Aphasiolgists from Australia have published a collaborative study with colleagues from 5 other nations (New Zealand, Canada, USA, UK, and Ireland) to assess the current state of affairs regarding: (a) increasing the intensity of aphasia rehabilitation services; (b) increasing also its comprehensiveness; and (c) initiating Intensive Comprehensive Aphasia Programs (ICAP), which aim to boost both service delivery intensity and comprehensiveness within the framework of structured, evidence-based, time-limited groups. The purpose of this investigation is to identify and understand factors contributing to and impeding progress towards these goals in the target countries.
The researchers conducted six focus groups (n = 34) to gather data for analysis using the Theoretical Domain Framework (TDF), with the aim of understanding main factors influencing service delivery by country. The TDF identifies conceptual areas for attention including: environmental contexts and resources; cultural beliefs about consequences, social/professional roles and identities; skill sets of actors; and their relevant knowledge. Through data analysis, the researchers identified 4 overarching themes to refine accounts of barriers and facilitators, namely: collaboration; advocacy; innovation; and culture.
Results of this work are of two distinct types. First, the researchers have produced a detailed, extended framework, presented at length in Table 3, that identifies and categorizes the primary factors influencing their emphasized service delivery factors (intensiveness, comprehensiveness, and ICAPs), and correlating themes (e.g., advocacy) via sub-themes (e.g., self-advocacy) with TDF theoretical domains (e.g., environmental context and resources, also social/professional roles and identities). This represents a contribution to the field applicable across countries, useful for understanding the nature of phenomena encountered as clinicians work to improve service delivery broadly. Second, the investigators discuss, with examples, particular phenomena that consequentially influence service delivery adaptability, whether the influences stem from differing cultural values, or medical reimbursement models, or professional considerations, or something else. For example, they observe that – broadly – “[a]n impairment focus of health services, identified within the theme of culture, was repeatedly emphasized as a factor influencing the de-prioritization of communication and associated discharge pressures.” Specific effects, of course, will be country-dependent, varying according to differing national reimbursement systems, financial incentives, and stakeholder roles; but overemphasis of impairment-level improvement appears to be very widespread.
The authors have elaborated a broad-based conceptual framework for supporting clinicians seeking to increase comprehensiveness and intensity of aphasia rehabilitation services through structured programs. The next stage will be to apply that framework within countries, identifying what steps are available to make progress within countries, while promoting international collaboration.
For further reading: Megan Trebilcock, Linda Worrall, Brooke Ryan, et al. 2019. Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries. Aphasiology, 33(7):865–887. DOI: 10.1080/02687038.2019.1602860