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Barriers and facilitators to meeting aphasia guideline recommendations: what factors influence speech pathologists' practice?

Abstract：

PURPOSE:To explore factors influencing Australian speech pathologists' guideline recommended aphasia management practices. METHODS:Semi-structured interviews were conducted with hospital-based speech pathologists (n = 20). Interviews focused on barriers and facilitators to implementing recommendations related to five practice areas: Aphasia-friendly Information; Collaborative Goal Setting; Timing of Therapy; Amount and Intensity of Therapy; and Conversation Partner Training. RESULTS:Speech pathologists working only in inpatient rehabilitation settings reported performing the recommended behaviours consistently, and identified few implementation barriers. However, clinicians working in the acute setting reported performing the majority of behaviours inconsistently or rarely. Seven (of 14) Theoretical Domains Framework domains were identified as key influencing factors. Three of these - "Environmental Context and Resources," "Beliefs about Consequences," and "Social Influences" - were consistently reported as influencing practice across all five behaviours. Other important domains included "Knowledge", "Beliefs about Capabilities," "Goals," and "Social/Professional Role and Identity", which each influenced at least two practice behaviours. CONCLUSIONS:Speech pathologists report a number of key factors influencing their practice, which differ in how they influence behaviours (i.e., a factor may be a barrier or a facilitator) depending on the behaviour and clinical setting. Future implementation interventions need to account for the strong influence of beliefs and social influences on speech pathology practice, which may facilitate successful implementation. Implications for rehabilitation Speech pathologists' aphasia management practices are often inconsistent with guideline recommendations. Environmental and contextual barriers were identified for all guideline-recommended practices that were investigated; however, these barriers did not necessarily impede implementation for speech pathologists working in inpatient rehabilitation settings. Strategies to improve both team functioning (social influences) and the belief systems of individual clinicians (beliefs about consequences) should be considered to improve speech pathologists' implementation of guideline-recommended aphasia practices.

journal_name

Disabil Rehabil

journal_title

Disability and rehabilitation

authors

Shrubsole K,Worrall L,Power E,O'Connor DA

doi

10.1080/09638288.2018.1432706

subject

Has Abstract

pub_date

2019-06-01 00:00:00

pages

1596-1607

issue

eissn

0963-8288

issn

1464-5165

journal_volume

pub_type

杂志文章

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Barriers and facilitators to meeting aphasia guideline recommendations: what factors influence speech pathologists' practice?