Does a champion-led implementation toolkit have the potential to improve aphasia guideline adherence? Results from a feasibility study

Abstract

Purpose: Active implementation efforts are needed to reduce evidence-practice gaps in post-stroke aphasia services. One potential solution is a comprehensive toolkit incorporating evidence-based implementation tools, led by trained Change Champions. We explored the feasibility, acceptability, and potential effectiveness of a prototype toolkit to improve speech-language pathologists' practice.

Method: Mixed-methods, pre-post, feasibility study within one Australian health service (n = 12 speech-language pathologists). Two Change Champions completed training then selected tools to support provision of written aphasia-friendly information for 3 months. Outcome measures included: a) Pre-post medical record audits, b) pre-post behavioural-determinants surveys, and c) post-study clinician focus groups. Data were analysed using descriptive statistics and non-parametric tests for quantitative data and content analysis for qualitative data, then integrated using a convergent interactive approach.

Result: Clinicians perceived the toolkit was feasible and acceptable, and highlighted the benefit of Change Champions and resources in facilitating change. Post-implementation written aphasia-friendly information provision increased by 60% (p = 0.005) and most (12/14) targeted barriers improved, suggesting the toolkit with Change Champion support had the potential to improve practice.

Conclusion: The champion-led implementation toolkit prototype was feasible and acceptable, improving guideline-recommended aphasia care. Result support further development of a theory-informed, tailorable implementation toolkit to improve aphasia services.

Keywords: aphasia; behaviour change; champion; clinical guideline; evidence-based practice; implementation.