RESULTS – STUDIES II AND III

The main results of Studies II and III are presented below. For exemplifying quotes and elaborated analyses, see the results sections of Paper II and Paper III.

Study II: Men’s acceptance of health professionals addressing sexuality, ED and i-PAVED was identified in six out of seven components of the TFA, as no narratives were identified in relation to the component of ‘opportunity costs’. An overview of themes, subthemes and examples of identified narratives is provided in Table 2 (and in Paper II, Table 3):

Table 2. Themes, subthemes and examples of identified narratives Theme Subtheme Examples of identified

narratives

Temporal perspective

TFA Component Interpreted Interpreted Coded Coding

category

Shyness “Well, that’s just something I find it really difficult to talk about.” (11)

Retrospective

Speechless ness and frustration

“It's a little bit strange, so we have 2019 and sexuality is still a taboo, and they (HPs) can't talk about it. I think it is acids, why the hell should we not be able to talk about these things (i-PAVED)?” (5).

"But I think you [HPs) could have talked about it [sexuality and ED] a little more dignified instead of just casually: "Well, just try these [PDE5-i]". A doctor and a nurse should be able to do that. I find it strange that it is about such things. I can only

Prospective

speak for myself. Maybe some will be offended that they [HPs] ask questions about their sex life. It would not bother me, but some might problems for a long time. So, it has not developed in 5 minutes – the arteriosclerosis – it has probably been there all 10 years. It is certainly relevant. You get so much information and much of it is about heart problems, and there is nothing about that [ED] in those leaflets. It could have been nice if she [the nurse] had said that [atherosclerosis] could be the reason why you can't get an erection, that atherosclerosis was all over in the body, instead of just right there in the heart" (6).

is common sense. Yes, it

“It is important to know how it all works, and especially if you go around speculating about a whole lot of things [ED]. Then I could have avoided that, if I had known something about it;

"Yes, but I think so, because my wife also tries to guess what is the cause [of ED], and I also think it would be nice to “lay some ghosts to rest; that it's not her fault, so I think that would be completely relevant. Because I also know that my wife is just as affected as I have been and still am, and I have felt people would like to hear is if you can do something about talk about it [ED] or describe it [ED] so men can see, though I am on my way there,

Prospective Self-efficacy

what can I do to turn it around before it's too late.

Leaflets should be available, like dietary guidance – a potency guide, what can you do about it yourself ". (10)

A just to be reminded that it [physical activity] has an may be that they are told that you live a year or two longer, but that is out in the future”

(7).

Prospective

The analysis revealed men’s experience that cardiac health professionals either had not addressed or only briefly addressed sexuality and ED. The men seemed to be prospectively interested, motivated and open-minded in relation to health professionals addressing these issues, and they did not seem to consider the topic to be annoying, bothersome or offensive. The address of sensitive issues such as ED could be a potentially emotional effort when sexual issues are addressed in group sessions. Men who were perceived as shy underlined the importance of the possibility to keep their head down, and for men in general individual sessions with health professionals trained in communication in the field of sexology could fulfil an unmet need of sexual counselling. Retrospectively, men had feelings of frustration when health professionals did not address relevant issues in relation to sexuality and ED.

Health professionals addressing sexuality, ED and i-PAVED was in harmony with men’s attitudes and values, and they cared for their own and other men’s integrity and boundaries. The men had not received any information about links between cardiovascular diseases and vascular ED or about i-PAVED; however, these links were found to be understandable, meaningful and relevant. Health professionals’

potential address of these links appeared to be useful for men and their partners, both in understanding vascular ED and in improving communication in couples.

Prospectively, the men accepted that health professionals provided information, dialogue, self-care advice and written material about treatment options and self-care to prevent or reduce ED. The men found that the address of i-PAVED might be a potential facilitator for their self-efficacy by increasing their motivation to be more

physically active and thereby reduce vascular ED and improve cardiovascular rehabilitation. A prerequisite for men's acceptance of health professionals’ address of sexuality, ED and i-PAVED was that health professionals are educated, competent and trained in communication in the field of sexology (2).

Study III: According to the men, ED was perceived as a major problem and they requested help to self-help by health professionals competent in the field. An overview of these themes and related subthemes are presented in Table 3.

Table 3 Overview of themes and subthemes regarding HPs’ communication Health professionals’ communication concerning i-PAVED⁹ – perspectives of men in cardiac secondary prevention and rehabilitation Themes Erectile dysfunction

– a major problem

Help to self-help Competent health professionals communication about ED was needed because the men experienced ED as a major problem diminishing their masculinity and leading to unsolved, uncertain, inexplicable mystery that negatively affected their relationships. In relation to the content and context of health professionals’ communication, the men only wanted general information in group sessions about sexuality, (vascular) risk factors for ED, i-PAVED and intimacy, which could provide them with knowledge and understanding of ED. Health professionals should give permission to address these sensitive issues as well as general information regarding self-help on how to prevent, reduce, compensate for and cope with ED. More specific and person-centered counselling was considered better suited in individual sessions, either alone or together with their partner. Available written material regarding ED and i-PAVED was also believed to be beneficial. Health professionals should be able to communicate about sexuality, ED and i-PAVED in an open, empathetic, trustful and emotionally safe way and be knowledgeable, educated and competent in this field (3).

9i-PAVED: information about physical activity to reduce vascular erectile dysfunction

3.4. CAPACITY OF FUTURE HEALTH PROFESSIONALS