals’ Attitudes towards Addressing Sexual Health (PA-SH-D).

Methods

The SA-SH-D was adapted to PA-SH-D and a face validity evaluation focusing on phrasing, functionality, perception and relevance was done. In a pilot study, the PA-SH-D was answered by health professionals and internal consistency reliability and floor and ceiling effects were evaluated.

Outcomes

Face validity included phrasing, functionality, perception and relevance of the items in PA-SH-D, internal consistency with Cronbach's alpha in the total scale and floor and ceiling effects.

Results

Face validity of the PA-SH-D was acceptable. The sample size was 52 health professionals working with rehabilitation, the internal consistency reliability (Cronbach's alpha: 0.89 [lower confidence interval {CI}: 0.85]) and floor and ceiling effects (0.0%–13.7%) of the PA-SH-D were acceptable.

Clinical translation

As sexual health is important in human quality of life, the validation of the PA-SH-D is highly valuable as it evaluates health professionals’ attitudes towards addressing sexual health, and thereby is able to measure the need for education and training in sexual health and detect changes in attitudes following an educational intervention.

Strengths and limitations

Strengths were that the PA-SH-D measures both attitudes and competences and covered a need in clinical practice. The recruitment was broad and we used the work of others to orient this work. Limitations were that this study covered a preliminary psychometric evaluation and a thorough evaluation covering other aspects of psychometry should be done. We used both paper-based and online-based survey which possibly could cause bias. The study had a relatively small sample size. Comparing health professionals to students can be seen as both a limitation and a strength.

Conclusion

The results in face validity and internal consistency reliability indicate usefulness of the PA-SH-D to measure health professionals’ attitudes towards addressing sexual health. Further evaluation of psychometric properties of the PA-SH-D is recommended.

Elnegaard CM, Christensen J, Thuesen J, et al. Psychometric Properties of the Danish Version of the Questionnaire Professionals’ Attitudes towards Addressing Sexual Health (PA-SH-D). Sex Med 2022;10:100527.

Care Staff's Sense-making of Intimate and Sexual Expressions of People with Dementia in Dutch Nursing Homes

OBJECTIVES

The Person-centered Care (PCC) philosophy emphasizes close care relationships to enable care professionals to recognize the needs of nursing home residents with dementia. This study explored how care professionals make sense of resident behavior with regard to intimacy and sexuality.

METHODS

26 nursing home care professionals (15 Nurses, 9 Health Care Professionals and 2 Managers) completed in-depth interviews that were subjected to an Interpretative Phenomenological Analysis (IPA).

RESULTS

Three thematic layers were identified. 1. Care Professionals pursue a "true" understanding of intimate and sexual behavior that underpins a resident's expression. 2. When care professionals feel the need to protect themselves, they can reframe a specific care relation in order to continue care. 3. The social context around the resident, from family to professionals (i.e. peers), influences interpretation of behavior and, consequently, the provision of care.

CONCLUSIONS

Intimate and sexual expressions of residents can put care relations under pressure. Care relations that lack professional distance may compromise care professionals' judgments, impede their natural boundaries and decrease their well-being.

CLINICAL IMPLICATIONS

Along with implementing PCC principles, organizations should empower staff to develop, discuss and include self-reflection skills and personal boundaries within their work.

Perspectives on sexual history taking in routine primary care consultations in North West, South Africa: Disconnect between patients and doctors

Background: Sexual history is rarely taken in routine consultations and research reported on common barriers that doctors experience, such as gender, age and cultural differences. This article focuses on how patients and doctors view sexual history taking during a consultation and their perspectives on barriers to and facilitators of sexual history taking.Aim: This study aimed to explore doctors’ and patients’ perspectives on sexual history taking during routine primary care consultations with patients at risk of sexual dysfunction.Setting: The research was conducted in primary care facilities in the Dr Kenneth Kaunda Health District, North West province.Methods: This was part of grounded theory research, involving 151 adult patients living with hypertension and diabetes and 21 doctors they consulted. Following recording of routine consultations, open-ended questions on the demographic questionnaire and brief interactions with patients and doctors were documented and analysed using open inductive coding. The code matrix and relations browsers in MaxQDA software were used.Results: There was a disconnect between patients and doctors regarding their expectations on initiating the discussion on sexual challenges and relational and clinical priorities in the consultation. Patients wanted a doctor who listens. Doctors wanted patients to tell them about sexual dysfunction. Other minor barriers included gender, age and cultural differences and time constraints.Conclusion: A disconnect between patients and doctors caused by the doctors’ perceived clinical priorities and screening expectations inhibited sexual history taking in a routine consultation in primary care.

Knowledge attitudes and readiness of nursing students in assessing peoples' sexual health problems

BACKGROUND

Sexual health is an important part of human physical health. Sexual wellbeing is a condition of physical, emotional, mental, and social ease concerning sexuality. Therefore, all health care professionals should respect, protect, and fulfil the sexual-health needs of a person.

PURPOSE

This research aims to assess the knowledge, attitudes, and readiness of nursing students in assessing people's sexuality.

METHODOLOGY

Cross-sectional descriptive research design was used to conduct this research. A stratified random sampling technique was used to recruit 195 nursing students from BSN (semester VI & VIII), Post RN (semester II & IV). Three self-administered tools Sexually Transmitted Diseases Knowledge Questionnaire (STD-KQ), Self-Addressing Sexual-Health (SA-SH), and Self-Addressing Sexual-Health History Taking was used to collect data from the participants. Data analysis was conducted on SPSS V-23.

