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CommuniCare. Developing and evaluating an intervention aimed at improving the communication environment for people with aphasia in health care settings.

Maren Van Rijssen1*, Lizet Van Ewijk1, Marloes Veldkamp1, Nicole Ter Wal1, Lianne Remijn2, Puck Goossens2, Dorien Vandenborre3, Els Bryon3 and Jeroen Van Grondelle1
  • 1 HU University of Applied Sciences Utrecht, Netherlands
  • 2 HAN University of Applied Sciences, Netherlands
  • 3 Thomas More Kempen, Belgium

Background. The importance of improving the communicative environment for people with aphasia (PWA) to facilitate participation in conversations has been repeatedly shown (Simmons- Mackie & Raymer, 2016). A commonly used intervention aimed at improving the communication environment of PWA is Communication Partner Training (CPT). CPT teaches conversation partners to use supported conversation techniques and tools in their communication with PWA. Behaviour change is at heart of this type of complex intervention. Complex interventions are notoriously difficult to evaluate in terms of effectiveness: outcomes of an intervention can be strongly affected by implementation failure, contextual factors or certain mechanisms of impact (Craig et al., 2008). The aim of this project is to develop and evaluate the intervention CommuniCare aimed at improving the communication environment in complex health care settings, by involving the needs, wishes and experiences of health care professionals (HCP), PWA and their informal caregivers. Procedures and analyses. The Medical Research Council (MRC)- model for developing and evaluating complex interventions was used (Craig et al., 2008). We used an explorative qualitative design to explore the needs and wishes of HCP, PWA and informal caregivers. These data informed the development of two interventions: CommuniCare for HCP aimed at improving supported conversation techniques and the use of conversation tools by HCP. Communicare for informal caregivers aimed at improving support for informal caregivers and their access to information. The interventions are currently implemented in five health care settings in the Netherlands and Belgium. The outcomes of the interventions will be analysed using a qualitative design. The process of implementation is evaluated using the Behaviour Change Wheel by Michie et al. (2011) and the Theoretical Domains Framework (TDF) of behaviour change by Atkins et al. (2017). Results/findings. To inform the development of the interventions 18 HCP from several disciplines were interviewed. Four themes were derived: “aphasia impedes rehabilitation”, “aphasia causes negative feelings”, “improving communication with PWA” and “changing the organisation”. These themes were used to construct the intervention that included CPT for all HCP in mixed groups, the development of aphasia friendly materials and a strategic plan for embedding of the principles of the intervention in the organisation. Interviews with PWA and their informal caregivers show that they have both positive and negative experiences with communication in health centres. The large majority agrees that informal caregivers have a need for more information on aphasia; that they are not ready to receive CPT in the first year post stroke of their partner; and that they should be better monitored during rehabilitation of their partner. Conclusions. Current service provision for PWA in the Netherlands can and should be improved from the perspectives of HCP, PWA and informal caregivers. This will only be achieved by combining training of HCP, with organisational changes that facilitate behaviour change in HCP. We show that by actively and systematically involving users and recipients in the development and evaluation of a complex intervention such as generic CPT in health care organisations, the process of implementation and changes of success are increased.

References

Atkins, L., Francis, J., Islam, R., O’Connor, D., Patey, A., Ivers, N., ... & Lawton, R. (2017). A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implementation Science, 12(1), 77. Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ (Clinical Research Ed.), 337 Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 42. Simmons- Mackie N, Raymer A, C. L. (2016). Communication Partner Training in Aphasia: An Updated Systematic Review. Arch Phys Med Rehabil, 97(12), 2202–2221.

Keywords: Health care professional beliefs, informal care givers, Conversation partner training, Medical Research Council (MRC), complex intervention development

Conference: Academy of Aphasia 57th Annual Meeting, Macau, Macao, SAR China, 27 Oct - 29 Oct, 2019.

Presentation Type: Platform presentation

Topic: Eligible for student award

Citation: Van Rijssen M, Van Ewijk L, Veldkamp M, Ter Wal N, Remijn L, Goossens P, Vandenborre D, Bryon E and Van Grondelle J (2019). CommuniCare. Developing and evaluating an intervention aimed at improving the communication environment for people with aphasia in health care settings.. Front. Hum. Neurosci. Conference Abstract: Academy of Aphasia 57th Annual Meeting. doi: 10.3389/conf.fnhum.2019.01.00020

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Received: 25 Apr 2019; Published Online: 09 Oct 2019.

* Correspondence: Ms. Maren Van Rijssen, HU University of Applied Sciences Utrecht, Utrecht, Netherlands, maren.vanrijssen@hu.nl