From evidence base to intervention specification: Example of a sexual counselling intervention in cardiac rehabilitation

Abstract

Background: There are few published examples of studies which have taken a systematic approach to developing implementation interventions. We present the development of the CHARMS [Cardiac Health and Relationship Management Study] intervention to improve provision of sexual assessment and counselling in hospital cardiac rehabilitation. Methods: Sixty general practitioners, 61 cardiac rehabilitation staff and 382 cardiac patients were surveyed about provision of sexual counselling in health services. We conducted one-to-one and focus group interviews with key stakeholders [cardiac rehabilitation staff (n=14), patients/service users (n=13) and general practitioners (n=9)] to model intervention components. Findings: Staff reported lacking awareness, knowledge and confidence in addressing sexual issues and wanted more training and specific guidelines. Patients reported that they would like more opportunity to discuss sexual issues with health professionals, but were reluctant to initiate discussions. Intervention components include: (1) staff training on current clinical guidelines, (2) structured patient sexual assessment and counselling session during cardiac rehabilitation, (3) organisational measures in cardiac rehabilitation to raise awareness of sexual issues. Discussion: Our intervention development work was informed by a comprehensive theoretical assessment of the behavioural problem.