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Hwang JHA, Downing M, Ponsford JL. "Maybe if this was addressed sooner, maybe things might be different in our relationship. I don't know. But who knows?" Sexuality after TBI and its place in healthcare: A qualitative exploration of survivors' experiences. Neuropsychol Rehabil 2024:1-22. [PMID: 39093937 DOI: 10.1080/09602011.2024.2383340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/16/2024] [Indexed: 08/04/2024]
Abstract
Changes in sexual functioning and wellbeing after a traumatic brain injury (TBI) are common but remain poorly addressed. Little is known about the lived experiences and perspectives of individuals with TBI. Through semi-structured interviews with individuals with TBI (n = 20), this qualitative study explored their experiences with post-TBI sexuality, along with their needs and preferences for receiving sexuality support and service delivery. Three broad themes were identified through reflexive thematic analysis of interview transcripts. First, individuals differed significantly at the start of their journeys in personal attributes, TBI-associated impacts, and comfort levels in discussing sexuality. Second, journeys, feelings, and perspectives diverged based on the nature of post-TBI sexuality. Third, whilst responses to changes and preferences for support varied widely, individuals felt that clinicians were well-placed to help them navigate this area of their lives. The impacts felt by individuals with TBI, and the infrequency of clinical discussions highlight the need for clinician education and clinically validated assessment and treatment tools to improve how post-TBI sexuality is addressed and managed.
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Affiliation(s)
- Jill H A Hwang
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Marina Downing
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Epworth Healthcare, Richmond, Victoria, Australia
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Fraser EE, Downing MG, Haines K, Bennett L, Olver J, Ponsford JL. Experience of adapted cognitive behaviour therapy to address sexuality problems after traumatic brain injury: A qualitative study. Neuropsychol Rehabil 2024; 34:572-599. [PMID: 37306485 DOI: 10.1080/09602011.2023.2221858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
Although sexuality has been shown to be negatively impacted in up to half of individuals who sustain traumatic brain injury (TBI), few studies have sought to evaluate the efficacy of targeted interventions. Gaining insight into the participant experience of undergoing treatment for post-TBI sexuality changes is a crucial aspect of intervention evaluation. This study aimed to investigate participants with TBI experience of undergoing eight sessions of a novel CBT intervention designed to help both couples and singles improve sexual wellbeing after TBI. Eight participants (50% male) with moderate-severe TBI, and a mean age of 46.38-years (SD = 13.54), completed a qualitative interview. A six-phase reflexive thematic analysis approach was used. Despite variability in participant characteristics, the findings suggested that participants with TBI experience reflected that of a positive treatment journey characterized by high levels of enjoyment and satisfaction. Key themes identified included contextual factors that preceded treatment, factors that facilitated treatment engagement, outcomes derived from the treatment experience, and feedback provided on reflection. The results not only provide an enriched understanding of the client experience of the intervention but provide corroborating preliminary evidence of efficacy for this novel CBT intervention in addressing complex and persistent sexuality problems after TBI.
