Evaluating a co-design and implementation project to improve sexuality support following traumatic brain injury in a multi-disciplinary rehabilitation unit: a mixed-method study

Despite sexuality changes occurring in up to half of individuals with traumatic brain injury (TBI), sexuality is frequently not addressed in Australian rehabilitation settings. This study evaluated an implementation project aimed at improving sexuality support in an Australian TBI rehabilitation unit. Through a mixed-method design, 81 individuals with TBI (48 pre-implementation and 33 post-implementation) completed surveys, 26 clinicians completed a repeated survey and 15 clinicians participated in semi-structured interviews. Post-implementation individuals with TBI experienced significantly higher frequency of sexuality support (<i>χ</i>2(1, <i>n</i> = 81) = 11.2, <i>p</i> &lt; .001), and were more likely to seek help (<i>t</i>(67.9) = −2.08, <i>p</i> = .04). Significant reductions in clinician Sexuality Attitudes and Beliefs Scale scores indicated improved attitudes and beliefs towards addressing sexuality (<i>t</i>(25) = 7.0, <i>p</i> &lt; 001). Qualitatively, clinicians indicated growth in attitudes, comfort and skills, and that sexuality was more normalised. However, clinicians still rely on champions to address sexuality, which may be limiting individual behavioural changes. This study highlights the use of co-design and implementation approaches to improve sexuality support attitudes and behaviours in a rehabilitation setting. Ongoing efforts will be essential to sustain these positive changes and normalise clinical discussions on sexuality. Australian New Zealand Clinical Trials Registry (ACTRN12622001033730) registered on 25/07/2022. Approximately half of individuals with TBI experience changes in sexual functioning and wellbeing.Co-designed implementation with rehabilitation teams can increase sexuality support and improve clinician attitudes.Findings can guide future projects to achieve lasting attitudinal and behavioural changes in sexuality support. Approximately half of individuals with TBI experience changes in sexual functioning and wellbeing. Co-designed implementation with rehabilitation teams can increase sexuality support and improve clinician attitudes. Findings can guide future projects to achieve lasting attitudinal and behavioural changes in sexuality support.