HU University of Applied Sciences, Utrecht, The Netherlands.
Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
Int J Lang Commun Disord. 2021 Nov;56(6):1190-1203. doi: 10.1111/1460-6984.12659. Epub 2021 Aug 9.
Communication between people with aphasia and their healthcare professionals (HCPs) can be greatly improved when HCPs are trained in using supportive conversation techniques and tools. Communication partner training (CPT) is an umbrella term that covers a range of interventions that train the conversation partners of people with aphasia. Several CPT interventions for HCPs have been developed and used to support HCPs to interact successfully with people with aphasia.
The objective of this study was to identify the mechanisms of change as a result of a Dutch CPT intervention, named CommuniCare, in order to evaluate and optimise the intervention.
METHODS & PROCEDURES: A total of 254 HCPs from five different healthcare centres received CommuniCare. An explorative qualitative research design was chosen. Two interviews were conducted with 24 HCPs directly after and 4 months after receiving the training that was part of CommuniCare. Two conceptual frameworks were used to deductively code the interviews. HCPs' perspectives were coded into a four-part sequence following CIMO logic: the self-reported use of supportive conversation techniques or tools pre-intervention (Context), the intervention elements (Intervention) that evoked certain mechanisms (Mechanisms), resulting in the self-reported use of supportive conversation techniques and tools post-intervention (Outcomes). The Capabilities Opportunities Motivation-Behaviour (COM-B) model was used to fill in the Mechanisms component.
OUTCOMES & RESULTS: Three themes were identified to describe the mechanisms of change that led to an increase in the use of supportive conversation techniques and tools. According to HCPs, (i) information, videos, e-learning modules, role-play, feedback during training and coaching on the job increased their psychological capabilities; (ii) information and role-play increased their automatic motivations; and (iii) information, videos and role-play increased their reflective motivations. Remaining findings show HCPs' perspectives on various barriers to use supportive conversation techniques and tools.
CONCLUSIONS & IMPLICATIONS: HCPs in this study identified elements in our CPT intervention that positively influenced their behaviour change. Of these, role-play and coaching on the job were particularly important. HCPs suggested this last element should be better implemented. Therefore, healthcare settings wishing to enhance HCPs' communication skills should first consider enhancing HCPs' opportunities for experiential learning. Second, healthcare settings should determine which HCPs are suitable to have a role as implementation support practitioners, to support their colleagues in the use of supportive conversation techniques and tools.
What is already known on this subject? Several communication partner training (CPT) interventions for healthcare professionals (HCPs) have been developed and used to support HCPs to interact successfully with people with aphasia. To date, there is limited evidence of the mechanisms of change that explain exactly what changes in HCPs' behaviour after CPT and why these changes take place. What this paper adds to existing knowledge Evaluating our CPT intervention by identifying mechanisms of change from the perspectives of HCPs provided us with: (i) a better understanding of the elements that should be included in CPT interventions in different contexts; and (ii) an understanding of the important remaining barriers identified by HCPs to use supportive conversation techniques, even after CPT is implemented. What are the potential or actual clinical implications of this work? This study shows the different intervention elements in our CPT intervention that improve HCPs' capabilities, motivations or opportunities to use supportive conversation techniques and tools. Essential ingredients of CPT according to HCPs in this study were role-play and coaching on the job by an expert and were linked to an increase in HCPs' motivations or beliefs about self-competency. Healthcare settings wishing to enhance HCPs' communication skills should therefore consider appointing implementation support practitioners to coach and support HCPs, and facilitate these practitioners to fulfil this role.
通过培训医疗保健专业人员（HCP）使用支持性对话技术和工具，可以极大地改善失语症患者与其 HCP 之间的沟通。沟通伙伴培训（CPT）是一个涵盖一系列干预措施的总称，这些干预措施培训失语症患者的对话伙伴。已经开发并使用了几种针对 HCP 的 CPT 干预措施，以支持 HCP 与失语症患者成功互动。
本研究的目的是确定荷兰 CPT 干预措施 CommuniCare 的结果机制，以便评估和优化干预措施。
来自五个不同医疗中心的 254 名 HCP 接受了 CommuniCare。选择了一种探索性定性研究设计。在接受培训后直接对 24 名 HCP 进行了两次访谈，培训是 CommuniCare 的一部分。使用两个概念框架对访谈进行了演绎编码。HCP 的观点按照 CIMO 逻辑被编码为四部分序列：干预前自我报告的支持性对话技术或工具的使用（背景）、引发某些机制的干预元素（干预）、导致干预后自我报告的支持性对话技术和工具的使用（结果）。使用能力机会动机-行为（COM-B）模型来填补机制部分。
确定了三个主题来描述导致支持性对话技术和工具使用增加的变化机制。根据 HCP 的说法，（i）信息、视频、电子学习模块、角色扮演、培训期间的反馈以及在职辅导提高了他们的心理能力；（ii）信息和角色扮演提高了他们的自动动机；（iii）信息、视频和角色扮演提高了他们的反思动机。其余的发现显示了 HCP 对使用支持性对话技术和工具的各种障碍的看法。
本研究中的 HCP 确定了我们 CPT 干预措施中的一些元素，这些元素积极影响了他们的行为改变。其中，角色扮演和在职辅导尤为重要。HCP 建议应更好地实施最后一项元素。因此，希望提高 HCP 沟通技巧的医疗保健机构应首先考虑增强 HCP 的体验式学习机会。其次，医疗保健机构应确定哪些 HCP 适合担任实施支持从业者的角色，以支持同事使用支持性对话技术和工具。
这篇论文增加了什么新内容？：目前已知在这个主题上有哪些内容？已经开发并使用了几种针对医疗保健专业人员（HCP）的沟通伙伴培训（CPT）干预措施，以支持 HCP 与失语症患者成功互动。迄今为止，关于 CPT 后 HCP 行为变化的确切解释以及这些变化发生的原因的机制变化证据有限。这篇论文在现有的知识基础上增加了什么？：通过从 HCP 的角度评估我们的 CPT 干预措施来确定变化机制，为我们提供了：（i）更好地理解在不同背景下 CPT 干预措施中应包含的元素；以及（ii）对 HCP 在实施 CPT 后使用支持性对话技术所面临的重要剩余障碍的理解。
这项工作有哪些潜在或实际的临床意义？：这项研究显示了我们 CPT 干预措施中的不同干预元素，可以提高 HCP 使用支持性对话技术和工具的能力、动机或机会。根据本研究中的 HCP，CPT 的基本要素是由专家进行的角色扮演和在职辅导，并与 HCP 动机或自我效能感的增加有关。因此，希望提高 HCP 沟通技巧的医疗保健机构应考虑任命实施支持从业者来辅导和支持 HCP，并为这些从业者提供履行这一角色的便利。
