ICT usage in aphasia rehabilitation – beliefs, biases, and influencing factors from the perspectives of speech and language therapists

Figures & data

Table 1. Participant details – speech and language therapists

Focus Group	SLT	Time spent working as SLT (years)	Time spent working with adults with acquired communication disorders (years)	Percentage of time spent working with adults with acquired communication disorders	Work setting
1	1	10–15	6–10	61–80%	rehab & community
1	2	> 20	15–20	41–60%	community
1	3	6–10	6–10	61–80%	community
1	4	10–15	10–15	< 10%	community & long-term care
2	1	6–10	6–10	< 10%	hospital
2	2	1–5	1–5	61–80%	hospital
2	3	15–20	15–20	81–100%	hospital
3	1	1–5	1–5	11–20%	community
3	2	> 20	> 20	21–40%	community
3	3	1–5	1–5	< 10%	community
4	1	6–10	1–5	41–60%	community
4	2	6–10	1–5	21–40%	community
4	3	1–5	1–5	41–60%	community
4	4	1–5	1–5	61–80%	rehab
4	5	6–10	6–10	61–80%	rehab

Table 2. Themes, subthemes, and quotes

	Subtheme	Supporting quotes
Infrastructure, Resources and Support	Relationships	“And that depends on your working environment, I suppose we can run down the corridor and find the OT and say to them, listen, I notice on task that they are consistently missing the object or the space to the right they are not scanning all the way over” FG4P4“Even that gap between us and IT or programme developers like … how do you meet in the middle … because they don’t know what we want but they could do it and you know that relationship is missing” FG3P3“And you see that’s another level of support … the IT support that we need on the job, do you know, that we could call someone and say you know look will you help me with this and we don’t have that, like we have IT support for the big computers in the office if something goes wrong”. FG3P2
	Service Delivery & Professional Support	“ … actually a specialist IT therapist would be great if we had one of those in every department that went around, not just an IT technician but a specialist SLT IT technician!” FG2P1
	Training Needs	“I’d like more training and more education opportunities” FG4P2“I’m hesitant to use it because you’d be spending so much time teaching them actually how to use an iPad, even though the apps are very intuitive, I think you have to have a mind for it. So like, if you were spending your time being like, ‘oh no, backward, forward, here’s the home button’, showing the basics, I think it would be a bit of a barrier” FG1P3
	Technological Change	“I think technology is so ubiquitous … like everyone has an iPhone and then they’ll know to work an iPad, someone somewhere will know how to work the iPad, so I think that’s a facilitator and even basic functions it’s like go away and take photos of that or go and video on your own phone … that’s very straightforward”. FG4P3
	Time	“It’s the time taken to up-skill on it, and I suppose you can use things like the aphasia software finder website, but you don’t really know. You have to go download it, test it out, you know” FG4P3“we have 45 minutes here I’m not going to spend half of the time that this person has in front of me fighting with the iPad” FG3P2
	Cost	“I think I’m slow enough to recommend it to somebody just because it’s quite pricey” FG1P1
	ICT Access and Availability	“we have three iPads and we do have a lot of [named commercially available programmes] apps on them. Some of the girls use them regularly in their therapy” FG4P2we do have one or two [referencing therapeutic software programmes] unfortunately here for us they’re downloaded to one particular computer, so trying to get access to the room” FG2P3
SLT Beliefs, Biases and Influencers	Ageism	“I suppose I do think well if … and it’s terrible, if they are a younger client they are going to be more willing to use it and it’s terrible, like, and I should automatically think about using it with older clients”. FG3P1“I wonder with that client age group whether … who is wanting the technology?” FG4P5“And I suppose as the years go on, it’s becoming more expected that we are au fait with it [ICT], it’s kind of nearly at this stage you can’t really say oh gosh, I actually don’t know anything about it, I feel I should know something about it, that’s what they are looking for. And as the next generation comes up … they are going to be more demanding of skills and support and knowledge in that area. So I think it’s really, really essential that we get it, that we up skill on it and have the support” FG3P2
	Harmonising Patients with ICT	“ … establishing a patient’s baseline IT skills is probably the initial thing that you do and then develop your programme or your advice around that”. FG4P5“So I think it’s interest and it’s often they ask for it before I produce it or a family will ask for it” FG3P2“I think it’s that difficulty that they think that this magic slate is going to give communication back”. FG3P2
	Questioning Traditional Mind-Sets	“I guess sometimes the IT ones might cue better than you might imagine some family members, you know, unless you’ve done a lot of training with them about cueing and if you imagine them doing a paper-based task at home together, you might wonder how that other person supports them in a task, whereas at least on the iPad you know that they’re going to do appropriate … cueing” FG1P3“But technology is interactive and there is an element of fun about it too, whereas the paper-based stuff is not so fun”. FG3P3“I wouldn’t see any difference between giving paper-based activities or IT-based activities in terms of, kind of, cueing” FG1P2“I struggle with that one [referring to training ICT skills for PwA] because I don’t think that the role is defined for us” FG4P5 // “Yes, if we don’t do it, who will?” FG4P3
	Digital Discomfort	“I think if I were more familiar with them and had more accessibility to them and if I were bringing them very naturally into therapy sessions, I think I would see much quicker” FG3P2“we bought one app and I can’t even remember what it was and then no clients came through for us to use it! And then we forgot about it and we never used it”. FG3 P1“I had a phone call this week from … an outpatients’ son who had downloaded an app that I’ve never heard of and wanted to know my opinion on it. So I just had to say I’ve never heard of it, but I’ll have a look at it … and, I did and then he asked what other apps I’d recommend and I kind of felt slightly panicked” FG1P1
Function and Fit	Therapeutic Practice and Benefits	“And I suppose some clients going home, I suppose if there was going to be a wait for community, they would use the [named commercially available app] app as well” FG3P1“you know the way being dependant on someone else to do the homework with you, they can go away and do it independently and they don’t feel that someone is correcting them whereas they’ll get that feedback from the likes of the [named commercially available] apps and those ones” FG4P3“ … it’s fantastic but I think more often than not they are not doing it themselves [working independently on ICT-delivered homework activities], you are trying to get them to do it or the family”. FG3P2“they [reference to the PwA] still need the face to face support” FG2P1 “I wouldn’t actually completely replace with IT” FG3P2
	Fit for Purpose?	“There’s no quality control, it doesn’t have to reach a certain standard to have ‘Aphasia app’ on it” FG1P2“And some of those low-quality ones offer a free trial, but there’s no way of actually using the free trial. I downloaded a couple of them” FG1P1“Because there is apps there but they don’t have everything that you’d want and how do you move onto the next step or if there was another folder within it, where you know to edit it, you can’t” FG3P3“so like both the Android and the Apple devices now, I find retrofit a lot of accessibility features so not just physical stuff but also things that is really beneficial for our patients with aphasia so using the readability feature just simplifies and declutters like an Irish Independent article so somebody who is milder on the spectrum that would just declutter the whole thing, makes it much easier for them there is no junk on the page for them to have to process” FG4P4
ICT and Living Well with Aphasia	Emotional Effects of ICT	“ … and then they’ve had a stroke and all of a sudden you’re putting this iPad in front of them and they can kind of, with lots of help, get through like, the [named commercially available application] … or something, and there’s great sense of like “I’ve achieved something”“ FG1P2“I guess there’s the risk as well that, when they go home, even if you’ve given them clear instructions about what they’re going to do, when, if they go into the wrong or, you know an ad- area that’s not suitable for them and it’s too challenging, they could easily have a negative experience of it, you know” FG1P3“And often the higher functioning clients, they’re educating us rather than us educating them”. FG1P2
	Levelling the Playing Field	“And I wonder will that [stronger focus on speech output in therapy over total communication] change over time because WhatsApp you know, it’s all more frequently used”. FG4P3“So yea, some of the communication apps, the communication aid apps, are quite nice and I think they are really nice for an iPhone or smart phone, that some people in my experience, some people who wouldn’t bring around a communication book in their pocket will take out an iPhone and communicate with you through an iPhone because it’s much more normal”. FG3P2
	Redefining Independence and Social Affiliation	“And it kept her role pivotal in the family which is so important for mum” FG4P2“I had a lady who did that as well, we developed her strategies over a session or two, I typed them up and then she was, right, took a picture and posted it up to Facebook there and then, and she was like when I’m home at the weekend this is what I want everyone to know how they can support me, how I’m helping myself as well. So, it was just really empowering for her to just take charge. Again, someone who was very cognitively able”. FG4P3

