Development of a tailored intervention to implement an Intensive and Comprehensive Aphasia Program (ICAP) into Australian health services

ABSTRACT

Background

The Aphasia Language Impairment and Functioning Therapy (LIFT) program is one example of an Intensive and Comprehensive Aphasia Program (ICAP) developed in a research setting. This ICAP has shown promising improvements in naming, communication participation and communication-related quality of life, and is ready for translation into health services. However, there are challenges to implementing ICAPs into clinical services, including delivering high treatment doses with existing staffing, and providing a cohort model where patients start and finish concurrently. No Australian studies have investigated local clinicians’ or clinical stakeholders’ perspectives on translating the Aphasia LIFT program into existing health services. It is vital to understand the clinical context in which implementation is intended so that a theory-informed implementation intervention can be tailored to address identified barriers.

Aims

This study aimed to identify potential barriers and facilitators to implementing Aphasia LIFT into existing healthcare services from the perspectives of clinical stakeholders and experienced LIFT clinicians, and develop a theory-informed implementation intervention for Aphasia LIFT, tailored to the intended implementation context.

Methods and Procedure

This study comprised two distinct phases. In phase 1, qualitative semi-structured interviews were conducted with clinical stakeholders (n = 13) and Aphasia LIFT clinicians (n = 5) to identify key barriers and facilitators to Aphasia LIFT implementation. Interviews were informed by the Theoretical Domain Framework and data analysed using content analysis. In phase 2, barriers were mapped to behaviour change techniques and implementation strategies using two mapping approaches, leading to the development of the implementation intervention.

Outcome and Results

Combined clinical stakeholder and Aphasia LIFT clinician perspectives revealed six main barriers: ‘patient-level factors’, ‘environmental context and resources’, ‘beliefs about capabilities’, ‘the Aphasia LIFT innovation’, ‘knowledge’, and ‘skills’. Key implementation barriers included a perceived lack of flexibility of the Aphasia LIFT program’s structure, and an overall lack of confidence that the program could be feasibly delivered within a constrained healthcare environment. An implementation intervention was subsequently designed that incorporated six components: (i) Executive, leadership and stakeholder support, (ii) Allocation of clinical staff, (iii) Interactive education and training program, (iv) Resource procurement and provision, (v) Ongoing implementation support, and (vi) Consumer engagement and promotion.

Conclusion

The context-specific barriers and facilitators identified in this study informed the development of a tailored implementation intervention to facilitate translation of the Aphasia LIFT ICAP into clinical services. This implementation intervention will be evaluated in a future study.

KEYWORDS:

• Intensive and Comprehensive Aphasia Program
• implementation science
• aphasia
• behaviour change

Acknowledgement

The authors wish to thank all the speech language pathologists who participated in this study. In addition, we thank and acknowledge Emma Caird and Dr Sarah Wallace for their input into the interview guide. Finally, we thank and acknowledge the contribution of Annabel Dunphy, Amanda Holland and Grace Kim, speech-language pathology students who contributed to coding the participant data.

Data Availability

The data that supports the findings of this study are available in the supplementary material of this article.

Correspondence details for this paper are: Dr Kirstine Shrubsole, Faculty of Health, Southern Cross University, Gold Coast, Qld 4225, Australia. E-mail: [email protected]

Disclosure of interest

Authors LW, DC and AR were involved in the development of the Aphasia LIFT program.

All other authors report no conflict of interest.

Declarations

• All authors read and approved the final manuscript.

• Ethics approval and consent to participate: The study had approval by a Human Research Ethics Committee.

Disclosure Statement

No potential conflict of interest was reported by the authors.

Supplementary Materials

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02687038.2022.2095608.