ImPACT: a multifaceted implementation for conversation partner training in aphasia in Dutch rehabilitation settings

Abstract

ImPACT: a multifaceted implementation for conversation partner training in aphasia inDutch rehabilitation settings. AbstractPurpose: Exploration of the clinical uptake of a novel conversation partner training (CPT) programme in aphasia in ten Dutch rehabilitation facilities and identification of its perceived facilitators and barriers in service providers, and the evaluation of the implementation methods used. Method:Ten rehabilitation centres took part in a multifaceted implementation of conversation partner training over thirteen months. Each centre selected two speech and language therapists to act as knowledge brokers whose role it was to raise awareness of CPT in the team and to facilitate getting partners of people with aphasia into the programme. The implementation was evaluated using analysis of recruitment data and questionnaires, supplemented by consensus data and scrutiny of implementation plans.Results: Successful implementation was described as 1) four dyads included during the intervention period, 2) two more dyads included after the intervention period, before the end of the study and 3) inclusion of Partners of Aphasic Clients Conversation Training (PACT) in a description of the logistics of local stroke care (stroke care pathway). Seven centres were successful in reaching the target inclusion of 6 dyads in total. Only one centre had care pathways in place. From a recruitment pool of 504 dyads, 41 dyads were recruited and 34 partners completed the implementation of PACT study (ImPACT). Observed facilitators included the motivation to engage partners in the rehabilitation process and the perceived added value of PACT. The perceived barriers focused on time limitations within current systems to discuss the consequences of PACT with relevant professionals and to establish allocated time for PACT within existing care routines. Conclusions:The motivation of professionals to involve partners in the rehabilitation process assisted with the introduction of PACT in practice. The main barrier was time, linked to the requirement to think through integration of this innovation within existing care. Longer term evaluation would ascertain how centres sustain uptake without support.

The Acute Aphasia IMplementation Study (AAIMS): a pilot cluster randomized controlled trial

“…The final implementation study in aphasia was a qualitative before and after study conducted in the Netherlands (Wielaert et al . ). This study focused on implementing a conversation partner training programme in 10 rehabilitation centres.…”

Communication partner training: re-imagining community and learning

“…to an innovation such as CPT is exemplified in the 'fuzzy boundaries' of implementation discussed by Wielaert et al (2018), where an organisation with its interconnected activity systems adapts to the innovation, while the innovation is adapted to the local context, touching on "existing attitudes and expectations about aphasia treatment in service providers as well as service users" (Wielaert et al, 2018: 84).…”

“…Implementation science (e.g. Bauer et al, 2015), which was the basis for the PACT implementation study (Wielaert et al, 2018) may provide a more appropriate model for future investigations. In addition, we would argue that the radical exploration of experiences, 'learning what is not yet there' through incremental exploration and ongoing co-configuration work is highly relevant to other contexts such as student healthcare professional training, community work with families, friends and public service providers.…”

Delivering an iterative Communication Partner Training programme to multidisciplinary healthcare professionals: A pilot implementation study and process evaluation

“…One example is the Theoretical Domains Framework (TDF), which conceptualizes theories into 14 domains (Cane et al 2012), and is a useful tool in designing implementation interventions in clinical settings (Phillips et al 2015). Shrubsole et al (2019) recently reviewed the aphasia implementation literature and identified six implementation studies, with four involving CPT (Horton et al 2016a, Jensen et al 2015, Simmons-Mackie et al 2007, Wielaert et al 2018. The review authors found that none of the CPT studies included baseline measures, making it difficult to establish whether practice change had occurred.…”

“…Despite increasing attention on improving CPT implementation, a number of ongoing implementation barriers have been identified. These barriers relate to organizational and resource constraints (such as a lack of time and staffing) (Horton et al 2016a, Simmons-Mackie et al 2007, Wielaert et al 2018, Jensen et al 2015, poor implementation leadership (Wielaert et al 2018), a lack of positive reinforcement and feelings of discomfort linked to unsuccessful interactions (Simmons-Mackie et al 2007, Jensen et al 2015, patient factors such as the severity of a person's aphasia (Horton et al 2016a, Jensen et al 2015 and a lack of opportunity to interact with PWA (Wielaert et al 2018). These ongoing implementation barriers indicate that it is likely necessary to review and modify implementation strategies as new barriers emerge or the organizational context changes.…”