Supporting adults with intellectual disabilities with relationships and sex: A systematic review and thematic synthesis of qualitative research with staff

Staff working with individuals with Intellectual Disabilities (ID) play an important role in enabling them to fulfill their sexual and romantic needs. Given the lack of recent reviews providing a synthesis of qualitative research in this population, the present review explored how staff working with individuals with ID in a variety of capacities (e.g. support workers, service managers, nurses, educators, psychologists, social workers) perceived their role in relation to supporting sexuality and relationships. A systematic search of EMBASE, PsychINFO, MEDLINE, CINAHL, ASSIA and SCOPUS was carried out and identified articles were rated against inclusion and exclusion criteria, as well as quality criteria. Findings were analyzed using thematic synthesis. The application of criteria resulted in the inclusion of 15 articles. Four themes were identified: (a) “Attitudes towards sexuality and relationships: A right and a challenge”, (b) “Responding to sexuality and relationships: A conflicted discourse”, (c) “Uncertainty and lack of systemic support”, and (d) “Influences on decision-making”. Findings suggest that staff hold ambivalent attitudes and often respond inconsistently to issues relating to service users’ sexuality. Role uncertainty, fear of accountability, lack of training and policy, as well as factors related to employing organizations and family caregivers were identified as barriers. The findings highlight the importance of providing training and supervision for staff in order to address ambivalent attitudes and anxieties, further developing national and local policy in relation to sexuality and relationships, and supporting family caregivers to meaningfully work alongside staff on issues relating to service users’ sexuality.