Barriers and facilitators to meeting aphasia guideline recommendations: what factors influence speech pathologists' practice?

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