The CHARMS pilot study: a multi-method assessment of the feasibility of a sexual counselling implementation intervention in cardiac rehabilitation in Ireland
Background: Many people living with cardiovascular disease (CVD) are affected by sexual problems associated with
the condition. International guidelines recommend all patients with CVD should receive sexual counselling, yet this
is rarely provided by health professionals. The current study piloted the Cardiac Health and Relationship
Management and Sexuality (CHARMS) intervention, a complex multi-level intervention designed to increase
the implementation of sexual counselling guidelines in hospital-based cardiac rehabilitation (CR) in Ireland.
Methods: The CHARMS intervention, consisting of awareness training and skills development for staff, and education
and support for patients, was implemented in two CR centres. Following a repeated measures design, quantitative and
qualitative feasibility, fidelity, cost, and outcome data were collected from staff and patients at baseline (T1,
pre-intervention), at 3 months post-baseline (T2, post-intervention), and at 6 months post-baseline (T3, postintervention). Data were organised according to a 14-point reporting framework of methodological issues that
should be examined in pilot and feasibility studies. To inform a future definitive trial, potential solutions to identified
feasibility issues were generated using the ADePT process for decision-making after pilot and feasibility trials.
Results: Most elements of the study protocol were executed smoothly, and intervention implementation was
successful. Patients’ (N = 42) responses to the intervention were positive. The reporting framework and the
ADePT process facilitated the identification of two overarching feasibility problems, as well as solutions to be
implemented in a definitive trial: (1) a high level of patient attrition in the pilot study, to be addressed through the use
of financial incentives, reducing the length of the patient questionnaire, and providing a telephone survey option; and
(2) negative staff perceptions, to be addressed through an augmented staff intervention, reframing ‘sexual counselling’
as ‘sexual education and support’ to fit with professional role perceptions, and reviewing all intervention terminology
with a CR staff member to ensure acceptability.
Conclusions: This article reports the successful piloting of a novel sexual counselling implementation intervention in
cardiac rehabilitation. The utilisation of an extended reporting framework and the ADePT process facilitated
the identification of adaptations necessary to ensure the feasibility of a definitive trial, thereby maximising
methodological transparency