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Affiliation(s)
- Elinor E Fraser
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Epworth Healthcare, Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Marina G Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Epworth Healthcare, Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Kerrie Haines
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Linda Bennett
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - John Olver
- Epworth HealthCare, Rehabilitation Medicine, Richmond, Australia
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Epworth Healthcare, Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
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Hwang JHA, Downing MG, Specht RAG, Ponsford JL. Co-designing for behavioural change: understanding barriers and enablers to addressing sexuality after traumatic brain injury and mapping intervention strategies in a multi-disciplinary rehabilitation unit. BRAIN IMPAIR 2024; 25:IB23068. [PMID: 38566291 DOI: 10.1071/ib23068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/24/2023] [Indexed: 04/04/2024]
Abstract
Background Persistent changes in sexuality often follow traumatic brain injury (TBI). However, health professionals remain reticent about discussing sexuality and have reported barriers including uncertainties around whose role it is and limited educational and institutional support. This study employed a co-design and implementation process, aiming to promote team-wide behavioural change, whereby health professionals at a TBI rehabilitation unit would attempt to address sexuality with patients routinely. Methods Focus group sessions with multidisciplinary health professionals were conducted to identify barriers and enablers to behavioural change, identify areas for development, and co-design intervention options. Implementation deliverables were then finalised and provided to the team. The Theoretical Domains Framework was used to map factors influencing behaviours and the Behaviour Change Wheel was used to map interventions. Thematic analysis was used to further analyse barrier themes. Results Thirty-five barriers and eight enablers falling within 12 theoretical domains to behavioural change were identified. Thematic analysis revealed highly correlated barriers in initiating and sustaining change. Nine co-designed intervention options aligned with five intervention functions of the Behaviour Change Wheel, resulting in six final implementation deliverables. Conclusions Barriers were highly interrelated, influencing the approach to implementation deliverables. Simultaneously addressing multiple barriers could potentially alleviate discomfort associated with discussing sexuality. Concerns around initiating change were related to confidence in achieving sustainable changes. Achieving change requires organisational and team-level environmental restructuring and enablement. The next step involves evaluating the effectiveness of the co-design and implementation process in driving behavioural change and potential impacts on patient satisfaction and sexuality outcomes.
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Affiliation(s)
- Jill H A Hwang
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic. 3121, Australia; and Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Vic. 3121 Australia
| | - Marina G Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic. 3121, Australia; and Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Vic. 3121 Australia
| | - Riccarda A G Specht
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic. 3121, Australia; and Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Vic. 3121 Australia
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Ek AS, Holmström C, Elmerstig E. Unmet Need for Sexual Rehabilitation after Acquired Brain Injury (ABI): A Cross-Sectional Study Concerning Sexual Activity, Sexual Relationships, and Sexual Rehabilitation after ABI. SEXUALITY AND DISABILITY 2023. [DOI: 10.1007/s11195-023-09788-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
AbstractIn relation to brain injury rehabilitation, research has stressed the importance of including sexuality issues due to increased risk for sexual dysfunctions after Acquired Brain Injury (ABI). This study aims to explore experiences after non-stroke ABI concerning individual and relational aspects of sexuality, received information about sexuality at rehabilitation, and gender differences. A postal nationwide survey was conducted in Sweden, 2018–2019. The sample included individuals who had participated in brain injury rehabilitation 2014–2016, response rate 40% (250/624). Among all participants 78% had resumed sexual activity, and there was a significant difference between males (84%, 118/140) and females (69%, 76/110, p = 0.004). Among all participants, 95% reported physical intimacy as important, 80% considered sex as important on an individual level, and 91% stated sexuality as important for the relationship (no gender differences). Significantly more females (52%) than males (22%) reported that they had tried sexual aids (p = 0.000), and more males (29%) than females (16%) reported that professionals addressed sexuality issues during brain injury rehabilitation (p = 0.024). However, only a few participants were offered specific sexual counseling during brain injury rehabilitation, such as individual counseling (3%), couples counseling (2%), and group counseling (3%). To conclude, the vast majority valued both individual and relational aspects of sex and sexuality highly, and more males than females had resumed sexual activity. Few had received information about sexuality after ABI, and even fewer females compared to males reported that the issue was raised during rehabilitation. Clinical implications are discussed in relation to sexual rehabilitation.
