A Mixed Methods Evaluation of Implementation Outcomes of a Self-Regulation Strategy for Health Education: Perspectives of Clinicians and Older Adults With and Without Traumatic Brain Injury.

IF 2.3 3区医学 Q1 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY American Journal of Speech-Language Pathology Pub Date : 2025-01-08 DOI:10.1044/2024_AJSLP-24-00100

Amy M Kemp, Katy H O'Brien

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Abstract

Purpose: Effective self-management is key for older adults with and without traumatic brain injury (TBI) to maintain their health, safety, and independence. Self-regulation is one method of promoting self-management. However, it is essential to examine effective methods of self-regulation interventions to maximize the use of such health promotion.

Method: Forty-one older adults (19 with TBI; 22 without TBI) participated in an in-person or telepractice health education intervention for fall prevention with 15 speech-language pathology student clinicians. The intervention was a self-regulation strategy, mental contrasting with implementation intentions (MCII), for promoting fall prevention. This mixed methods study explored treatment adherence and evaluated implementation outcomes through acceptability, appropriateness, feasibility, modifications to treatment, and therapist adherence and client participation.

Results: All participants demonstrated some behavior change. Participants without TBI evaluated the MCII protocol as more acceptable, F(1, 39) = 5.88, p = .018; appropriate, F(1, 39) = 5.34, p = .023; and feasible, F(1, 39) = 9.56, p = .003, than participants with TBI, although all ratings were perceived as neutral or positive. From clinician data, protocol adherence, F(1, 39) = 1.57, p = .22, and client participation, F(1, 39) = 0.10, p = .92, were similar across injury groups, but participants with TBI required more fidelity-consistent modifications to treatment, F(1, 39) = 6.88, p = .012. There were no differences between settings except that those in telepractice had more client participation, F(1, 39) = 21.02, p < .001. Clinicians felt MCII was equally appropriate for both groups in all settings, acceptability: F(1, 48) = 0.082, p = .78; appropriateness: F(1, 48) = 0.554, p = .46; feasibility: F(1, 48) = 0.197, p = .66.

Conclusion: MCII may be a feasible tool to provide health education as it offers enough structure and individualization to be considered appropriate and relevant for older adults, and for novice clinicians to administer and modify as needed based on client needs.

Supplemental material: https://doi.org/10.23641/asha.28074443.

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健康教育自我调节策略实施结果的混合方法评价：临床医生和有和没有创伤性脑损伤的老年人的观点。

目的：有效的自我管理是有或无创伤性脑损伤（TBI）的老年人保持健康、安全和独立的关键。自我调节是促进自我管理的一种方法。然而，必须研究自我调节干预的有效方法，以最大限度地利用这种健康促进。方法：41例老年人(19例TBI；22名无TBI的学生参加了面对面或远程的健康教育干预，与15名语言病理学学生临床医生一起预防跌倒。干预是一种自我调节策略，与实施意图（MCII）进行心理对比，以促进预防跌倒。这项混合方法研究探讨了治疗依从性，并通过可接受性、适当性、可行性、治疗修改、治疗师依从性和客户参与来评估实施结果。结果：所有参与者都表现出一定的行为改变。无TBI的参与者评价MCII方案更可接受，F(1,39) = 5.88, p = 0.018；适当，F(1,39) = 5.34, p = 0.023；和可行性，F(1,39) = 9.56, p = 0.003，比TBI参与者，尽管所有的评级被认为是中性或积极的。从临床数据来看，方案依从性（F(1,39) = 1.57, p = 0.22）和客户参与（F(1,39) = 0.10, p = 0.92）在损伤组之间相似，但TBI患者需要更符合保真度的治疗修改，F(1,39) = 6.88, p = 0.012。除了远程实习的客户参与度更高外，其他设置之间没有差异，F(1,39) = 21.02, p < .001。临床医生认为MCII在所有情况下对两组都同样合适，可接受性：F(1,48) = 0.082, p = 0.78；适宜性：F(1,48) = 0.554, p = 0.46；可行性：F(1,48) = 0.197, p = 0.66。结论：MCII可能是提供健康教育的可行工具，因为它提供了足够的结构和个性化，被认为适合和相关的老年人，并且新手临床医生可以根据客户的需要进行管理和修改。补充资料：https://doi.org/10.23641/asha.28074443。

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来源期刊

American Journal of Speech-Language Pathology AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-REHABILITATION

CiteScore

4.30

自引率

11.50%

发文量

353

审稿时长

>12 weeks

期刊介绍： Mission: AJSLP publishes peer-reviewed research and other scholarly articles on all aspects of clinical practice in speech-language pathology. The journal is an international outlet for clinical research pertaining to screening, detection, diagnosis, management, and outcomes of communication and swallowing disorders across the lifespan as well as the etiologies and characteristics of these disorders. Because of its clinical orientation, the journal disseminates research findings applicable to diverse aspects of clinical practice in speech-language pathology. AJSLP seeks to advance evidence-based practice by disseminating the results of new studies as well as providing a forum for critical reviews and meta-analyses of previously published work. Scope: The broad field of speech-language pathology, including aphasia; apraxia of speech and childhood apraxia of speech; aural rehabilitation; augmentative and alternative communication; cognitive impairment; craniofacial disorders; dysarthria; fluency disorders; language disorders in children; speech sound disorders; swallowing, dysphagia, and feeding disorders; and voice disorders.