Harnessing insights from a community of practice to progress aphasia psychological care in Ireland: A mixed methods integration study informed by normalisation process theory

Background: A range of individual and systemic barriers to delivering psychological care to people living with aphasia are widely reported. An integrated model of care, stepped care, has been proposed. Integrated aphasia care constitutes a complex intervention that necessitates local adaptation and implementation. Whilst a need for better access to aphasia psychological care has been documented in Ireland; no coordinated approach has been developed or actioned. Aims: To discern overarching principles for advancing the implementation of coordinated aphasia psychological care in Ireland by drawing on the perspectives of Speech and Language Therapists (SLTs), Occupational Therapists, and Clinical Psychologists. Methods & Procedures: A convergent parallel mixed methods study comprising qualitative interviews with SLTs; a survey of interdisciplinary stroke professionals; and an integration by triangulation of the interview and survey findings. The implementation science framework Normalisation Process Theory was used as a lens to discern how clinicians make sense of, are enrolled in, and enact aphasia psychological care. Outcomes & Results: Four SLTs were interviewed and there were 40 survey respondents. Empowering clinicians to deliver aphasia psychological care requires training, professional and emotional support, and clarity around the way that care is integrated across settings and disciplines. It is necessary to develop a shared interdisciplinary conceptualisation of such a pathway, and to leverage the apparent desire for change. Conclusions: The findings address a lack of empirical knowledge about the ways in which clinicians might be supported to delivering integrated aphasia psychological care in Ireland. The study will inform ongoing research and has relevance for other jurisdictions.