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Almalki DM, Kotb MA, Albarrak AM. Discussing sexuality with patients with neurological diseases: A survey among neurologists working in Saudi Arabia. Front Neurol 2023; 14:1083864. [PMID: 36798810 PMCID: PMC9928181 DOI: 10.3389/fneur.2023.1083864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/04/2023] [Indexed: 02/01/2023] Open
Abstract
Background Neurological diseases frequently affect sexual activity, and the resulting sexual dysfunction can cause much distress for patients. However, despite the importance of such complaints, neurologists frequently do not ask patients about their sexual symptoms or how their neurological illness and medications are affecting their sexual health. This study aimed to identify these difficulties as well as potential obstructions to conversations for addressing sexual dysfunction in patients with neurological diseases. Methods This cross-sectional study was performed by sending invitation letters and questionnaires to registered neurologists in Saudi Arabia. The questionnaire was constructed to determine the possibility of discussing sexual activities and function with patients with neurological diseases and the possible obstacles neurologists face in this regard. Statistical analyses were performed using the Statistical Package of Social Sciences (SPSS) program version 25, and p-values of <0.05 were considered statistically significant. Results A total of 258 of 750 neurologists (34.4%) returned the survey, of which 252 had completed the entire survey; therefore, their responses were considered suitable for further analysis. The majority of the respondents (63.1%) seldom discussed sexuality with their patients, more than half of the participants never discussed sexuality with female patients, and patients aged 60 years or older. The most commonly reported barriers were the lack of spontaneous communication by patients regarding their sexual problems (82.1%), insufficient consultation time (60.7%), and barriers based on language/culture/religion (53.6%). The majority of the respondents (61.9%) expressed the need for training on discussing sexuality as a measure that may enhance the discussion of sexual life with patients. Most of the respondents (92.9%) considered the patients responsible for bringing up problems in their sexual functioning during a patient interview. Conclusion Sexual dysfunction is rarely discussed with patients showing neurological diseases, particularly with female patients. This is due to the patient's inability to articulate their sexual problems freely as well as a lack of consultation time. Training on discussing sexuality may enhance the discussion of sexual life with patients.
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Affiliation(s)
- Daifallah Mohammed Almalki
- Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia,*Correspondence: Daifallah Mohammed Almalki ✉
| | - Mamdouh Ali Kotb
- Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia,Neurology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Anas Mohammed Albarrak
- Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Hwang JHA, Fraser EE, Downing MG, Ponsford JL. A qualitative study on the attitudes and approaches of Australian clinicians in addressing sexuality after acquired brain injury. Disabil Rehabil 2022; 44:8294-8302. [PMID: 34951561 DOI: 10.1080/09638288.2021.2012605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Studies indicate that up to 50% of survivors of acquired brain injury (ABI) experience persistent changes in sexuality. However, research on clinicians' perspectives in addressing sexuality issues post-ABI is limited. This study explored the attitudes and approaches, barriers and facilitators, and training preferences of Australian clinicians in addressing sexuality in individuals post-ABI. METHOD Purposive sampling was used to recruit 20 Australian multi-disciplinary clinicians from a related survey study. Semi-structured interviews were conducted and qualitatively analysed using thematic analysis. RESULTS Three broad themes were identified: ABI results in multi-faceted changes in sexuality; there is a fundamental discomfort in talking about sexuality; and, strategies proposed by clinicians may help to improve sexuality support. Participants also provided suggestions for sexuality training, which they believed should start at university. CONCLUSION Most clinicians are aware of sexuality issues post-ABI but fail to adequately address sexuality in individuals post-ABI due to personal levels of discomfort, perpetuated by institutional factors. Therefore, participants believe that changes made at individual and institutional levels may increase sexuality support for individuals with ABI. However, further research on the causes and treatment of sexual problems and patient perspectives is required to provide the evidence-based guidelines and training programs that clinicians require.Implications for rehabilitationUp to half of individuals experience changes in sexuality after ABI that restrict quality of life and relationships.The consequences of ABI and their impacts on sexuality are understood by Australian clinicians but remain largely unaddressed due to individual discomfort, perpetuated by institutional factors.This study suggests that professional training targeted towards understanding, assessing and treating sexuality issues post-ABI may help to reduce the discomfort.Adjustments should also be made at individual, policy and procedural levels to ensure that sexuality is addressed within rehabilitation post-ABI.
