"We got there in the end…. somehow, we got there": a qualitative study of healthcare professionals providing care in the community to people with chronic aphasia, and how technology could assist

Figures & data

Table 1. Demographic information of recruited healthcare professionals.

	HCP 1	HCP 2	HCP 3	HCP 4	HCP 5	HCP 6	HCP 7
Professional speciality	GP	Dentist	Optometrist	Psychologist	Physiotherapist	Neuro Occupational Therapist	Stroke Nurse Practitioner
Self-reported number of clients with aphasia worked with in last year^a	2	1	30	1	1	30	50-60
Circumstances of the HCP interactions with people with aphasia	Private Healthcare provider working in own GP practice providing long term GP care to two people with aphasia they had experience with (over a couple of years).	Private healthcare provider working in own Dental practice providing long term dental care to person with aphasia (over 11 years).	Private healthcare provider working in a private practice providing visual assessments and prescriptions of glasses to numerous clients reported to be aphasic. Clients reportedly often returned for annual check-ups.	Private healthcare provider working in a private practice providing long term psychology care over a year or so to the one person with aphasia.	Private healthcare provider working in a private practice providing long-term home-based service for NDIS participant with the one person with aphasia.	Public healthcare provider working in a specialist stroke team for large public health service, providing short term time-limited outpatient and home-based rehabilitation to people with aphasia within the stroke team.	Public healthcare provider working in a specialist stroke team for large public health service, providing short term time-limited outpatient and home-based education and support to people with aphasia within the stroke team.
Received supported conversation training for PWA	No	No	No	No	No	Yes	Yes

^a At least one client seen in the last 6 months to be eligible for interview.

Table 2. Communication situations that HCP believes are helpful and unhelpful within the interactions.

Communication situations HCP believe are helpful within the interaction.	Avoiding chit chat (not doing small talk, trying to keep the communication minimal) Relying on objective assessment (making sure do really good objective testing so they don’t need to respond much) Guess work Allowing more time, slow rate of speech Reducing distraction, i.e., closing door Doing one thing at a time Using eye contact, gesture Taking non-verbal cues from the person with aphasia, i.e., facial expression, gestures Modelling behavior, i.e., “using gesture to assist auditory comprehension.” Repeating back information (to ensure comprehension) Using visual supports, i.e., diagrams, photographs, writing, resources Using technology, i.e., showing videos, googling images Providing person with aphasia with written info for later use Asking person with aphasia for their communication strategies Support from Speech Pathologist, utilising MDT Person with aphasia opened up more when attending alone (rather than with support person) Assistance of significant others; before the interaction (preparing together beforehand), during the interaction (assisting communication), after the interaction (clarifying miscommunications or help with complex documentation) Providing reassurance
HCP situations that are not helpful within the interaction	Distractions in room, i.e., music, others talking HCP had no expertise to draw on Not using resources (if limit self to just talking and don’t use accessory communication tools) Family member doesn’t support interaction ,i.e., talking for the person with aphasia Person with aphasia attending alone (with no support person to assist)
Observed successful strategies person with aphasia uses	Person with aphasia telling the HCP what communication strategies help Using writing Texting Using technology/electronic communication aids Using Yes/No Taking their time Using gesture Pausing and taking deep breaths

Key: acronyms; MDT: multidisciplinary team.

Table 3. Subthemes for how technology could help interactions.

Enablers to using tech	Understanding communication techniques for person with aphasia To make interactions easier, i.e., aiding comprehension/ expression Would embrace the technology if it came with person with aphasia^a Portable and adaptable technology Positive opinions that any technology is helpful^a
Barriers to using tech	Older clients may not be tech savvy^a Technology would need to be instigated by person with aphasia^a Uncertainty if person with aphasia could use technology^a Tried some technologies before and found it unsuccessful^a Already know person with aphasia well so don’t really need technology^a May be challenging for GPs due to large range of topics GP’s cover^a
Ideas for development in tech:	Explanation about aphasia and communication strategies “About me” section; information about family names, life experiences, social supports, personalised phrases, explanation of person with aphasia’s health conditions^a Electronic whiteboard for the HCP to write keywords, or person with aphasia to write message Pictures to help person with aphasia’s comprehension Mood scale Pain scale, descriptors of pain Yes/No to verify messages Electronic keyboard to type message or help with eye assessments so person with aphasia could point to letters. Education resources, e.g., secondary prevention for stroke, medications, complex psychology concepts^a Tech enabled pre-appointment activity, i.e., send out basic questions before appointment about what they’re coming for^a Section where person with aphasia could save notes or video function to watch later^a Prompt app, regularly updated, responsive to feedback^a App being all-in-one tool for person with aphasia.

^a Items noted with an Asterix were “new” ideas for technology identified by the HCPs, not from the prototype of the Aphasia app which they viewed.