Barriers and facilitators to meeting aphasia guideline recommendations: what factors influence speech pathologists’ practice?
Creators: name: Shrubsole, Kirstine
name: Worrall, Linda
name: Power, Emma
name: O’Connor, Denise A.
Publisher: name: Taylor & Francis
Year: 2019
Subjects: subject: Space Science
subject: Medicine
subject: 59999 Environmental Sciences not elsewhere classified
subject: FOS: Earth and related environmental sciences
subject: FOS: Earth and related environmental sciences
subject: Sociology
subject: FOS: Sociology
subject: FOS: Sociology
subject: 69999 Biological Sciences not elsewhere classified
subject: FOS: Biological sciences
subject: FOS: Biological sciences
subject: 111714 Mental Health
subject: FOS: Health sciences
subject: FOS: Health sciences
subject: Hematology

description: <b>Purpose:</b> To explore factors influencing Australian speech pathologists’ guideline recommended aphasia management practices. <b>Methods:</b> Semi-structured interviews were conducted with hospital-based speech pathologists (<i>n</i> = 20). Interviews focused on barriers and facilitators to implementing recommendations related to five practice areas: <i>Aphasia-friendly Information; Collaborative Goal Setting; Timing of Therapy; Amount and Intensity of Therapy;</i> and <i>Conversation Partner Training.</i> <b>Results:</b> 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 <i>all</i> 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. <b>Conclusions:</b> 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 rehabilitationSpeech 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. 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.