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

Figures & data

Table 1. Normalisation Process Theory constructs and Aphasia Psychological Care (APC)

Construct	Explanation and sub-constructs	Operationalisation in this study
Coherence	Differentiating the intervention from usual ways of working. Individual and/or shared understanding about the purpose of an intervention (individual specification and communal specification, respectively. Perceiving the intervention to have value for their work (internalising).	How do clinicians make sense of APC?
Cognitive participation	Initiating; being enrolled or joining in with an intervention. Legitimating, activating, or having continued support for, an intervention	How do clinicians value and legitimise APC?
Collective action	How people do the work required (interactional workability). People’s confidence in one another (relational integration) and confidence that tasks are being allocated appropriately (skill-set workability). Contextual integration or organisational and system-level support for an intervention.	How do clinicians enact, or are enabled to enact APC into their routine work?

Table 2. Survey participant characteristics

Summary of responses
Total consented	44
Total eligible	40
Total datasets ab	40
Completion rate	88%
Professional role: n (%)
SLT	26 (65)
PSY	6 (15)
OT	4 (10)
Other	4 (10)
Work setting(s): n (%)
Primary Care/Community	16 (40)
Inpatient rehabilitation	11 (28)
Acute/sub-acute hospital	8 (20)
Inpatient stroke unit	7 (18)
Early Supported Discharge	5 (13)
3^rd sector support organisation	4 (10)
University	4 (10)
Outpatient rehabilitation	2 (5)
Residential care	1 (3)
Works in multiple settings	10 (25)

Table 3. Summary of integration by triangulation process

	Interviews	Survey	Convergence and completeness
Coherence How do clinicians make sense of APC?	Interview participants were not asked about their familiarity with APC.	Survey participants did not consistently have a clear understanding of the concept of APC (about 1/3 ‘very familiar’; another 1/3 ‘somewhat so’). Less than half felt that APC was part of their current work. However, most were positive around the possibility of APC being part of their future work.	Methodological silence from interview findings. APC implications were generated from survey data only.
Cognitive participation How do clinicians value and legitimise APC?	All participants believed that delivering emotional support was a legitimate part of the SLT role; but identified a need for further clarity around professional scope of practice.	All participants were open to working with colleagues in new ways. Most believed that their SEA involvement was a legitimate part of their role and confirmed their continued support for it.	Partial agreement. Overall, both sets of findings were complementary despite differences in scope and focus. (Interdisciplinary, though predominantly SLT) survey participants were asked questions about the SEA Community of Practice. Interview participants, all SLTs, were asked about supporting emotions with aphasia as part of APC delivery.
Collective action How do clinicians enact or are enabled to enact APC into their routine work?	Participants discerned a need for professional training opportunities and emotional support. Organisational barriers, including lack of access to interdisciplinary colleagues for themselves and their patients, were identified and perceived to exacerbate risk of burn-out.	Most participants were interested in a range of training, support, and networking activities as part of SEA. In the main, they wanted insights into the lived experience of aphasia; case presentations; and opportunities for within- and inter-disciplinary support and mentorship. Organisational, geographical, and technological barriers to partaking in SEA activities were additionally identified.	Partial agreement. Overall, both sets of findings were complementary despite differences in scope and focus, including differences in participant composition. Both datasets complemented one another in highlighting a need for within-discipline support and mentorship. Methodologically, there was silence from survey participants regarding need for professional emotional support and debriefing structures.

Data availability statement

No further data are available in keeping with research ethics requirements.