CommuniCare: Development, evaluation, and implementation of a generic Communication Partner Training using perspectives of people with aphasia and healthcare professionals

Abstract

Aphasia is a language disorder as a consequence of stroke. People with aphasia experience difficulties with understanding and communicating with others, such as healthcare professionals. As result, people with aphasia have higher risks of receiving inadequate care, show worse rehabilitation outcomes, lower satisfaction rates, higher risks for adverse events and higher medical costs. International studies have shown positive effects on communication between people with aphasia and healthcare professionals (HCPs) after providing HCPs with Communication Partner Training (CPT). CPT is an umbrella term for interventions that are aimed at improving communication between people with aphasia and their conversation partners. CPT interventions often include training modules where HCPs learn to use supportive conversation techniques. Positive effects include an increase in the use of conversation techniques, increased satisfaction and participation of the person with aphasia and improved quality of life scores. However, although the implementation of CPT intervention was included in best-practice statements and evidence-based guidelines, there were no CPT interventions available that were developed for the Dutch or Flemish context. Also, due to underreporting of CPT interventions, lack of outcome measures and lack of implementation research, there was little understanding of how different intervention elements in CPT interventions produce different outcomes. In this PhD thesis, we aimed to develop and evaluate a CPT intervention that is applicable for the Dutch and Flemish context. The CPT intervention was named CommuniCare and was developed based on the needs and wishes of the users (HCPs) and end-users (people with aphasia and their relatives) (Chapter 1-4). Chapter 5 describes the CommuniCare intervention in detail. From 2018-2020, almost 300 HCPs were provided the intervention. The evaluation of CommuniCare was conducted by analyzing the mechanisms of change from HCPs' perspectives (Chapter 6). Different intervention elements in CommuniCare improved HCPs skills, capacities and confidence to use supportive conversation techniques during conversations. The main barriers included time constraints, remaining lack of confidence and lack of positive beliefs. Using implementation theory, participating healthcare centers developed implementation strategies to address these barriers. This PhD thesis provides recommendations for implementing CPT interventions in healthcare centers, in order to improve communication between HCPs and people with aphasia. Implementation strategies include leadership, the development of supportive tools, financial and organizational facilitation by management and a change in role of Speech-and Language Therapists (SLTs). We also provide recommendations on how to lay the foundations of good communication skills in early-career healthcare students. Examples include teaching SLTs to coach and support their colleagues, and providing student courses for becoming Implementation Support Practitioners.