Is sexual expression and Irish occupational therapy curriculum blind spot? The occupational therapy student perspective

The American Occupational Therapy Association (AOTA) validates sexual expression as a legitimate intervention activity by including it in its activities of daily living (ADL) list in the Uniform Terminology for Occupational Therapy. Sexual expression is frequently affected by disability, but seems to be infrequently addressed by practicing occupational therapists (Friedman et al 1997; Couldrick 2005). The literature indicates that occupational therapists omit sexual expression from their treatment process due to lack of training and comfort in addressing client’s sexual expression. (Couldrick 1998 & 2005, Evans 2000) The aim of this research was to determine Irish occupational therapy students’ opinion in relation to sexual expression and their perception of whether their educational curriculum addressed it. Method: A questionnaire survey was completed by 33 final year students enrolled in Irish occupational therapy courses. Responses to survey questions were analyzed using SPSS 19.0. Qualitative data obtained from open-ended questions was analyzed using thematic coding. Results: The barriers to sexual expression intervention identified in the study were similar to previous studies exploring this area. The respondents felt uncomfortable and educationally unprepared to address sexual expression. While 90.9% of the respondents felt it was within the OT role to address sexual expression the majority 97% (N=32) felt that their course did not prepare them. A need for appropriate training in relation to sexual expression was identified

Sample Characteristics (N = 1393).

*<p>UAI with 2 or more partners, UAI with casual partners, and/or UAI with unknown/discordant partners in the previous 12 months.</p>†<p>HIV treatment optimism – ‘I am less worried about HIV infection now that treatments have improved’.</p

Factors associated with willingness to be part of a research study on Pre-exposure Prophylaxis for HIV prevention (N = 1393).

<p>OR = odds ratio; AOR = adjusted odds-ratio; 95% CI = 95% confidence interval.</p>*<p>UAI with 2 or more partners, UAI with casual partners, and/or UAI with unknown/discordant partners in the previous 12 months.</p>†<p>HIV treatment optimism – ‘I am less worried about HIV infection now that treatments have improved’.</p

Factors associated with Awareness of Pre-exposure Prophylaxis for HIV prevention (N = 1393).

<p>OR = odds ratio; AOR = adjusted odds-ratio; 95% CI = 95% confidence interval.</p>*<p>UAI with 2 or more partners, UAI with casual partners, and/or UAI with unknown/discordant partners in the previous 12 months.</p>†<p>HIV treatment optimism 1– ‘I am less worried about HIV infection now that treatments have improved’.</p

Factors associated with likelihood of using Pre-exposure Prophylaxis for HIV prevention (N = 1393).

<p>OR = odds ratio; AOR = adjusted odds-ratio; 95% CI = 95% confidence interval.</p>*<p>UAI with 2 or more partners, UAI with casual partners, and/or UAI with unknown/discordant partners in the previous 12 months.</p>†<p>HIV treatment optimism – ‘I am less worried about HIV infection now that treatments have improved’.</p

Factors associated with the acceptability of PrEP use (N = 690).

<p>Factors associated with the acceptability of PrEP use (N = 690).</p

Survey Sample Characteristics (N = 690).

Survey Sample Characteristics (N = 690).</p

Focus Group Participants by Recruitment Site.

<p>Focus Group Participants by Recruitment Site.</p

Factors associated with Awareness of PREP (N = 690).

<p>Factors associated with Awareness of PREP (N = 690).</p

Characteristics of participants.

Many pregnant smokers need support to quit successfully. In the United Kingdom, trained smoking cessation advisors deliver structured behavioural counselling alongside access to free nicotine replacement therapy (NRT); known as the ‘Standard Treatment Programme’ (STP). Pregnant smokers who access STP support are more likely to quit, but uptake is low. A digital intervention could be offered as an adjunct or alternative to existing STP support to increase cessation rates. However, there are few pregnancy-specific digital options routinely available and, among those that are, there is limited evidence of their effectiveness. This study investigated experts’ views on the feasibility of translating the STP into a comprehensive digital intervention. Virtual group and individual interviews were undertaken with 37 experts (11 focus groups, 3 interviews) with a real-time voting activity in the focus groups to prompt discussion. Framework Analysis was applied to the data to examine themes and patterns. Experts were supportive of a digital translation of the STP and considered most behavioural counselling content to be transferable. However, replicating human-to-human accountability, empathy and the ability to go ‘off-script’ was thought more challenging. Suggestions for how this might be achieved included tailoring and personalisation, use of artificial intelligence tools, peer support and the option to escalate contact to a human advisor. Experts had mixed views on the role that exhaled breath carbon monoxide monitoring might have in a digital cessation intervention for pregnancy. Electronic provision of free NRT, and potentially e-cigarettes, without interpersonal support was generally well received. However, experts had concerns about it exacerbating low NRT adherence, governance issues (e.g. being accountable for the suitability of recommended products), and people’s ability to misrepresent their eligibility. The STP was considered largely transferable to a digital intervention and potentially helpful for cessation in pregnancy, so merits further development and evaluation.</div