Factors that influence Australian speech-language pathologists’ self-reported uptake of aphasia rehabilitation recommendations from clinical practice guidelines
Young, L, Shrubsole, K, Worrall, L & Power, E 2018, 'Factors that influence Australian speech-language pathologists’ self-reported uptake of aphasia rehabilitation recommendations from clinical practice guidelines', Aphasiology, vol. 32, no. 6, pp. 646-665.
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Background: There are clinical practice guidelines for speech-language pathologists’ aphasia management practices. However, reported adherence to aphasia guideline recommendations is variable. The barriers and facilitators to meeting aphasia management recommendations are not well understood. In order to develop theory-informed strategies to improve implementation of aphasia management practices, a better understanding of these barriers and facilitators is required.
Aims: This study aimed to describe barriers and facilitators to speech-language pathologists’ uptake and implementation of five prioritised recommended practices for aphasia management.
Methods & Procedures: An online survey sought information from Australian speech-language pathologists working with clients with aphasia. The survey focused on five practices including goal setting, information provision, constraint-induced language therapy, timing, and intensity of intervention. The Theoretical Domains Framework was used to design the survey, with several statements generated about factors influencing practice for each domain.
Outcomes & Results: Surveys were completed by 63 respondents. The theoretical domain “environmental context and resources” (e.g., “I have insufficient time to engage in…”) was the main perceived barrier for the majority of practices being investigated, whilst the theoretical domain “social/professional role and identity” (e.g., “It is part of my role with the multidisciplinary stroke team to engage in…”) was the main perceived implementation facilitator for all practices. The top three barriers and facilitators varied for each of the five recommended practices being investigated. Across clinical settings, there were commonalities and differences in the perceived barriers and facilitators to implementation. There was a significant correlation between self-reported uptake of all of the aphasia rehabilitation recommendations we investigated and participants’ total barrier scores. Total barrier scores were also significantly different between clinical settings in the area of goal setting, with acute settings having a higher number of reported barriers to goal setting than rehabilitation settings (p = 0.011).
Conclusions: Implementation interventions that seek to overcome the barriers of environmental context and resources (time, competing priorities and resources) are likely to have the most effect on aphasia best practice uptake. Encouraging behaviour change in the “social professional role and identity” domain by emphasising the role of the speech-language pathologist in aphasia rehabilitation within the multidisciplinary stroke team should further improve uptake of recommended practices. At a local level, departments or individual speech pathologists need to identify their own barriers and facilitators and choose effective implementation interventions using the Behaviour Change Wheel. Both strategies should help close the evidence-practice gap in aphasia rehabilitation.