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Reviewed research
Authors Dyer K, das Nair R.
Review Date September 2012
Citation Journal of Sexual Medicine 2012: DOI: 10.1111/j.1743-6109.2012.02856.x (epub ahead of print)
Background
Sexuality is considered to be an important aspect of holistic care, yet research has demonstrated that it is not routinely addressed in healthcare services. Research from the UK has shown that health professionals, in the main, believe sexual issues ought to be addressed. However, only a small proportion regularly initiated discussion of such matters on a regular basis. A small number of Australian studies on this topic support these findings.
To understand the reasons for the lack of discussion of sexual issues in health consultations, and to identify ways to address the barriers to discussion, qualitative studies can be very useful. A synthesis of qualitative studies through systematic review provides a more powerful evidence-base, than single studies, on which to either do further research or design interventions. The authors of this study have reviewed qualitative studies from the UK that have addressed this topic from the health professional perspective.
Aim
To gain an in-depth understanding of healthcare professionals’ subjective experience of discussing sexuality with service users by identifying the factors that impede and facilitate such discussions.
Methods
Electronic databases and reference lists of published articles were searched in July 2011. Primary research studies were included in the review if they explored health professionals’ experiences of discussing sexuality with adult service users, used qualitative methods, and were conducted in the United Kingdom over the last 10 years. Each study was reviewed and assessed. An inductive secondary thematic analysis method was used where key themes were extracted and grouped and key concepts were explored.
Results
Eight articles were included in the review but they were not all independent studies, rather some studies published more than one paper. Together the articles reported on data from 181 health care professionals. Nineteen interconnected themes emerged relating to healthcare professionals’ experience of discussing sexuality with service users, including fear about “opening up a can of worms,” lack of time, resources, and training, concern about knowledge and abilities, worry about causing offense, personal discomfort, and a lack of awareness about sexual issues. Some themes were particularly marked relating to discussing sexual issues with the opposite gender, black and ethnic minority groups, older and non-heterosexual service users, and those with intellectual disabilities. Potential facilitators identified included training, policy development, making written information available and communication between professionals.
Conclusion
The authors concluded from the review that the majority of healthcare professionals do not proactively discuss sexuality issues with service users, and this warrants further attention. They suggested that the perceived barriers and facilitators identified in the review indicate that interventions to improve the extent to which sexuality issues are addressed need to take organizational, structural, and personal factors into consideration.
Points to Note
- This review included only UK studies, mostly from specific areas in the UK, and the studies were few in number, thus limiting generalisability of the findings. However, the few available Australian reports suggest similar barriers to discussing sexual issues in consultations.
- There is no consensus on how to synthesise the findings from qualitative studies so the authors chose a method they thought best suited the data they were reviewing and has been used successfully elsewhere.
- Although these studies were not specifically related to male patients, findings are likely to apply to men and sexual issues.
- The fact that only eight studies could be identified from the past 10 years in all of the UK shows that research in this area is limited and effective interventions to improve communication between health professionals and patients about sexual health need to be tested.
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