JCPSLP Vol 23 Issue 2 2021

Implementation science

The Social Brain Toolkit Implementation considerations from the development of a suite of novel online social communication training programs for adults with acquired brain injury and their communication partners Melissa Miao, Emma Power, Rachael Rietdijk, Melissa Brunner, Leanne Togher, and Deborah Debono

Acquired brain injuries (ABI) commonly cause cognitive, behavioural, and communication changes that can dramatically alter the lives and relationships of affected individuals, their families, friends, and communities. The Social Brain Toolkit is a suite of online, evidence- based interventions to improve the in-person and online communication skills of people with ABI and their communication partners. However, even clinically effective electronic health interventions frequently fail to be sustained in real-world clinical settings. Therefore, speech-language pathologists seeking to use evidence-based online interventions like the Social Brain Toolkit need to be aware of potential implementation challenges if these interventions are to become part of routine clinical care. To this end, we use the Non-adoption, Abandonment, Scale- Up, Spread, and Sustainability theoretical framework to (a) describe developers’ efforts to support implementation, and (b) outline and explain potential implementation considerations for clinicians seeking to use evidence-based online interventions like the Social Brain Toolkit in their everyday clinical practice. T he global coronavirus disease 2019 (COVID-19) pandemic has seen a rapid and widespread transition to online health care delivery methods. Although this pervasive societal change has suddenly increased the uptake of telehealth and electronic health (eHealth) interventions, there are significant and varied complexities in the implementation of these forms of health care. Even clinically effective eHealth interventions frequently fail to be sustained long term (Christie et al., 2019) because they enter a resistant, complex, adaptive health care system that involves unpredictable interactions between multiple factors and agents (Greenhalgh et al., 2018). A systematic review of eHealth implementation barriers and facilitators found that success and failure pivoted on factors such as clinician workflow changes

or intervention costs (Granja et al., 2018), and a recent implementation study of eHealth interventions for carers revealed most interventions completely disappeared due to unsustainable business models, even when clinically effective (Christie et al., 2019). It is therefore argued that real-world clinical implementation of eHealth should be considered beyond intervention efficacy and effectiveness (Andersson, 2018). Given intervention design is critical to implementation success (Granja et al., 2018), it is recommended that implementation issues are considered during the development stage (Varsi et al., 2019) by co-designing with end-users themselves (Andersson, 2018; Titov et al., 2019). However, there has been limited implementation focus or end-user engagement in eHealth research to date (Andersson, 2018; Varsi et al., 2019). Additionally, implementation theories that could guide eHealth implementation research are not specific to eHealth and are infrequently used (Christie et al., 2018; Varsi et al., 2019). The Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) theoretical framework (Greenhalgh et al., 2017) synthesises multiple theories of technology implementation, including those concerning sociotechnical systems (i.e., systems that involve both technology and people, such as social media), technological adoption, and user-centred design. It does so within an overarching theory of complex, adaptive systems (Greenhalgh & Abimbola, 2019) to enable the multilevel complexity of eHealth implementation to be examined as early as intervention development. It itemises several eHealth implementation issues and how these might interact, as well as potential ways to reduce complexity to facilitate clinical implementation. Clinicians, services and implementation researchers can use the NASSS framework to systematically consider eHealth implementation challenges in their own clinical contexts, and thus incorporate evidence-based interventions into routine clinical care. Developers can also consider these issues from the outset. As a worked example of this process, we share our use of the NASSS framework as developers the Social Brain Toolkit (“the Toolkit”), a novel suite of three evidence-based online interventions to improve in-person and online communication of people with acquired brain injuries (ABI) and their communication partners. The Toolkit comprises three online social communication training interventions for adults with ABI and their communication partners: (a) convers-ABI-lity; a communication partner training program for adults with

KEYWORDS ACQUIRED BRAIN INJURY

CAREGIVERS DELIVERY OF HEALTH CARE IMPLEMENTATION SCIENCE INTERNET INTERVENTIONS SPEECH-

LANGUAGE PATHOLOGY

THIS ARTICLE HAS BEEN PEER- REVIEWED

Melissa Miao (top) and Emma Power

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JCPSLP Volume 23, Number 2 2021

Journal of Clinical Practice in Speech-Language Pathology