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Affiliation(s)
- Jill H A Hwang
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Elinor E Fraser
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marina G Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
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Fraser EE, Downing MG, Ponsford JL. Survey on the experiences, attitudes, and training needs of Australian healthcare professionals related to sexuality and service delivery in individuals with acquired brain injury. Neuropsychol Rehabil 2022; 32:2248-2268. [PMID: 34044727 DOI: 10.1080/09602011.2021.1934486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Elinor E Fraser
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Marina G Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
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Longoni Di Giusto M, Ertl MM, Ramos-Usuga D, Carballea D, Degano M, Perrin PB, Arango-Lasprilla JC. A Survey of Latin American Rehabilitation Professionals on Addressing Sexuality-Related Concerns After Spinal Cord Injury. SEXUALITY AND DISABILITY 2022; 40:439-459. [PMID: 37637469 PMCID: PMC10448980 DOI: 10.1007/s11195-022-09735-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
Abstract
To examine rehabilitation professionals' training and education, attitudes, beliefs or misconceptions, and assessment of issues related to sexuality in individuals with Spinal Cord Injury (SCI) and their romantic partners. 318 healthcare professionals from Latin America (LA) who worked with individuals with SCI completed an online survey. 99.0% affirmed that sexuality is an issue that should be addressed during the rehabilitation of people with SCI. 86.0% reported being asked questions about sexuality after SCI by their patients and/or their partners, but only 33.2% of the professionals affirmed that it was very likely for them to initiate a conversation about the topic. Only 35.4% reported discussing sexuality issues with patients and their partners as a regular practice; further, 61.5% of the sample reported not being prepared at a scientific, therapeutic, and/or educational level to be able to advise people with SCI in the area of sexuality. 95.9% indicated they would be interested in attending courses, seminars, or conferences tailored to the topic of sexuality after SCI. Participants agreed nearly unanimously (96.8%) that it would be easier to discuss sexuality with people with SCI and their partners if they had more training on this topic, which they believed should have been received during their undergraduate (63.5%) and advanced (34.9%) studies. Findings provide insight into the way sexuality is addressed and attended to in the field of rehabilitation in LA and inform initiatives to improve the provision of care in the realm of sexuality for individuals after SCI.
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Affiliation(s)
- Melina Longoni Di Giusto
- Clínica UNER, Alicante, España
- ReDel Rehabilitation Center, Buenos Aires, Argentina
- Universidad Abierta Interamericana, Rosario, Santa Fe, Argentina
| | - Melissa M. Ertl
- Department of Psychiatry HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, NY, New York, USA
| | - Daniela Ramos-Usuga
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Biomedical Research Doctorate Program, University of the Basque Country, Leioa, Spain
| | | | | | - Paul B. Perrin
- Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- IKERBASQUE. Basque Foundation for Science, Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country, Leioa, Spain
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McGrath M, Low MA, Power E, McCluskey A, Lever S. Addressing Sexuality Among People Living With Chronic Disease and Disability: A Systematic Mixed Methods Review of Knowledge, Attitudes, and Practices of Health Care Professionals. Arch Phys Med Rehabil 2020; 102:999-1010. [PMID: 33045226 DOI: 10.1016/j.apmr.2020.09.379] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To systematically review health care professionals' practices and attitudes toward addressing sexuality with people who are living with chronic disease and disability. DATA SOURCES Scopus, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, and MEDLINE were searched to August 2020 for English language publications. Reference lists of relevant publications were also searched. STUDY SELECTION Eligible studies reported on knowledge, attitudes, and behaviors of health care professionals about addressing sexuality in the context of chronic disease and disability. The search yielded 2492 records; 187 full texts were assessed for eligibility and 114 documents were included (103 unique studies). Study quality was rated using the Mixed Methods Appraisal Tool. DATA EXTRACTION Characteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or by a third author. DATA SYNTHESIS A sequential, exploratory mixed studies approach was used for synthesis. Pooled analysis showed that 14.2% (95% CI, 10.6-18.9 [I2=94.8%, P<.001]) of health professionals report routinely asking questions or providing information about sexuality. Professionals reported limited confidence, competence, and/or comfort when initiating conversations about sexuality or responding to patient questions. Sexual rehabilitation typically focused on the effect of disease, disability, and medication on sexual function. Broader dimensions of sexuality were rarely addressed. CONCLUSION Despite recognizing the value of sexuality to health and well-being, most health professionals regardless of clinical context fail to routinely include assessment of sexuality in their practice. Professionals have limited knowledge and confidence when addressing sexuality and experience significant discomfort when raising this topic with people living with chronic disease and disability. Multicomponent implementation programs are needed to improve health professionals' knowledge, competence, and comfort when addressing sexuality for people living with chronic disease and disability.
