Improving speech pathologists' implementation of recommended practices in acute aphasia management: What works?

Multifaceted behaviour change interventions were delivered to speech pathologists working with people with acute post-stroke aphasia, in 4 hospitals. Sites were randomised to receive either intervention A (which focussed on improving the provision of aphasia friendly information to patients) or B (which focussed on improving collaborative goal setting with people with aphasia), with two sites randomised to each arm. The interventions comprised of a single, face-to-face, two-and-a-half hour interactive education session and workshop. The session included intervention functions aimed at addressing the known barriers to the target behaviours (either Information Provision or Goal Setting), including education, persuasion, environmental restructuring, modelling and enablement. These functions were used in the following ways: 1. Education - Education about the target behaviour to increase knowledge and understanding about the key evidence underlying the guideline recommendations, how to modify information to meet patient and family needs, and resources available. Feedback of each cluster’s own baseline audits was also provided. 2. Persuasion - Persuasive communication was used to motivate increased performance. A video was presented of a person with aphasia and a family member discussing the importance of receiving information about aphasia from their therapist and how they would have liked to receive this information (using persuasive language). The researchers also presented case studies of people with aphasia who reported improved outcomes after receiving information. 3. Environmental restructuring - Teams were provided with resources to help change the physical environment and increase the target behaviour. For Intervention A, this included a newly-developed interactive PDF information package (called "What’s happening to me now?"), and instructions to support the package. Written protocols were provided in order to assist the participants embed the enhanced information package into their departments, as well as opportunities for discussion and action planning. 4. Modelling – Use of the information package was explained and modelled by the researchers using different case examples. Following this, experiential learning opportunities were created to impart skills and participants practiced and observed each other using the various information resources in role-play scenarios. 5. Enablement – The workshop was interactive and promoted discussion, with teams asked to identify barriers and strategies to implement better information provision throughout. At the completion of each workshop, teams were asked to identify a goal for their implementation phase, and brainstorm strategies for success. Records kept by research SP re intervention fidelity, and participant feedback and interaction during the intervention session, along with goals and strategies identified by participants. Following the intervention, participating clusters implemented the recommended practices in an 'implementation phase' for a minimum of 12 weeks until 10 eligible patients with aphasia were seen, up to a maximum of 24 weeks.