Barriers and facilitators to meeting aphasia guideline recommendations: what factors influence speech pathologists’ practice?

Abstract

Speech pathologists report a number of key factors influencing their practice, which differ in how they influence behaviours (i.e., a factor may be a barrier or a facilitator) depending on the behaviour and clinical setting. Future implementation interventions need to account for the strong influence of beliefs and social influences on speech pathology practice, which may facilitate successful implementation. Implications for rehabilitation Speech pathologists' aphasia management practices are often inconsistent with guideline recommendations. Environmental and contextual barriers were identified for all guideline-recommended practices that were investigated; however, these barriers did not necessarily impede implementation for speech pathologists working in inpatient rehabilitation settings. Strategies to improve both team functioning (social influences) and the belief systems of individual clinicians (beliefs about consequences) should be considered to improve speech pathologists' implementation of guideline-recommended aphasia practices.

Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries

“…The 14 domains of the TDF contain multiple theoretical constructs which aid the identification of factors influencing implementation and intervention development (Cane, O'Connor, & Michie, 2012). The TDF is commonly applied within rehabilitation literature when identifying key barriers and facilitators to implementation (McCluskey, Vratsistas-Curto, & Schurr, 2013;Sakzewski, Ziviani, & Boyd, 2014;Shrubsole et al, 2018).…”

“…Clinician factors include professional skill, confidence, and the ability to both research and prepare new therapy techniques (Babbitt, Worrall, & Cherney, 2013;Rose et al, 2014;Shrubsole, Worrall, Power, & O'Connor, 2018). Challenges associated with the environment include the location (access to private space and travel time), caseload demands, and staffing Shrubsole et al, 2018).…”

“…Clinician factors include professional skill, confidence, and the ability to both research and prepare new therapy techniques (Babbitt, Worrall, & Cherney, 2013;Rose et al, 2014;Shrubsole, Worrall, Power, & O'Connor, 2018). Challenges associated with the environment include the location (access to private space and travel time), caseload demands, and staffing Shrubsole et al, 2018). The effects of patients' fatigue, expectations, and readiness will also impact on the successful implementation of intensive aphasia services (Gunning et al, 2017;Rose et al, 2014;Shrubsole et al, 2018).…”

“…Challenges associated with the environment include the location (access to private space and travel time), caseload demands, and staffing Shrubsole et al, 2018). The effects of patients' fatigue, expectations, and readiness will also impact on the successful implementation of intensive aphasia services (Gunning et al, 2017;Rose et al, 2014;Shrubsole et al, 2018).…”

“…Difficulties incorporating current aphasia evidence within everyday clinical practice has been experienced on an international scale. Within Australia, dysphagia management is frequently prioritised over communication intervention (Foster, O'Halloran, Rose et al, 2014;Shrubsole et al, 2018) as the speech pathology culture continues to reflect a medical model of service provision . In the UK individuals with aphasia perceive services to be provided at the convenience of the provider, therefore impacting the availability and timing of aphasia support (Law, Huby, Irving, & Pringle, 2010).…”