(145) Health Practitioner Attitudes and Values Towards Problematic Sexual Behaviours
Authors: Balasubramanian S , Fox C , Ramanathan V 
Published: March 2024

Abstract

Introduction
Sexuality is expressed through an individual’s sexual behaviours. Distinguishing “problematic” or atypical sexual behaviours from “typical” sexual behaviours depends on sociocultural conceptions of the norm. Perceptions of problematic sexual behaviour evolve in response to societal change. These perceptions influence and reflect the attitudes and vales of health practitioners. The attitudes and values of health practitioners directly affects clients with problematic sexual behaviours. Therapy approaches are not value-free. Practitioners are influenced by sociocultural norms which create and reinforce stereotypes. These social forces are especially pronounced in the context of problematic sexual behaviours. The nosological classification of sexual “disorders” risks pathologizing normal variants of sexual behaviours. Despite this, research examining health practitioner attitudes and values toward problematic sexual behaviours is scant. Existing measures of attitudes either focus on a broad range of sexual behaviours or on sexual health overall. We therefore sought to understand the themes underlying health practitioner attitudes and values toward problematic sexual behaviours.

Objective
To assess the themes influencing health practitioner attitudes and values towards problematic sexual behaviours.

Methods
An inductive qualitative approach provided the framework using in-depth, semi-structured interviews. An interview schedule was based on deductive domains gleaned from a review research exploring health practitioner attitudes and values toward problematic sexual behaviour, and the research team’s experience of the field. A case vignette of a distressed person reporting a problematic sexual behaviour was created to trigger discussion. A diverse range of health practitioners working with people reporting problematic sexual behaviours was recruited. This included five medical doctors (general practice, psychiatry, sexual health) and two sexual health nurses. A coding matrix was generated based on a priori review of the literature and a posteriori review of the interviews. Thematic analysis of interview transcripts was performed using the software program NVivo.

Results
Five themes emerged from the interviews. Two deductive themes were identified: methods of inquiry about sexual behaviours; discrepancies in defining problematic sexual behaviours. Myriad frameworks underpin a practitioner’s exploration of sexual behaviour issues. Interviewees also could not operationalise a consistent definition of the “problem”. Three inductive themes emerged: managing judgement in consultations; reflections on practitioner knowledge; the tension between fantasies and problematic sexual behaviours. Interviewees referred to “non-judgemental care” as essential in addressing sexual behaviour problems. There was consistent reference to a “limited understanding” of problematic sexual behaviours. A need to differentiate thoughts (fantasies) from actions (behaviours) for risk stratification was apparent.

Conclusions
The attitudes and values of health practitioners are influenced by sociocultural conceptions of normative sexual expression. These attitudes and values affect practitioner responses to people with problematic sexual behaviours. To better understand this, we propose three recommendations: the development of tailored supports to assist practitioners in managing judgements; an educational module to build understanding of problematic sexual behaviours; the development of a survey instrument to investigate the attitudes and values of health practitioners more broadly in responding to problematic sexual behaviours.

Disclosure
No.