RESULT

Majority (111, 56.9%) of participants belong to the public sector as compared to the private. The majority of the students were female (n = 117, 60%). Most (153, 78.5%) of the participants were interested in people's sexual-health history taking; they had positive attitudes toward people's sexuality. Most (139, 71.3%) of the study participants were comfortable and ready to some extent to deal with sexual health issues. Religion, culture, and people's opposite-gender were identified barriers in assessing people's sexuality.

CONCLUSION

This study identified that nursing students had insufficient knowledge regarding STDs, but they had positive attitudes toward addressing peoples' sexual-health concerns. Students are comfortable and ready to some extent to deal with sexual problems.

Assessment of the psychometrics of the Students' Attitudes towards Addressing Sexual Health Extended (SA-SH-Ext) questionnaire for social educator students

Background

Social educators have an important role in promoting and rehabilitating sexual health as they provide information, discuss, and support sexual health in daily life for persons living with impairments, intellectual disabilities, and complex needs.

Aim

The study aimed to assess the psychometrics of the Students´ Attitudes towards addressing Sexual Health Extended (SA-SH-Ext) questionnaire for social educator students.

Methods

A sample of 213 Norwegian social educator students was used to test internal consistency reliability and construct validity with explorative factor analysis.

Outcomes

Internal consistency reliability showed a Cronbach's alpha of 0.906 and construct validity measured with explorative factor analysis showed good results with the Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) being high (0.929) and Bartlett´s test of sphericity being significant (P = .000).

Results

The SA-SH-Ext is reliable and valid for social educator students, however the psychometric assessment revealed that the domains of the SA-SH-Ext should be revised compared to the original SA-SH questionnaire.

Clinical implications

Measuring the effectiveness of sexual health education interventions is important and to have a valid and reliable questionnaire to assess future professionals’ attitudes towards addressing sexual health increases the ability to target specific client needs or knowledge gaps, such as addressing sexual health for persons with intellectual disabilities.

Strengths

and limitations: In comparison with previous studies of the original SA-SH, SA-SH-Ext has high reliability and validity. The current study was performed with classical test theory. Performing Rasch analysis may detect other psychometric issues, by improving precision and thereby providing a deeper understanding of both how to optimise a questionnaire and understand the results of a used questionnaire. Despite the response rate of 34%, the results are seen as valid considering the low correlation between response rate and validity and that the sample size was sufficient for the chosen psychometric tests.

Conclusion

The SA-SH-Ext is a valuable questionnaire for assessing the level of perceived preparedness among social educator students in addressing sexual health, a field often neglected in health and care.

Lunde GH, Blaalid L, Gerbild H, et al. Assessment of the psychometrics of the Students' Attitudes towards Addressing Sexual Health Extended (SA-SH-Ext) questionnaire for social educator students. Sex Med 2022;10:100507.

Sexual expression involving people with dementia living in long-term care facilities: staff's reactions

This study aims to explore and compare the reaction of long-term care staff towards situations of sexual intercourse in which one or both partners have dementia. Participants were 538 staff members at 28 Portuguese long-term care facilities. Data were collected using a printed questionnaire with seven vignettes with situations related to the sexuality of LTCF residents. In this study, three of these vignettes were analysed with situations in which residents were having relationships in their bedrooms: (1) one male resident and one female resident; (2) two residents with dementia; (3) two residents, one of them with dementia. For each of the vignettes, participants are asked what they think their 'colleagues' would do in each vignette, i.e. 'What do you think most of your colleagues would do?' The results revealed that when sexual relationships involved both partners living with dementia, the most selected reaction was 'Comment on what happened with supervision or direction', which may suggest that the situation was perceived as difficult or problematic. The most restrictive reactions were most often chosen when only one partner had dementia. This study suggests the need to improve and provide training, so that staff have knowledge and strategies that allow people living with dementia to preserve their sexual rights in long-term care facilities.

Sexual Activity and Physical Tenderness in Older Adults: Prevalence and Associated Characteristics From a Belgian Study

BACKGROUND

Despite the World Health Organization calling for sexuality to be recognized as an aspect of well-being, no studies have explored sexual activity and physical tenderness in older adults aged ≥ 75 years in Belgium or those aged ≥ 85 years worldwide.

AIM

To assess the prevalence and predictors of sexual activity and physical tenderness in a sample of older adults.

METHODS

Using data from a Belgian cross-sectional study on sexual violence (UN-MENAMAIS), information on sexual activity, physical tenderness, and associated characteristics was collected during structured face-to-face interviews with older adults living in the community, assisted living facilities, or nursing homes. Cluster random probability sampling with a random route-finding approach was used to select the participants.

OUTCOMES

Current sexual activity and physical tenderness in the previous 12 months, sociodemographic characteristics, chronological age, subjective age, number of sexual partners, sexual satisfaction, attitudes toward sexuality in later life, quality of life, and lifetime sexual victimisation.

RESULTS

Among the 511 participants included, 50.3% were in a relationship, mainly living with their partner; 31.3% indicated they were sexually active; and 47.3% of sexually inactive participants reported having experienced forms of physical tenderness in the previous 12 months. Sexual activity was associated with the presence of a partner, satisfaction with sexual life, permissive attitudes regarding sexuality in later life, a younger age, and a lack of disability. Physical tenderness was associated with the presence of a partner, community residency, and permissive attitudes regarding sexuality in later life.

CLINICAL IMPLICATIONS

Raising awareness among the general population, healthcare professionals, and older adults about sexuality in later life could contribute to ending this taboo and should therefore be a priority for society.

