Addressing Sexuality Among People Living With Chronic Disease and Disability: A Systematic Mixed Methods Review of Knowledge, Attitudes, and Practices of Health Care Professionals

Margaret McGrath; Michelle Anne Low; Emma Power; Annie McCluskey; Sandra Lever

doi:10.1016/j.apmr.2020.09.379

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. 2021 May;102(5):999-1010. doi: 10.1016/j.apmr.2020.09.379. Epub 2020 Oct 9.

Authors

Margaret McGrath¹, Michelle Anne Low², Emma Power³, Annie McCluskey⁴, Sandra Lever⁵

Affiliations

¹ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Electronic address: Margaret.mcgrath@sydney.edu.au.
² Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
³ 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.
⁴ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; The StrokeEd Collaboration, Sydney, Australia.
⁵ 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.

PMID: 33045226
DOI: 10.1016/j.apmr.2020.09.379

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.

Keywords: Attitude; Chronic disease; Rehabilitation; Sexuality.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Chronic Disease*
Disabled Persons*
Health Knowledge, Attitudes, Practice*
Health Personnel / psychology*
Humans
Sexuality*