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

Abstract

M. ORCID: 0000-0001-7344-2262, Pritchard, M. and Le Dorze, Guylaine (2019). Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries. Aphasiology, Increasing the intensity and comprehensiveness of aphasia services:Identification of key factors influencing implementation across six countries. AbstractBackground: Aphasia services are currently faced by increasing evidence for therapy of greater intensity and comprehensiveness. Intensive Comprehensive Aphasia Programs (ICAPs) combine these elements in an evidence-based, time limited group program. The incorporation of new service delivery models in routine clinical practice is however likely to pose challenges for both the service provider and administering clinicians. This program of research aims to identify these challenges from the perspective of aphasia clinicians from six countries and will seek to trial potential solutions. Continual advancements in global communication technologies suggest that solutions will be easily shared and accessed across multiple countries. Aims:To identify the perceived and experienced barriers and facilitators to the implementation of 1) intensive aphasia services, 2) comprehensive aphasia services, and 3) ICAPs, from aphasia clinicians across six countries. Methods and procedures:A qualitative enquiry approach included data from six focus groups (n=34 participants) in Australia, New Zealand, Canada, United States of America (USA), United Kingdom (UK), and Ireland. A thematic analysis of focus group data was informed by the Theoretical Domains Framework (TDF). Outcomes and results: Five prominent theoretical domains from the TDF influenced the implementation of all three aphasia service types across participating countries: environmental context and resources, beliefs about consequences, social/professional role and identity, skills, and knowledge. Four overarching themes assisted the identification and explanation of the key barriers and facilitators: 1. Collaboration, joint initiatives and partnerships, 2. Advocacy, the promotion of aphasia services and evidence-based practice, 3. Innovation, the ability to problem solve challenges, and 4. Culture, the influence of underlying values. Conclusions:The results of this study will inform the development of a theoretically informed intervention to improve health services' adherence to aphasia best practice recommendations.

Do best practice recommendations align with current aphasia practices in the Swedish care context: a national survey

“…Each factor was considered to act both as a facilitator and barrier, depending on when and to what extent the factor was present. Trebilcock et al (2019) thereby provided additional support to the conclusions drawn earlier by Stephens and Upton. (2012), that lack of time for research, lack of time for implementation, lack of access to resources, and lack of skills in accessing and understanding the research were the primary barriers preventing SLPs from complying with EBP.…”

“…The results further indicated that a large proportion of SLPs and audiologists had limited knowledge of EBP. Trebilcock et al (2019) investigated barriers and facilitating factors for the implementation of intensive and comprehensive aphasia services for PWA among SLPs, and found that environmental context and resources (factors affecting a situation/circumstance or a physical environment), beliefs about consequences (presumed outcomes of a caring effort), professional role and identity (personal or professional characteristics and/or behaviors), skills (level of skill in operating) and knowledge (knowledge of a condition, treatment, or environment) impacted the implementation of the services. Each factor was considered to act both as a facilitator and barrier, depending on when and to what extent the factor was present.…”

Supporting people with post‐stroke aphasia to live well: A cross‐sectional survey of Speech & Language Therapists in Ireland

“…There remains however a lack of consensus and high‐quality guidance around the optimum approach to aphasia rehabilitation, for example in relation to goal setting, counselling and patient/caregiver support, and this may impact on care quality and consistency (Brady et al., 2013; CCRE in Aphasia Rehabilitation, 2014; Rohde, Worrall, & Le Dorze, 2013; Shrubsole, Worrall, Power, & O’Connor, 2017). This evidence gap is compounded by an evidence‐practice gap including the provision of aphasia‐friendly information, support with depression and SLT of adequate intensity to maximise effectiveness (Code & Petheram, 2011; Foster, Worrall, Rose, & O'Halloran, 2015; Hickey, Shrubsole, Worrall, & Power, 2019; Hilari et al., 2015; Rose, Worrall, McKenna, Hickson, & Hoffmann, 2009; Shrubsole, Worrall, & Power, 2019; Shrubsole, Worrall, Power, & O'Connor, 2018; Thomas et al., 2013; Trebilcock et al., 2019). Surveys of SLTs in Australia and Hong Kong highlighted that PWA received sub‐optimum dosage for effective therapy (Kong, 2011; Kong & Tse, 2018; Rose, Ferguson, Power, Togher, & Worrall, 2014; Verna, Davidson, & Rose, 2009).…”

Intensive Comprehensive Aphasia Programmes: a systematic scoping review and analysis using the TIDieR checklist for reporting interventions

“…Though one article elicited views of clinicians delivering ICAPs [144] and another explored clinicians' views on experienced and perceived barriers to ICAP implementation [161], the literature provides no qualitative data from PWA or significant others about the perceived value of ICAPs. It is crucial to access the insights, lived experience, and expertise of PWA, their families, and key stakeholders in intervention design and this process is a recommended key stage in the development of a complex intervention [162,163].…”