STRENGTHS AND LIMITATIONS

Our study fills a gap in the literature regarding sexual activity and physical tenderness in older adults aged ≥ 70 years, including respondents aged up to 99 years. Additionally, we explored different forms of sexual expression beyond intercourse, and face-to-face interviews contributed to the quality of the collected data. The main limitation of this study was the sample size, although the findings were similar to recent statistical indicators in Belgium.

CONCLUSION

One in 3 older adults aged ≥ 70 years living in Belgium are sexually active. These findings provide an opportunity to inform the general public and older adults about later life sexuality and to educate healthcare professionals about aging sexuality to increase discussions and avoid assumptions of asexuality in later life. Cismaru-Inescu A, Hahaut B, Adam S et al. Sexual Activity and Physical Tenderness in Older Adults: Prevalence and Associated Characteristics From a Belgian Study. J Sex Med 2022;19:569-580.

Ethiopian women's sexual experiences and coping strategies for sexual problems after gynaecological cancer treatment: a qualitative study

OBJECTIVE

This study explored women's sexual experiences and coping strategies for sexual problems after gynaecological treatment.

SETTING

The research was carried out at Tikur Anbessa Specialized Hospital, one of the two cancer centre hospitals in the country.

STUDY DESIGN

A phenomenological qualitative study design was employed in this study.

STUDY PARTICIPANTS

Participants were recruited using purposeful sampling. Thirteen eligible study participants were interviewed face to face. Data were collected from 2 February to 15 March 2019 and analysed at the same time. For data analysis, thematic analysis was used, which comprises three stages: data reduction, data display and data conclusion.

RESULTS

Four themes resulted from the analysis of individual interview data, including treatment side effects, sexual issues following radiation therapy, lack of awareness regarding cancer treatment and sexual dysfunction, and coping strategies for sexual dysfunction following gynaecological cancer treatment. Three subthemes emerged as coping mechanisms for managing sexual issues and dysfunction among Ethiopian women with gynaecological cancer: avoiding sexual intercourse, praying for healing and seeking professional help. These themes were identified as the rich and detailed account of the experiences of sexually active women who have received treatment for their cervical cancer.

CONCLUSION

This study has broadened the perspectives on sexuality in the setting of gynaecological cancer and challenged certain commonly held beliefs about sexuality after treatment. Researchers should look into how inclusive sexuality education and training may be better integrated into the training programmes of healthcare workers. More research is needed to learn how partners of women with gynaecological cancer cope with sexual changes after treatment, how the couple as a partnership negotiates changes after treatment, and the facilitators and barriers that healthcare providers face when discussing sexuality issues with patients.

The characteristics and practice proficiency of nurse practitioners who care for older adults

Roughly 54 million Americans are 65 years of age or older. Given the number of comorbid diseases reported in older adults, healthcare tailored to the specific needs of this population is imperative. Nurse practitioners (NPs) are uniquely positioned to provide care to older adults; yet little is known about the geriatric-oriented NP workforce. In this study, four professional organizations distributed a survey link to their members who were queried on their demographic, employment, and practice characteristics; one organization's members responded to a previous survey, providing two time points for comparison. Compared with 2016 respondents, there was minimal growth in diversity, fewer who practice in suburban or rural areas, and restrictions on clinical education related to the ongoing pandemic. The findings from this study should alert policymakers of the need to address the development of an adequate workforce of clinicians who specialize in geriatrics.

Exploring sexual dysfunction in care homes

Sexual needs and sexuality in older adults continues to be a neglected area of clinical intervention, particularly in longer term care settings. This is often due to older adults in long term care beds presenting with increased frailty, and often with significant neurocognitive disorders, making it difficult for care staff to evaluate the capacity of an older adult resident to participate in sexual activities or a sexual relationship. Talking about sexuality, intimacy and sexual health can be embarrassing at any age and sex is often still considered taboo for people who live in care homes. The World Health Organization recently declared that sexual health is a central aspect of life and that each individual has the right to love and be loved, to receive appropriate information and treatment, and to enable intimate relationships and personal control over sexual behavior. This chapter explores sexual behaviors, and barriers to this, in later life, and focuses on the sexual behavior of care home residents with Parkinson's disease. Reasons for sexual dysfunction, potential age-related changes to sexual functioning, along with issues such as changes to body image, intimacy and hyper sexuality, are examined for people with Parkinson's disease. Recommendations for practice are given, and acknowledge that older people may still want to be sexually active or intimate is the first step to addressing the issues and overcoming any barriers.

Health care professionals and care staff challenges and experiences of managing sexual expression among older adults ≥60 years in long-term care facilities: a qualitative review and meta-synthesis

Long-term care (LTC) facilities, in which older adults are institutionalised, have the responsibility to address their residents' rights, privacy and comfort in expressing themselves sexually in an acceptable manner. However, many older adults have reported barriers in their sexual expression, which is often a result of the care staff's attitudes in the facilities. This review synthesis evidence from qualitative studies on the challenges faced by care staff when supporting sexual expression of older residents in LTC facilities. The systematic review and meta-synthesis is reported according to the Enhanced Transparency in Reporting the Synthesis of Qualitative Research Statement. A systematic literature search for peer-reviewed studies was conducted on PubMed, Cochrane Library, EMBASE, Scopus, Web of Science, PsycINFO, CINAHL and ProQuest Theses and Dissertations from inception until December 2020. Sandelowski and Barroso's two-step approach was used to synthesise the evidence. Seventeen qualitative studies published between 2004 and 2020 were included. This review encapsulated the experiences and challenges of 4,387 care staff whose age ranged from 18 to 69 years. Through the meta-synthesis, four themes were identified: varying manifestations of sexual expression and situations encountered, a spectrum of care staff's attitudes, setting boundaries in dementia care and workplace support. Managing sexual expression can be challenging for the care staff, given the complex interplay between personal beliefs, social contexts, moral dilemmas, practical barriers and the lack of clear policies. This review highlighted the need to equip them with knowledge, skills and confidence in managing sexuality in LTC facilities.

