Coproducing Knowledge of the Implementation of Complex Digital Health Interventions for Adults with Acquired Brain Injury and their Communication Partners: Protocol for a Mixed Methods Study

Abstract

Background The Social Brain Toolkit, conceived and developed in partnership with stakeholders, is a novel suite of web-based communication interventions for people with brain injury and their communication partners. To support effective implementation, the developers of the Social Brain Toolkit have collaborated with people with brain injury, communication partners, clinicians, and individuals with digital health implementation experience to coproduce new implementation knowledge. In recognition of the equal value of experiential and academic knowledge, both types of knowledge are included in this study protocol, with input from stakeholder coauthors. Objective This study aims to collaborate with stakeholders to prioritize theoretically based implementation targets for the Social Brain Toolkit, understand the nature of these priorities, and develop targeted implementation strategies to address these priorities, in order to support the Social Brain Toolkit’s implementation. Methods Theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation, a maximum variation sample (N=35) of stakeholders coproduced knowledge of the implementation of the Social Brain Toolkit. People with brain injury (n=10), communication partners (n=11), and clinicians (n=5) participated in an initial web-based prioritization survey based on the NASSS framework. Survey completion was facilitated by plain English explanations and accessible captioned videos developed through 3 rounds of piloting. A speech-language pathologist also assisted stakeholders with brain injury to participate in the survey via video teleconference. Participants subsequently elaborated on their identified priorities via 7 web-based focus groups, in which researchers and stakeholders exchanged stakeholder perspectives and research evidence from a concurrent systematic review. Stakeholders were supported to engage in focus groups through the use of visual supports and plain English explanations. Additionally, individuals with experience in digital health implementation (n=9) responded to the prioritization survey questions via individual interview. The results will be deductively analyzed in relation to the NASSS framework in a coauthorship process with people with brain injury, communication partners, and clinicians. Results Ethical approval was received from the University of Technology Sydney Health and Medical Research Ethics Committee (ETH20-5466) on December 15, 2020. Data were collected from April 13 to November 18, 2021. Data analysis is currently underway, with results expected for publication in mid-2022. Conclusions In this study, researchers supported individuals with living experience of acquired brain injury, of communicating with or clinically supporting someone post injury, and of digital health implementation, to directly access and leverage the latest implementation research evidence and theory. With this support, stakeholders were able to prioritize implementation research targets, develop targeted implementation solutions, and coauthor and publish new implementation findings. The results will be used to optimize the implementation of 3 real-world, evidence-based interventions and thus improve the outcomes of people with brain injury and their communication partners. International Registered Report Identifier (IRRID) DERR1-10.2196/35080

Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review

“…The refinement in focus from neurological conditions in criterion 3 to the condition of ABI in criterion 6 aimed to reduce complexity in the first domain of the NASSS framework [ 20 ] by “scaling back on the kinds of illness or condition for which the technology is claimed to be useful.” It was also introduced to reflect stakeholders’ prioritization of the condition of ABI compared with other NASSS domains [ 21 ].…”

“…The data extraction form drafted in our study protocol [ 30 ] was updated ( Multimedia Appendix 2 ) to reflect the refined exclusion criteria. New extraction items were also added from a published taxonomy of digital health intervention features [ 38 ] to both consistently capture the diversity of interventions and technologies and incorporate implementation considerations identified by stakeholders in a concurrent study [ 21 ]. These included the order in which intervention contents were presented and the potential benefit of peer interaction.…”

“…Each domain includes multiple subdomains, with published definitions of how each specific subdomain can be made simple , complicated , or complex [ 17 ]. A complexity paradigm has not yet been adopted for digital interventions targeting ABI, despite both the prevalence of this condition [ 1 ] and the value of a condition-specific focus from both theoretical [ 20 ] and stakeholder perspectives [ 21 ].…”

A Web-Based Service Delivery Model for Communication Training After Brain Injury: Protocol for a Mixed Methods, Prospective, Hybrid Type 2 Implementation-Effectiveness Study

“…A prospective hybrid type 2 design especially reflects a collaborative ethos because it allows formative evaluation by end users to inform the refinement and improvement of both the clinical interventions and their implementation processes [ 37 ]. Preemptive implementation strategies will be devised during intervention development, including through consultation with people with ABI, communication partners, and clinicians supporting people with ABI, and people with experience implementing digital health [ 38 ], as well as reference to current implementation science literature [ 39 ]. Additional user-identified implementation strategies will be determined as part of the formative evaluation processes in this study, rather than solely a priori, in keeping with our collaborative ethos and approach.…”

“…Preemptive strategies deployed to support the implementation of the Social Brain Toolkit at launch, devised through current implementation evidence [ 39 ] and stakeholder input from a separate study [ 38 ].…”