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Affiliation(s)
- Margaret McGrath
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Michelle Anne Low
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Power
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; The StrokeEd Collaboration, Sydney, Australia
| | - Sandra Lever
- Graythwaite Rehabilitation Centre, Ryde Hospital, Sydney, Australia; Susan Wakil School of Nursing and Midwifery (Sydney Nursing School), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Abstract
Traumatic brain injury (TBI) is one of the leading causes of long-term disability in the United States. Persons with TBI can experience numerous alterations in functional status, self-care ability, and cognitive, emotional, and social functioning. Understanding TBI features, treatment, and rehabilitation is imperative for nurses in every setting. Trauma, intensive and acute care, and rehabilitation nurses are an essential part of the interprofessional team that promotes optimum outcomes through specific interventions to foster hope for TBI patients and families.
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Marier-Deschênes P, Gagnon MP, Déry J, Lamontagne ME. Traumatic Brain Injury and Sexuality: User Experience Study of an Information Toolkit. J Particip Med 2020; 12:e14874. [PMID: 33064104 PMCID: PMC7434066 DOI: 10.2196/14874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/01/2019] [Accepted: 12/19/2019] [Indexed: 01/30/2023] Open
Abstract
Background After having sustained a traumatic brain injury (TBI), individuals are at risk of functional impairments in information processing, abstract reasoning, executive functioning, attention, and memory. This affects different aspects of communicative functioning. Specific strategies can be adopted to improve the provision of health information to individuals with TBI, including the development of written materials and nonwritten media. Objective A user-centered design was adopted to codevelop four audiovisual presentations, a double-sided information sheet, and a checklist aimed at informing individuals about post-TBI sexuality. The last phase of the project was the assessment of the user experience of the information toolkit, based on the User Experience Honeycomb model. Methods Overall, two small group discussions and one individual semistructured interview were conducted with individuals with moderate to severe TBI. Results The participants mentioned that the toolkit was easily usable and would have fulfilled a need for information on post-TBI sexuality during or after rehabilitation. They mostly agreed that the minimalist visual content was well-organized, attractive, and relevant. The information was easily located, the tools were accessible in terms of reading and visibility, and the content was also considered credible. Conclusions Aspects such as usability, usefulness, desirability, accessibility, credibility, and findability of information were viewed positively by the participants. Further piloting of the toolkit is recommended to explore its effects on the awareness of the potential sexual repercussions of TBI in individuals and partners.
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Affiliation(s)
- Pascale Marier-Deschênes
- Université Laval, Department of Rehabilitation, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada.,Centre de recherche sur les soins et services de première ligne de l'Université Laval, Québec, QC, Canada
| | - Marie-Pierre Gagnon
- Centre de recherche sur les soins et services de première ligne de l'Université Laval, Québec, QC, Canada.,Université Laval, Faculty of Nursing, Québec, QC, Canada.,Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - Julien Déry
- Université Laval, Department of Rehabilitation, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada
| | - Marie-Eve Lamontagne
- Université Laval, Department of Rehabilitation, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada
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12
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O’Shea A, Frawley P, Leahy JW, Nguyen HD. A Critical Appraisal of Sexuality and Relationships Programs for People with Acquired Brain Injury. SEXUALITY AND DISABILITY 2020. [DOI: 10.1007/s11195-020-09616-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Marier-Deschênes P, Gagnon MP, Lamontagne ME. Co-creation of a post-traumatic brain injury sexuality information toolkit: a patient-oriented project. Disabil Rehabil 2019; 43:2045-2054. [PMID: 31729237 DOI: 10.1080/09638288.2019.1686543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM Different studies and two clinical practice guidelines emphasize the necessity to provide patients undergoing rehabilitation with information about commonly occurring changes in sexuality following traumatic brain injury (TBI). The purpose of this study was to co-create information resources for individuals with moderate to severe TBI and their partners to consult during