Protection against discrimination in national dementia guideline recommendations: A systematic review

BACKGROUND

National dementia guidelines provide recommendations about the most effective approaches to diagnosis and interventions. Guidelines can improve care, but some groups such as people with minority characteristics may be disadvantaged if recommended approaches are the same for everyone. It is not known if dementia guidelines address specific needs related to patient characteristics. The objectives of this review are to identify which countries have national guidelines for dementia and synthesise recommendations relating to protected characteristics, as defined in the UK Equality Act 2010: age, disability, gender identity, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation.

METHODS AND FINDINGS

We searched CINAHL, PsycINFO, and Medline databases and the Guideline International Network library from inception to March 4, 2020, for dementia guidelines in any language. We also searched, between April and September 2020, Google and the national health websites of all 196 countries in English and in each country's official languages. To be included, guidelines had to provide recommendations about dementia, which were expected to be followed by healthcare workers and be approved at a national policy level. We rated quality according to the iCAHE guideline quality checklist. We provide a narrative synthesis of recommendations identified for each protected characteristic, prioritising those from higher-quality guidelines. Forty-six guidelines from 44 countries met our criteria, of which 18 were rated as higher quality. Most guidelines (39/46; 85%) made at least one reference to protected characteristics, and we identified recommendations relating to age, disability, race (or culture, ethnicity, or language), religion, sex, and sexual orientation. Age was the most frequently referenced characteristic (31/46; 67%) followed by race (or culture, ethnicity, or language; 25/46; 54%). Recommendations included specialist investigation and support for younger people affected by dementia and consideration of culture when assessing whether someone had dementia and providing person-centred care. Guidelines recommended considering religion when providing person-centred and end-of-life care. For disability, it was recommended that healthcare workers consider intellectual disability and sensory impairment when assessing for dementia. Most recommendations related to sex recommended not using sex hormones to treat cognitive impairment in men and women. One guideline made one recommendation related to sexual orientation. The main limitation of this study is that we only included national guidelines applicable to a whole country meaning guidelines from countries with differing healthcare systems within the country may have been excluded.

CONCLUSIONS

National guidelines for dementia vary in their consideration of protected characteristics. We found that around a fifth of the world's countries have guidelines for dementia. We have identified areas of good practice that can be considered for future guidelines and suggest that all guidelines provide specific evidence-based recommendations for minority groups with examples of how to implement them. This will promote equity in the care of people affected by dementia and help to ensure that people with protected characteristics also have high-quality clinical services.

Nursing students' competence profiles in gerontological nursing-A cross-sectional study

AIM

The study aimed to describe and explain the self-assessed gerontological nursing competence levels of Finnish nursing students and factors relating to it.

DESIGN

A cross-sectional study design, reported by The Strengthening the Reporting of Observational studies in Epidemiology guidelines.

METHODS

Data were collected with the GeroNursingCom instrument, which features 53 items relating to 11 competence factors. The K-clustering technique and the Chi-squared, Kruskal-Wallis and Mann Whitney tests were used to analyse the data.

RESULTS

Seven hundred and ninety-nine nursing students from nine randomly selected higher education institutions were invited to participate in 2019. Three distinct student profiles were identified according to the data (N = 274): Profile A-lower intermediate competence (23.1% of students), Profile B-intermediate competence (45.8%) and Profile C-high competence (31.1%). The strongest competence area for all students was appreciative encounter and interaction, and the weakest was supporting the older person's sexuality. Nursing students have diverse backgrounds and their overall competence in gerontological nursing is shaped in part by their previous education, motivations and work experience.

RELEVANCE TO CLINICAL PRACTICE

Recognizing students' different gerontological nursing competence profiles enables the implementation of targeted education to improve competence in clinical practice.

Content validity and reliability of the danish version of health care students' attitudes towards addressing sexual health: a psychometric study

BACKGROUND

The Danish version of Health Care Students' Attitudes towards Addressing Sexual Health (SA-SH-D) is a questionnaire for measuring the attitudes of health care professional students' towards addressing sexual health in their future professional practice and care.

AIM

To assess content validity and reliability of the SA-SH-D.

METHOD

Following COSMIN guidelines, the study consisted of a cognitive interview study and a questionnaire study. Health care students from nursing, physiotherapy and occupational therapy programmes participated; seven were interviewed following the 'Think Aloud' method and 111 responded to two paper-based SA-SH-D administered with a two-week interval.

RESULTS

The SA-SH-D was found to be relevant, comprehensive and comprehensible. Three suboptimal wordings were identified. Floor and ceiling effects were found for six items. Cronbach's α for the total scale was 0.84 indicating good internal consistency. After a two-week interval, the percentage of agreement per item ranged from 88.2% to 100% when allowing for a one-point difference. The mean agreement percentage for the overall scale was 95.2% when allowing for a one-point difference.

CONCLUSION

The Danish version of Health Care Students Attitudes towards Addressing Sexual Health is a valid and reliable questionnaire for measuring health care professional students' attitudes towards addressing sexual health in their future professional practice and care.

Social educator students' readiness to address sexual health in their future profession

BACKGROUND

Norwegian social educator students' attitudes towards addressing sexual health are unknown, even if their future clients often have needs related to sexual issues.

PURPOSE

To investigate social educator students' readiness to address sexual health in their future profession.

