Contact nurses’ experiences of using the BETTER model to address sexuality issues with cancer patients – A study based on the normalization process theory

BACKGROUND: Contact Nurses in Cancer Care (CNCCs) are well-positioned to address patients' concerns regarding sexual health, but many lack the tools and confidence to initiate such conversations. AIM: To explore how CNCCs perceive the use of the BETTER model as a new practice for integrating discussions of sexuality into cancer care. METHODS: Data were collected from 37 CNCCs through video-recorded educational seminars, written reflections, and focus group interviews. A directed qualitative content analysis was conducted, guided by the four constructs of the Normalization Process Theory: coherence, cognitive participation, collective action, and reflexive monitoring. RESULTS: The BETTER model was perceived as a valuable tool for initiating conversations about sexuality. The CNCCs highlighted the importance of personal reflection, peer support, and managerial backing. Time constraints and structural barriers were identified as key challenges to implementation. Many CNCCs viewed themselves as clinical champions, advocating for the sustained integration of the model into practice. CONCLUSION: Communication tools such as the BETTER model can enhance CNCCs' confidence and competence in addressing sexual health. Successful implementation requires organizational support and recognition of CNCCs' roles as facilitators of change. The Normalization Process Theory proved useful in understanding the implementation process, even across diverse clinical settings.