rehabilitation. METHODS An iterative user-centered design was used, combining focus group and individual interviews. A convenience sample of individuals with TBI and life partners was constituted. RESULTS The needs and expectations of these participants in terms of form and content of an information toolkit on post-TBI sexuality were explored. The subjects that matched the interests and needs of participants were numerous and supported by the literature. Contrasting with existing written resources, the participants' views oriented the creation process toward the development of a toolkit including five audiovisual presentations, a double-sided information sheet, and a checklist. CONCLUSIONS A similar approach of co-creation could be used to develop other information packs aimed at patients with other disabilities. The created material is expected to be a usable and useful tool for individuals with TBI, which can support clinicians in addressing the subject of sexuality.Implications for rehabilitationThe central role held by individuals with moderate to severe traumatic brain injury, in identifying the sexuality related topics to be addressed and the form of resources to be created, led to a better understanding of their needs.This patient-centered research brought solutions to difficulties related to the understanding of health information, prevalent among patients.This patient-oriented project highlights the necessity for adequacy between the health information provided by rehabilitation professionals and the capacity of their patients' to seek for, process, and understand its content.
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Affiliation(s)
- Pascale Marier-Deschênes
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval, Québec, Canada.,Centre de Recherche du CHU de Québec, Québec, Canada
| | - Marie-Eve Lamontagne
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Canada
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14
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Robert H, Pichon B, Haddad R. [Sexual dysfunctions after traumatic brain injury: Systematic review of the literature]. Prog Urol 2019; 29:529-543. [PMID: 31477433 DOI: 10.1016/j.purol.2019.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/23/2019] [Accepted: 08/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Sexual dysfunction (SD) is common in the general population, up to 50% in women and with no clearly defined prevalence in men but up to 30% in erectile dysfunction. Sexual dysfunctions (SD) are common after a traumatic brain injury (TBI) but remain underrated in clinical practice, yet it is a crucial aspect of the person with consequences for the relationship with the other, psychological wellbeing and quality of life. OBJECTIVE To determine, through a systematic literature review, the epidemiology, assessment tools and treatment of SD in the TBI population. SOURCES (keywords, languages): Medline, COCHRANE and OVID databases were used with specific keywords (MeSH), combined with Boolean operators: "sexual dysfunction", "sexuality", "erectile dysfunction" and "traumatic brain injury". STUDY SELECTION Only studies published in French or English, and with full-text available, have been included. Articles have been independently reviewed and extracted. RESULTS Of the 199 articles reviewed after exclusion of duplicates, 86 articles were reviewed in their full text. A total of 40 studies were included in the final analysis. After TBI, 6% to 83% of patients report SD: decreased frequency of sexual intercourse (47-62%), desire and/or arousal (24-86%), erectile dysfunction (24,2-57%), difficulties with orgasm (29-40%), inappropriate sexual behaviour (8,9%). There is no consensus method for evaluating SD in this population, with 16 tools identified. Among them, only two questionnaires were validated in this population, the Brain Injury Questionnary of Sexuality - not validated in French - and the Overt Behavior Scale, the latter being intended for the evaluation of sexual behaviour disorders. Several factors are significantly and positively associated with SD: age (P≤0.01), severity of TBI (P≤0.002), depression (P<0.001), anxiety (P<0.001), and fatigue (P=0.042). Others are negatively associated: time since injury (P=0.01), perceived physical health status (P<0.001) and social participation (P<0.001). There is little data on the treatment of SD outside of case studies. LIMITS Quantitative analysis could not be performed due to differences in the studies included in their design, evaluation tools, choice of TBI severity criteria, and post-TBI timeframes. Four unavailable articles could not be consulted. CONCLUSION SD are common after TBI but remain poorly evaluated in clinical practice, despite their impact on patients and their partners. Their evaluation and treatment should be part of the overall management of patients after TBI. Nevertheless, there is currently no validated tool in French to evaluate these SD, nor are there any guidelines on their treatment.