METHODS

In 2019, 213 social educator students (response rate 34%) responded to the Students' Attitudes towards addressing Sexual Health Extended online questionnaire.

RESULTS

Most of the social educator students felt comfortable and ready to address sexual health in their future profession, but thought they had insufficient competence and education concerning sexual health. There were gender and age differences when discussing sexual health among persons with intellectual disabilities.

CONCLUSION

Despite most Norwegian social educator students feeling ready to address sexual health, they needed additional competences and education. Further research is needed concerning the effectiveness of educational interventions targeting competence in sexual health, to ensure sufficient support for clients in this field.

Communicating with older adults about sexual issues: How are these issues handled by physicians with and without training in human sexuality?

Although sexuality is an important part of health and emotional well-being throughout the entire life cycle, including during old age, little is known about how physicians discuss or approach the topic of sexuality during later life. The present study examined the perspectives of two groups of physicians toward discussing sexuality with older patients: 17 physicians who did not have any training in human sexuality and 21 physicians who were certified as sex therapists. The interviews underwent thematic content analysis to identify and code major themes and patterns. Qualitative analysis of the interviews yielded three main themes: (a) discourse between physicians and older adults regarding sexuality, (b) diagnosing sexual dysfunction among older adults, and (c) treating sexual dysfunction among older adults. Physicians who were not trained in sex therapy did not regularly ask their older patients about sexual functioning and/or problems with sex, tended to diagnose sexual problems from a medical perspective, and offered medication as the main treatment for sexual problems. Physicians trained as sex therapists felt more comfortable discussing sex-related issues with their older patients and diagnosed sexual problems from a medical, social, dyadic and psychological perspective. Although they offered their older patients a greater variety of medication-oriented interventions than those without training in sexuality, they did not rush into such interventions and instead emphasised the importance of the psychological and relational aspects of sex. The present study highlights the importance of human sexuality training for physicians and points out the effects of such training on the discourse, diagnosis and treatment of sexual concerns in later life.

Evaluation of an online course for prevention of unwanted sexual behaviour in residential aged care services-A pilot study

BACKGROUND

Residential aged care services (RACS) staff have substantial gaps in knowledge to prevent and manage unwanted sexual behaviour (USB) in RACS.

OBJECTIVES

This study aimed to explore the feasibility of a pilot online course (intervention) addressing USB in RACS.

METHOD

Development of a self-guided e-learning educational course was based on existing research, national and international approaches to human rights approaches to sexual assault and underwent internal and external peer review. An anonymous, online, cross-sectional survey was conducted post-intervention completion. RAC-Communiqué subscribers were recruited via an e-invitation. English speaking enrolled or registered nurses, employed in an Australian RACS, were eligible. From the 167 participants who expressed interest to enrol, 129 were eligible and 45 returned completed consent forms. Fifteen survey items regarding perceived competence and intervention satisfaction were analysed.

RESULTS

The intervention addressed content pertaining to staffs' legal and regulatory requirements, managing incidents and awareness of key services. Thirty-eight of 45 eligible participants responded (84.4%). Participants reported they would recommend the intervention to a colleague (n = 36, 97.3%). Participants self-reported (i) advanced learning post-completion; (ii) raised awareness (n = 29, 78.4%) (iii) prompted current practice reflection (n = 35, 94.6%) and (iv) prompted improving USB workplace management (n = 34, 91.9%). Results are subjected to social desirability bias.

CONCLUSIONS

The intervention was relevant, engaging and practical. The findings contribute to a more comprehensive understanding of the specific training topics relevant and useful to RACS staff.

IMPLICATION FOR PRACTICE

E-learning tools could be an effective teaching method for USB in RACS. The intervention may be a useful tool to encourage staff to reflect and change current practice.

The Elephant in the Room - A Critical Interpretive Synthesis of Older Adults' Sexuality

Objectives

This study aimed to explore past studies that have focused exclusively on the sexuality of adults older than 65 from a positive public health approach.

Methods

We performed a critical interpretive synthesis, starting with the literature review on sexual behaviors in later life, adding policy documents on aging sexuality, and bringing new perspectives.

Results

Older adults continue to be sexually active. Healthcare professionals lack knowledge and communication skills surrounding aging sexuality and no policies before 2013 mention aging sexuality.

Conclusions

We posit that society's view of later life sexuality reflects on practice, policies, and research on this topic, which influence back society's view.

Communication about physical activity to reduce vascular erectile dysfunction - A qualitative interview study among men in cardiac rehabilitation

BACKGROUND

Physical activity, a core intervention in cardiac rehabilitation, can reduce vascular erectile dysfunction (ED). ED is a common sensitive problem for men with cardiac diseases, decreasing their quality of life. Cardiac health professionals rarely provide information about ED or its relation to physical activity. Developing health professionals' communicative component of the complex intervention 'Physical Activity to reduce Vascular Erectile Dysfunction' (PAVED) is important. Understanding the receiver needs is essential in designing a complex intervention.

AIM

To elucidate men's perspectives on cardiac health professionals' communication about PAVED.

ETHICAL ISSUES

An Institutional Data Protection Agency approved the study.

METHODS

An interpretive data-driven thematic analysis was applied to individual, qualitative semi-structured interviews with 20 Danish men attending cardiac rehabilitation.

RESULTS

The men wanted health professionals' communicating about ED, as it was perceived as a major problem diminishing masculinity and tabooed by health professionals. Men wanted help for self-help, which may be possible with the aid of competent health professionals' communication about how to prevent, reduce and cope with ED - including information about PAVED. The men wanted health professionals' communication about ED in various contexts: general information in groups, sexual counselling for individuals and couples and written material.

