The use and impact of a supported aphasia-friendly photo menu tool on iPads in the inpatient hospital setting: a pilot study

ABSTRACT

Background: People with aphasia (PWA) may have difficulty accessing information in their environment, including the hospital setting. Prior research has recommended the use of aphasia-friendly text-formatting principles, including using graphics when providing information to PWA. There is limited research into the impact of using such principles for hospital menus.

Aims: To evaluate the impact of an aphasia-friendly menu with assistance from a Speech Pathology Therapy Assistant (SPTA) compared with usual hospital menus in PWA on 1) oral intake, 2) self-reported involvement and 3) ease in meal ordering and 4) meal preference. The secondary aim was to investigate the feasibility of implementing the aphasia-friendly menu by exploring staff and caregiver experiences regarding the perceived barriers and facilitators to its implementation, along with time required to assist PWA to order meals.

Methods and procedures: This embedded mixed-methods design study was piloted at two hospitals in Queensland, Australia. Hospital inpatients with aphasia due to non-progressive neurological damage, their caregivers and SPTAs participated. Each day PWA received either the 1) aphasia-friendly menu: professional photos of menu items on an iPad with SPTA support, or 2) usual hospital menus provided in random order for up to 15 days during their inpatient stay. Each day, oral intake was measured and PWA rated their perceived involvement and ease with ordering from the menu provided on a 10-point Likert scale. SPTAs recorded time assisted using the menus and reported barriers and facilitators to the use of the menus daily. At the completion of the pilot, the PWA’s preferred menu type was recorded, SPTAs participated in a focus group and caregivers completed a questionnaire.

Outcomes and results: There was no significant difference in oral intake between menu types. PWA rated the aphasia-friendly menu more favourably for involvement (p = 0.004) and ease (p = 0.015) when ordering. Nineteen out of 20 PWA who provided a response preferred the aphasia-friendly menu (p = 4 × 10⁻⁵). SPTA comments were analysed using qualitative content analysis and outlined their perceived barriers and facilitators to the use of aphasia-friendly menus, experience with usual menus and recommendations for future directions. Meal ordering was approximately 4.4 minutes longer with PWA using the aphasia-friendly menus.

Conclusions: The aphasia-friendly menu was positively perceived by PWA, caregivers and SPTAs and may be a viable and preferred option for PWA when ordering food in hospitals. Staff are encouraged to consider the contextual barriers and facilitators identified in the pilot, prior to implementation of such aphasia-friendly menus.

KEYWORDS:

• Aphasia
• aphasia-friendly
• hospital
• oral intake
• menu
• picture-based

Acknowledgments

The authors would like to thank the participants with aphasia, their caregivers, SPTAs and treating speech-language pathologists and nursing staff for their engagement in this pilot.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by the Gold Coast Health Allied Health Research Officer Hours; Gold Coast Health “The Improvers” (2015); Gold Coast Health Allied Health Research Clinical Backfill Funding.