Table 3. Mapping factors identified by speech and language therapists against the unified theory of acceptance and use of technology (Venkatesh et al., 2003)

	Performance Expectancy	Effort Expectancy	Facilitating Conditions	Social Influence	Other factors
Person with Aphasia	Motivation and interest	Visual and cognitive skills	Prior ICT skills Family support with ICT	Family support and encouragement	Age of PwA
Speech and Language Therapists	Provides additional opportunities for practice	ICT skills and competency Paper is dependable	Training IT Support Time (upskilling & setting up) Specialist SLT support		Questioning role of SLT teaching ICT skills
Rehabilitation environment	ICT provides convenient options for augmenting and increasing intensity of therapy		Access to ICT devices and programmes Access to funds WiFi and internet access IT support Technology now part of everyday life		Data protection issues
ICT and programme features	Personalisation and flexibility Quality of programme and apps Feedback and cueing Remote monitoring of progress	Accessibility and ease of use features Touch screen interface	Outdated ICT Remote monitoring of progress Cost of licences	Technology now part of everyday life	Data protection issues
Some factors are mapped more than once as they may be present in more than one level

Venkatesh, V., Morris, M. G., Davis, G. B., & Davis, F. D. (2003). User acceptance of information technology: Toward a unified view. MIS Quarterly, 27(3), 425–478. https://doi.org/10.2307/30036540

 Web of Science ®Google Scholar