This study included the use of multiple methods to explore sexual concerns after an ICD. A multimethod component design, specifically a complementarity design, was used in this study. In phase 1, a retrospective descriptive method was used to determine issues and concerns, educational needs, and demographic information from persons with an ICD and their partners. A descriptive survey was chosen for the initial phase of the study to obtain a diverse sample and representative views of the population. The questionnaire was anonymous, increasing the likelihood that ICD patients and their partners would respond to questions of a personal nature. This approach allowed comparison of questionnaire responses to what is known about sexual activity after an ICD implantation and to determine if sexual concerns are addressed by health professionals. Important concepts and concerns revealed in this preliminary data analysis were further explored in the second phase of study. The information gained in phase I provided information about issues and concerns of importance to patients and their partners. The interviews conducted in phase 2 built upon the information gained in phase I and explored reasons for expressed concerns. The information gained should guide future patient education interventions and research.

Sample and Setting

Permission was obtained from the support group coordinator and medical director of two electrophysiology programs for use of support group lists. IRB approval was obtained prior to implementation of the study protocol. Consent was assumed by return of the anonymous questionnaire. Subjects were assured that participation in the study would not affect current or future support group participation.

A questionnaire was mailed to all 391 members of two support groups. Also enclosed was a partner questionnaire that the support group member was asked to share with his or her partner, if applicable. After allowing for postal delivery problems (n = 12), deaths (n = 11), and removal of the ICD (n = 1), the accessible population was 367 patients. The final sample included 82 patients and 47 partners.

Demographic data revealed that ICD patients were largely male (73%, n = 60), Caucasian (96%, n = 77), married (71%, n = 58), lived with a partner (68%, n = 56) and in their own home (54%, n = 44). Most participants had either completed high school (38%, n = 31), some college or trade school (39%, n = 32), or had completed college or a master's degree (19%, n = 16). Many were retired from their jobs (56%, n = 46) or working full time (23%, n = 19). Mean age was 65 years, although age of participants ranged from 20 to 85 years. The mean length of time with ICD was 3.5 years, ranging from less than a year to 12 years for this sample. Fifty-four percent (n = 43) revealed the ICD had fired, with some experiencing ICD firing in the last year (n = 16). For patients whose ICD had fired, they reported 0 to 100 firings with a mean of 5.61; eight subjects reported the ICD had fired only once in the last year. Partners were largely female (77%, n = 36), Caucasian (94%, n = 43), and had completed high school (38%, n = 18), some college or trade school (32%, n = 15), or college/ master's degree (19%, n = 9). Mean age of partners was 61 years with a range of 21-86.

Instrument and Data Collection

Questionnaires were reviewed for content validity by three registered nurses experienced in electrophysiology, two of whom are coordinators of ICD support groups and one who educates patients and staff members about the device. Reading level for ICD patient and partner questionnaires was between the 7th- and 8th-grade level. The questionnaires included demographic information, type of patient education received (if any), incidence of sexual problems or concerns, frequency of the ICD firing during sex, and other sexual issues and concerns. Questions were primarily closed-ended and included checklists from which participants selected items relevant to their ICD experience. Five items used a rating scale (never, rarely, occasionally, frequently) for sexual problems or concerns. These items included lack of interest in sex after the ICD, problems with erection after the ICD, overprotectiveness of the partner, and fears related to the ICD firing or not firing. Open-ended questions were used to allow participants to more fully describe their experiences.

Data Analysis

Demographic and study data were analyzed using descriptive statistics. Pearson's r product moment correlations were used to determine relationships among study variables, with an alpha set at 0.05.