Using intervention mapping to co-design a transitional care intervention for persons with post-stroke aphasia: a protocol paper

Background Persons with aphasia (PwA) and their caregivers experience unmet care needs due to inadequate discharge coordination and fragmented rehabilitation services. Transitional care interventions (TCI) – actions designed to ensure care continuity across settings and providers – have the potential to improve aphasia care delivery and outcomes when tailored to the needs of PwA.Aims This protocol paper aims to: engage a community advisory board (CAB) in the co-design of an aphasia-specific TCI and evaluate the feasibility, acceptability and organizational readiness for implementing this TCI for the inpatient rehabilitation to home transition. We hypothesize that the aphasia-specific TCI will be acceptable and feasible (≥80% rating of ≥4 on a 5-point scale; Theoretical Framework for Acceptability; Feasibility of Intervention Measure).Methods & Procedures Intervention mapping (IM) will guide the co-design and evaluation of the intervention using a CAB, consisting of 10–12 PwA, caregivers, clinicians, and a policy expert. CAB members will participate in 10 virtual workshop sessions over 1 year, generating content for each of the six IM steps. CAB engagement will be measured using the shortened Patient Engagement In Research Scale at 4 timepoints. Following the initial design of the aphasia-specific TCI, we will conduct two cycles of intervention pilot testing-refinement within the stroke unit of an inpatient rehabilitation hospital. Clinician implementors will be trained on the delivery of the intervention. Participants in the two pilot testing cycles will be recruited from the study site and will include the following: 1) 5–8 clinicians representing physiatry, nursing, care management and speech and language therapy disciplines; 2) 6 PwA; and 3) 6 care partners of PwA. Using a convergent mixed methods approach, we will examine acceptability from the perspective of PwA, caregivers, and clinicians and feasibility from clinicians following each of the two pilot tests. After pilot test 2, we will explore organizational readiness using the Clinical Sustainability Assessment Tool. Quantitative data will be summarized using descriptive statistics. Audio-recorded qualitative interview data will be transcribed and analyzed using Rapid Qualitative Analysis methods and informed by the Consolidated Framework for Implementation Research.Conclusions Addressing a research priority and critical gap in aphasia care, this research will yield an aphasia-specific TCI that is patient-centered and feasible to implement within clinical settings. Findings illustrate the use of implementation science methods to address gaps in aphasia care and inform future implementation-effectiveness studies. Ultimately this work will leverage community engagement and system level change to advance transitional care research.