Self-Guided, Web-Based Training for Communication Partners of Adults With Acquired Brain Injury: A 12-Month Prospective, Mixed Methods, Hybrid Type 2 Implementation-Effectiveness Study of ‘interact-ABI-lity’ (Preprint)
Authors: Miao Melissa , Rietdijk Rachael , Power Emma , Brunner Melissa , Debono Deborah , Togher Leanne 
Published: February 2023

BACKGROUND

To support the rehabilitation of adults with communication difficulty after acquired brain injury (ABI), it is internationally recommended best practice to provide formal (eg, support workers) and informal (eg, friends, family) ‘communication partners’ with communication partner training (CPT). However, ABI affects more than 135 million people globally, surpassing healthcare capacities to provide CPT. ‘interact-ABI-lity’ is a free, 2-hour, self-directed, web-based CPT program that includes education and strategies to support people with cognitive-communication disorders, aphasia, and dysarthria after ABI. It is unknown whether interact-ABI-lity can facilitate the scalability and accessibility of CPT.

OBJECTIVE

To investigate the implementation and effectiveness of interact-ABI-lity as a web-based service delivery model for CPT after ABI.

METHODS

This 12-month prospective, mixed methods, hybrid type 2 implementation-effectiveness study is theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. We documented and deployed implementation strategies coproduced with stakeholders and identified by users through formative evaluation. We prospectively observed theoretically-informed implementation outcomes through web analytics, survey data, and individual interviews incorporating think-aloud methods. Qualitative implementation data were deductively analyzed against the NASSS framework, and quantitative implementation data were analyzed descriptively. Effectiveness outcomes were obtained through custom, web-based knowledge and confidence questionnaires which were administered preintervention, postintervention, and at 3 months follow-up.

RESULTS

interact-ABI-lity received 1069 unique registrations from 29 countries. User feedback surveys (n=325) indicated high satisfaction (92% indicated interact-ABI-lity was “Extremely” or “Very” useful, and 95% rated 8-10 out of 10 likelihood of recommending it to others), with positive qualitative comments. Users also reported high usability (85% indicated interact-ABI-lity was “Very easy” or “Easy” to use). Users who were older, male, informal communication partners, had lower education levels or lower confidence communicating with people with ABI were underrepresented. Effectiveness data indicated significant improvements (p<0.001) in knowledge (n=307) and confidence (n=322) communicating with people with ABI postintervention. Among follow-up participants (n=52), there was no significant difference in confidence after 3 months. Although follow-up knowledge scores declined (p<0.001), they remained higher than at pretest (p<0.001).

CONCLUSIONS

interact-ABI-lity is the first completely self-directed CPT program to support adults with cognitive-communication disorders, aphasia, and dysarthria after ABI. Users reported high satisfaction and usability. Communication knowledge and confidence increased postintervention but were not fully retained after 3 months. Although this may reflect the limitations of a short, self-guided format, this alternate service delivery model was scalable across organizations and internationally, with potential to address unmet community and healthcare needs. Proactive reduction of complexity across a comprehensive range of domains of implementation, particularly a multidimensional value proposition, may have facilitated interact-ABI-lity’s implementation, scalability, and sustainability. Extended implementation research beyond 12 months is required.

CLINICALTRIAL

Australia and New Zealand Clinical Trials Registry: ACTRN12621001170819, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001170819, Universal Trial Number U1111-1266-6628.

INTERNATIONAL REGISTERED REPORT

RR2-10.2196/31995