Implementing aphasia recommendations in the acute setting: speech-language pathologists' perspectives of a behaviour change intervention

摘要

Background: Evidence-practice gaps have been identified in the implementation of post-stroke aphasia guideline recommendations. To address this, an implementation intervention tailored to local barriers was developed to target speech-language pathologists' implementation of two aphasia recommended management guidelines in the acute setting (targeting either information provision or collaborative goal setting). A qualitative process evaluation is recommended to understand the mechanisms of action and how context affects the implementation outcomes. Aims: This study aimed to understand the nature of the impact of an implementation intervention as perceived by the speech-language pathologists who participated in a pilot cluster randomised controlled trial (AAIMS). Speech-language pathologists' perceptions of the feasibility, acceptability, and potential effectiveness of the tailored implementation interventions were investigated. Methods & Procedures: Focus groups were conducted with speech-language pathologists (n = 19) as part of the process evaluation, after they completed the implementation interventions at four acute hospital sites. Focus groups explored speech-language pathologists' perceptions of the feasibility, acceptability, and potential effectiveness of the implementation strategy. Using content analysis, the qualitative data were analysed to determine themes. Outcomes & Results: Six interrelated themes were identified including the acute speech-language pathologists': (1) understanding of the workshop facilitators; (2) perceptions of the impact of the workshop on clinical practice; (3) understanding of facilitators for implementation of aphasia recommendations; (4) perceived challenges impacting the workshop and implementation; (5) perceived change in practice; and (6) understanding of the focus group acting as a follow-up reflective opportunity. The findings provide support for the perceived efficacy of the implementation intervention, key explanations for its perceived success, and areas for improved implementation processes for the future. Conclusions: This study highlights speech-language pathologists' perspectives regarding facilitators, barriers, and potential mechanisms for change. Implementation interventions should be embedded in context with consideration of local barriers and facilitators. Findings included identification of key intervention components - such as, interactive workshops, accessible resources, reminders, and follow-up - which provide direction to future implementation interventions in acute aphasia management.