STUDY LIMITATIONS

Recruitment was done from a Danish municipality's cardiac rehabilitation, and the transferability of the results may be limited to similar contexts.

CONCLUSION

Erectile dysfunction was experienced as a major biopsychosocial problem for the men and their partners. The men had a need for health professionals' communication about sexuality, ED and information about PAVED as well as about prevention, reduction and management of ED. The men had a need for professional communication about sexual health.

Acceptability of Health Professionals' Address of Sexuality and Erectile Dysfunction - A Qualitative Interview Study with Men in Cardiac Rehabilitation

INTRODUCTION

In the developing phase of the complex health intervention: Physical Activity to reduce Vascular Erectile Dysfunction (PAVED), it is crucial to explore whether men can accept the communicative component regarding information that regular aerobe Physical Activity can reduce Erectile Dysfunction (i-PAVED). This information is provided by health professionals (HPs) in cardiac rehabilitation, where sexuality issues such as erectile dysfunction (ED) are otherwise rarely addressed.

AIM

To explore how acceptance of cardiac HPs' address of sexuality, ED, and i-PAVED can be identified in men's narratives.

METHODS

In this descriptive qualitative study, we conducted semi-structured individual interviews with 20 men (range 48-78 years of age) attending municipal cardiac secondary prevention and rehabilitation programmes on their acceptance of HPs' address of sexuality, ED, and i-PAVED. The Theoretical Framework of Acceptability components (affective attitude, burden, ethicality, intervention coherence, perceived effectiveness, opportunity costs and self-efficacy) and three temporal perspectives (retrospective, concurrent and prospective) were used in the concept-driven first step of a content analysis, which was followed by a thematically data-driven second step.

MAIN OUTCOME MEASURES

Men anticipated and experiential acceptance was identified in six out of seven components of Theoretical Framework of Acceptability.

RESULTS

Men acceptance was identified as "expression of interest," "addressing sexuality," "attitudes and values," "understandable and meaningful," "insights" and "motivation," whereas no narratives were identified in relation to the component of opportunity costs.

CONCLUSION

As an aspect of the development of the complex cardiovascular health care intervention PAVED, this qualitative study showed that men attending cardiac secondary prevention and rehabilitation seemed to prospectively accept the communicative component of PAVED being HPs' address of sexuality, ED, and i-PAVED, if the HPs are professional, educated and competent in the field of sexual health. Gerbild H, Areskoug-Josefsson K, Larsen CM, et al. Acceptability of Health Professionals' Address of Sexuality and Erectile Dysfunction - A Qualitative Interview Study with Men in Cardiac Rehabilitation. Sex Med 2021;9:100369.

A scoping review of education and training resources supporting care home staff in facilitating residents' sexuality, intimacy and relational needs

Background

Having positive intimate, sexual and relational experiences is an important issue for older adults in care settings, yet little is known on the extent to which nursing staff and care workers have received education or training in addressing and meeting these needs among older residents. This scoping review aimed to identify and examine what education and training resources exist to assist nursing staff and care workers to meet their residents’ needs in this area.

Methods and analysis

Using the Arksey and O’Malley framework, we systematically searched papers and grey literature to identify education interventions and resources that aimed to facilitate care home staff to meet their residents’ sexuality, intimacy and relational needs.

Results

Eleven studies (one dissertation) and three education resources met the inclusion criteria; most were conducted in the USA and Australia. Across the studies and resources identified, the education content was mixed and the methodology, presentation, design and duration varied widely. The focus of the education interventions and resources was to increase knowledge and improve and/or change attitudes towards the: (i) sexual expression of older people living in residential aged care, (ii) sexuality and ageing and (iii) expression of sexuality in people with dementia.

Conclusion

Few education interventions and training resources were identified. The findings suggest that education interventions can improve knowledge and/or change care staff attitudes, in the short-term, towards older people’s sexuality, intimacy and relational needs in care home settings, which can lead to facilitating staff to enhance person-centred care in this area of need.

Danish Health Professional Students' Attitudes Toward Addressing Sexual Health: A Cross-Sectional Survey

Introduction

Danish health professional (HP) students' attitudes toward addressing sexual health are unknown.

Aim

To investigate Danish HP students' attitudes toward addressing sexual health in their future professions, and to assess differences in perceived competences and preparedness between professional programs.

Methods

A Danish national survey of nursing, occupational therapy, and physiotherapy students was conducted. Totally, 1,212 students were invited to respond to an online questionnaire “The Students' Attitudes toward Addressing Sexual Health.”

Main Outcome Measure

The main outcome measures investigated were Danish HP students' attitudes toward addressing sexual health in their future professions, and differences in perceived competences and preparedness depending on the professional program.

Results

A total of 584 students (48%; nursing 44%, occupational therapy 70%, physiotherapy 43%) responded. Mean total score ranged between 63.7 and 66.3 (±8.3–8.8) classifying students in the low-end of the class: “comfortable and prepared in some situations.” No clinically relevant differences were determined between the professional programs with respect to perceived competences and preparedness to address sexual health.

Conclusion

In the field of addressing sexual health, most Danish HP students reported positive attitudes and a need for basic knowledge, competences, communication training, and education.

H Gerbild, C M Larsen, T. Junge, B. S. Laursen, K. Areskoug-Josefsson. Danish Health Professional Students' Attitudes Toward Addressing Sexual Health: A Cross-Sectional Survey. Sex Med 2021;9:100323.

Did I learn enough to practice? Reflections of new nurse practitioner graduates in providing sexual and reproductive health care

BACKGROUND

The Centers for Disease Control and Prevention and the US Office of Population Health have published guidelines for providing family planning services.

