Creating space for sexuality: supporting healthcare professionals in spinal cord injury or disease rehabilitation settings - a mixed-methods study.

Abstract

Sexual health education in rehabilitation remains inconsistent and often absent due to structural and practical barriers. Healthcare professionals play a crucial role in creating a safe environment that enables patients to address sexual health concerns. This study explores healthcare professionals' experiences and identifies barriers and enablers for integrating sexuality into SCI/D rehabilitation. A sequential explanatory mixed-methods design was applied, prioritizing qualitative data. Healthcare professionals from three Swiss SCI/D rehabilitation centers completed a questionnaire assessing perceived importance of sexuality, experiences with education, and training needs. Focus groups with professionals from diverse backgrounds further examined barriers and enablers. Qualitative data were thematically analyzed and mapped to the Theoretical Domains Framework (TDF). Of 136 respondents, one-third had received training on sexuality after SCI/D, and almost half of them felt competent to provide related education. Although most considered sexuality important, fewer than 40% had initiated conversations. Three themes emerged (1): building confidence through knowledge (2), prioritizing sexuality as a shared responsibility, and (3) navigating social dynamics. Mapping to the TDF highlighted knowledge, skills, role clarity, context, and social influences as key factors. Addressing sexuality in SCI/D rehabilitation requires targeted training, clear responsibilities, and structured processes to foster holistic care.