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Affiliation(s)
- H Robert
- GRC n°18, service de rééducation neurologique, Sorbonne université, UPMC université Paris 06, handicap moteur, cognitif et réadaptation (HaMCRe), Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, AP-HP, 75013 Paris, France.
| | - B Pichon
- GRC n°18, service de rééducation neurologique, Sorbonne université, UPMC université Paris 06, handicap moteur, cognitif et réadaptation (HaMCRe), Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, AP-HP, 75013 Paris, France; GRC 001, GREEN groupe de recherche en neuro-urologie, Sorbonne université, hôpital Rothschild, AP-HP, 75012 Paris, France
| | - R Haddad
- GRC 001, GREEN groupe de recherche en neuro-urologie, Sorbonne université, hôpital Rothschild, AP-HP, 75012 Paris, France
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15
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de Rooy FBB, Buhmann C, Schönwald B, Martinez-Martin P, Rodriguez-Blazquez C, Putter H, Elzevier HW, van der Plas AA. Discussing sexuality with Parkinson's disease patients: a multinational survey among neurologists. J Neural Transm (Vienna) 2019; 126:1273-1280. [PMID: 31396705 PMCID: PMC6765045 DOI: 10.1007/s00702-019-02053-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/24/2019] [Indexed: 01/23/2023]
Abstract
Sexual dysfunction is a major non-motor feature of Parkinson’s disease (PD) that may affect the quality of life of many patients. In a Dutch survey, we demonstrated that neurologists often fail to discuss sexuality with their patients. Our objective was to determine to which extent neurologists in Spain and Germany address sexuality with their patients and whether cross-cultural differences exist. A 30-item questionnaire was sent out to 1650 German and 460 Spanish neurologists. The questionnaire addressed attitudes, knowledge, barriers, and feelings of responsibility regarding sexuality in PD. 160 German and 32 Spanish respondents completed and returned the questionnaire. The majority of German and Spanish participants discuss sexual dysfunction ‘regularly’ with male patients (61.7% and 78.9%, respectively), but ‘seldom’ with female patients (68.8% and 78.1%, respectively). Important barriers for German and Spanish respondents to discuss sexual dysfunction were patients not expressing sexual complaints spontaneously (52.9% and 75.0%, respectively) and insufficient consultation time (32.2% and 71.9%, respectively). Sexual dysfunction in PD was considered important by 68.3% of German and 96.9% of Spanish participants. German and Spanish neurologists do not routinely discuss sexual dysfunction with their patients, although many of them consider it important to address this topic. It is unclear why this lack of discussing sexual dysfunction is especially found for female patients and whether cultural aspects are involved. We recommend a self-assessment tool for patients to track their symptoms prior to consultation visits and advocate local guidelines that formulate who is responsible for discussing sexual dysfunction.
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Affiliation(s)
- F B B de Rooy
- Department of Urology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - C Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraβe 52, 20246, Hamburg, Germany
| | - B Schönwald
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraβe 52, 20246, Hamburg, Germany
| | - P Martinez-Martin
- National Center of Epidemiology and CIBERNED, Institute of Health Carlos III, Madrid, Spain
| | - C Rodriguez-Blazquez
- National Center of Epidemiology and CIBERNED, Institute of Health Carlos III, Madrid, Spain
| | - H Putter
- Department of Medical Statistics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - H W Elzevier
- Department of Urology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
- Department of Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - A A van der Plas
- Department of Neurology, Alrijne Hospital, Simon Smitweg 1, 2353 GA, Leiderdorp, The Netherlands
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16
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Marier Deschênes P, Lamontagne ME, Gagnon MP, Moreno JA. Talking About Sexuality in the Context of Rehabilitation Following Traumatic Brain Injury: An Integrative Review of Operational Aspects. SEXUALITY AND DISABILITY 2019. [DOI: 10.1007/s11195-019-09576-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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