PURPOSE

The study explores how nurse practitioners (NPs) perceived their preparation and competency in providing a range of sexual and reproductive health care in their first two years of community-based practice.

METHODOLOGICAL ORIENTATION

Qualitative. Thematic analysis used to analyze data from structured and open-ended interview questions.

SAMPLE

Through snowballing recruitment, 35 NPs participated in interviews.

CONCLUSIONS

Participants were most confident and likely to provide contraceptive and sexually transmitted infection services. Participants felt less prepared to provide male sexual health and care to the lesbian, gay, bisexual, transgender, queer, and intersex+ population. Nurse practitioners expressed interest in building skills with discussing healthy sexuality across the life span, specifically postmenopausal sexual concerns, teen sexuality, trauma-informed care related to sexual violence, and early pregnancy decision making. Some participants had little preparation in early pregnancy decision making/options counseling. Faculty need to examine barriers to teaching these skills because the curriculum should address all legal pregnancy options, including discussing the NP's professional obligations. More preparation was needed in the clinical management of erectile dysfunction, polycystic ovary syndrome, herpes, syphilis, abnormal uterine bleeding, dyspareunia, pelvic pain, miscarriage management, and how to discuss prostate cancer screening.

IMPLICATIONS FOR PRACTICE

The recommendations of the quality family planning, with additions, form a sound basis for sexual and reproductive health care standards, education, and clinical practice, should be part of NP education.

Knowledge and attitude of nursing students regarding older adults' sexuality: A cross-sectional study

BACKGROUND

Although older adults are sexual, sexuality is infrequently discussed with them by health care professionals. Nursing students, as future professionals, can make an important contribution by developing competences in discussing intimacy and sexuality with older adults to increase quality of life and to prevent sexual problems. In order to improve these competences, current levels of knowledge and attitude need to be explored.

OBJECTIVES

To investigate i) knowledge and attitudes of nursing students regarding intimacy and sexuality of older adults, ii) the difference in knowledge and attitudes of nursing students in different years of study and iii) frequency of discussing intimacy and sexuality with older adults.

DESIGN

Cross-sectional.

SETTINGS

A University of Applied Sciences in the Netherlands.

PARTICIPANTS

Nursing students, ≥16 years who were able to read and write in Dutch.

METHODS

The Ageing Sexual Knowledge and Attitudes Scale was used among nursing students. Furthermore, demographic information and frequencies were collected. Data was analyzed using SPSS.

RESULTS

In total, 732 students participated. The mean knowledge-score was 43.9 (SD = 8.9), the mean attitude-score 64.3 (SD = 16.0). Unlike attitude, the level of knowledge differed significantly per year of study: first year students had the lowest and third year students the highest knowledge. Most students stated they 'never' (54.1%) or 'once' (13.2%) discussed intimacy and sexuality with older adults. Reasons to avoid talking about intimacy and sexuality were feelings of 'not being the right person' (17.3%) and 'incompetence' (14.0%).

CONCLUSIONS

Nursing students had moderate knowledge and positive attitudes toward older adults' intimacy and sexuality. The knowledge-level differed per year of study, the attitude level did not. Only a minority discussed intimacy and sexuality with older adults. Moderate knowledge and positive attitudes do not mean that intimacy and sexuality is discussed. To ensure students feel responsible and competent, interventions should focus on continuous knowledge dissemination, role clarification and role modelling.

Do we need to worry about sexually transmissible infections (STIs) in older women in Australia? An investigation of STI trends between 2000 and 2018

Background This study examined trends in chlamydia, gonorrhoea and syphilis diagnosis, and chlamydia testing and positivity, among older women in Australia between 2000 and 2018.

METHODS

Using national notifiable disease data and Medicare data, diagnosis rates were calculated for each sexually transmissible infection (STI), as well as testing and positivity rates for chlamydia. Data were compared between two older groups (55-64 and 65-74 years) and two younger groups (15-24 and 25-34 years). Poisson regression examined trends for 2000-18 and 2014-18 separately.

RESULTS

Rates for all STIs increased across all age groups and were highest in the two youngest age groups. From 2014 to 2018, chlamydia rates increased the most among those aged 55-64 years [incidence rate ratio (IRR) = 1.06; 95%CI: 1.02-1.10] and declined in those aged 15-24 years (IRR = 0.99; 95%CI: 0.99-0.99). Gonorrhoea rates increased the most among those aged 65-74 years (IRR = 1.47; 95%CI: 1.23-1.77) and least in those aged 15-24 years (IRR = 1.12; 95%CI: 1.10-1.13). Syphilis rates increased the most among those aged 55-64 years (IRR = 1.58; 95%CI: 1.25-1.99) and least in those aged 15-24 years (IRR = 1.29; 95%CI: 1.23-1.35). Chlamydia test positivity declined among younger women but remained stable in older women.

CONCLUSIONS

In general, STIs are increasing among older women in Australia at a faster rate than among younger women. Although the greatest burden is among younger women, STIs need to be considered and monitored among older women.

Association between Frailty and Erectile Dysfunction among Chinese Elderly Men

Objective

This study is aimed at assessing association between frailty and erectile dysfunction among Chinese elderly men.

Methods

This community-based study was conducted with a sample of 341 Chinese elderly men (aged 60 to 83 years old) in Fuyang City (Anhui Province, China). Each of the participants completed a standard questionnaire, including demographics (age, height, weight, yearly income, educational status, comorbidity, lifestyle factors, etc.), medical and sexual history, and the Chinese version of Tilburg Frailty Indicator (TFI) and International Index of Erectile Function-5 (IIEF-5) for assessing frailty and erectile dysfunction (ED).

