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.
Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
Brain Impair. 2024 Jan;25. doi: 10.1071/IB23068.
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.
创伤性脑损伤（TBI）后，性的持久变化常常发生。然而，卫生专业人员仍然不愿讨论性问题，并报告存在障碍，包括对谁的角色有不确定性，以及教育和机构支持有限。本研究采用了共同设计和实施的过程，旨在促进整个团队的行为改变，即 TBI 康复病房的卫生专业人员将常规地试图与患者讨论性问题。
对多学科卫生专业人员进行了焦点小组会议，以确定行为改变的障碍和促进因素，确定发展领域，并共同设计干预措施。然后确定实施可交付成果并提供给团队。使用理论领域框架来映射影响行为的因素，使用行为改变轮来映射干预措施。使用主题分析进一步分析障碍主题。
确定了 12 个理论领域内影响行为改变的 35 个障碍和 8 个促进因素。主题分析揭示了启动和维持变革方面高度相关的障碍。九个共同设计的干预措施与行为改变轮的五个干预功能一致，产生了六个最终的实施可交付成果。
障碍高度相关，影响了实施可交付成果的方法。同时解决多个障碍可能会减轻讨论性问题时的不适。对启动变革的担忧与对实现可持续变革的信心有关。实现变革需要组织和团队层面的环境结构调整和支持。下一步是评估共同设计和实施过程在推动行为改变方面的有效性，以及对患者满意度和性结果的潜在影响。