Results

The prevalence of ED and frailty in Chinese elderly men was 77.13% and 68.04%, respectively. Compared with the non-ED group, the ED group had increased age, spouse's age, BMI, prevalence of diabetes, and scores of TFI and lower yearly income, educational levels, and ratio of irregular intercourse (less than once per week) (all P < 0.05). Multivariate analysis indicated that age (OR: 0.860, 95% CI: 0.763-0.969), diabetes (OR: 0.330, 95% CI: 0.165-0.661), irregular intercourse (OR: 3.416, 95% CI: 1.874-6.229), and scores of TFI (OR: 0.906, 95% CI: 0.846-0.970) were regarded as independent risk factors for ED (all P < 0.05). And after adjusting for age, the TFI score had a negative significant association with the IIEF score (r = −0.134, P = 0.013).

Conclusion

This study confirmed the strong associations between ED and frailty among elderly men. Sexual health care for elderly men with ED should be assessed and taken addressed on the multidimensional assessments of frailty.

The Relationship Between Gender Role Orientation and Sexual Health Care in Taiwanese Nurses: A Structural Equation Model

Introduction

Patients’ sexual concerns are private, sensitive issues, and providing sexual health care (SHC) is a legitimate area of concern for the nursing practice.

Aims

This study tests a structural equation model for factors that affect SHC among Taiwanese nurses.

Methods

A cross-sectional study was performed between August 2014 and July 2015. A total of 471 registered nurses from a medical center in Taiwan were enrolled in this study. All nurses participated anonymously and completed 3 questionnaires: Nursing Attitude in Sexual Health Care scale, Nursing Intervention in Sexual Health scale, and Gender Role Orientation scale. The Permission-Limited Information-Specific Suggestions-Intensive Therapy model based on scale was application, and theory of planned behavior was used to examine the relationship of these 3 scales in nurses.

Main Outcome Measures

SHC surveys were developed for nurses. These valid and reliable instruments included Nursing Attitude in Sexual Health Care, Nursing Intervention in Sexual Health, and Gender Role Orientation.

Results

The fitted structural equation model was valid. The construct reliability of latent variables ranged from 0.730 to 0.942, which met the requirement of 0.70. The attitude about SHC (β = 0.182, P < .001), subjective norms on SHC (β = 0.146, P < .001), and confidence about SHC (β = 0.583, P < .001) had significant effects on the behavioral intention to provide SHC. Subsequently, the behavioral intention to provide SHC had a significant, direct effect on the behavioral frequency of providing SHC (β = 0.356, P < .001). However, gender role orientation was not significantly associated with behavioral intention and behavioral frequency to provide SHC.

Conclusions

The good fit for the structural equation model suggests that the predictors of behavioral intention and behaviors of providing SHC include attitude, subjective norms, and perceived control. The stronger behavioral intention of providing SHC resulted in a higher frequency of providing SHC. However, the relationship between gender role orientation and SHC had no significant effect.

Huang C-Y, Liou C-F, Lee S-H, et al. The Relationship Between Gender Role Orientation and Sexual Health Care in Taiwanese Nurses: A Structural Equation Model. Sex Med 2020;8:565–573.

Sexual Expression and Cognitive Function: Gender-Divergent Associations in Older Adults

Prior research demonstrates a positive association between sexual activity and cognitive function in later life. However, the relationship between the type of sexual activity and cognitive function in older adulthood remains unclear. This study explored the associations between the frequency of engaging in different types of sexual activities (intercourse, masturbation, and kissing/petting/fondling) and cognitive function in older women and men. Using data from Wave 6 of the English Longitudinal Study of Aging (ELSA), 1915 women and 2195 men (age range 50-89 years; n = 4110) reporting any type of sexual activity over the past 12 months were included in the study. Multiple regression controlling for age, education, satisfaction with sex life, cohabiting, wealth, general health, physical activity, depression, and loneliness was used to explore the associations between the frequency of engagement in intercourse, masturbation, and kissing/petting/fondling, and two measures of cognitive function: word recall and number sequencing. For women, masturbation was linked to better word recall (p = .008), while for men, kissing/petting/fondling was associated with better number sequencing (p = .035). In women (p = .016) and men (p = .018), dissatisfaction with sex life was associated with better number sequencing. The results point to gendered links between sexual activity and cognitive function. These gender-related divergences may reflect differences in biological/neurological mechanisms, or in cognitive lifestyle factors that could influence cognitive reserve in later life. This novel study underscores the need to delineate the underlying mechanisms of the association between sex and cognition in men and women.

Exploration of clients living with HIV needs for reporting on experiences with sex

Talking about sex with people living with HIV receives insufficient attention in health care. A cross-sectional and exploratory study describes the preferences of people living with HIV to talk about sex with specialized HIV physicians and nurses in a clinic in Barcelona (Spain). A 27-item self-administered questionnaire was used between June 2017 and May 2018. One hundred fourteen people agreed to participate. Data were analyzed using multivariate logistic regression. Most of the participants reported "never or almost never" having been asked about sex practices in visits with the HIV specialist physician (n = 65 [57.0%]) or nurse (n = 74 [64.9%]). Older participants stated that neither physicians nor nurses talked about sex during visits. Women felt that physicians hardly ever asked about their sexual practices. Men who had sex with other men indicated that their physicians always asked about their sex practices compared with heterosexuals living with HIV. Health professionals should reformulate how to talk about sex with people living with HIV to facilitate communication and provide adequate care.