Acceptability, feasibility and preliminary efficacy of the Peer-led Hub-and-Spoke Community Aphasia Group program

Abstract

ABSTRACT Background Several programs addressing the long-term impacts of aphasia after stroke show promise. However, barriers restrict their implementation at scale. Hub-and-spoke models of care operate in several health contexts to reduce the health care costs associated with health professionals providing all direct services, and to improve the reach of services to communities at distance from the main service. We developed the Peer-led Hub-and-Spoke Community Aphasia Group (Peer-led HS CAG) program to address staff and service availability barriers. The Peer-led HS CAG organises service through a “Hub” of allied and mental health professionals, led by a speech pathologist, who provide consultative and occasional direct services to the aphasia group. The “spokes” are volunteers with and without aphasia, trained and supported by the “Hub” staff to facilitate groups in the community. Aims We aimed to investigate the feasibility, acceptability, and preliminary efficacy of the Peer-led HS CAG program to address long-term impacts of aphasia. Methods & Procedures In a Phase I, proof of concept, mixed methods design we utilised: (1) a pre-post observational quantitative design; (2) an embedded qualitative study using semi-structured in-depth interviews of group facilitators and participants. Four health professionals from speech pathology, psychology, art therapy, and music therapy formed the Hub. Four volunteers were trained as group facilitators over two, half-day sessions prior to the group programs commencing. The 12-week group programme was delivered twice in a community setting, consisting of weekly 2-hour sessions. Seven people with aphasia attended: four in programme one, three in program two. The group program consisted of four compulsory topic sessions and eight “members choice” sessions. Seven close others attended four of the twelve program sessions: two with their family members with aphasia; two with specific “hub” staff input. During the remaining eight weeks of the program close others chose whether to meet independently. Outcome measures were taken at four time points: 6 weeks pre-program; immediately pre-program; immediately after-program; 6-week follow up. Outcomes & Results Four participants showed clinically meaningful gains in communication-related quality of life and three in functional communication immediately post-program or at 6-week follow up. Qualitative interviews confirmed the feasibility and overall acceptability of the program. Close others requested additional sessions specific to their needs. Conclusions The Peer-led HS CAG program is a feasible and acceptable way to address the current lack of community aphasia groups. Future phase II and III research should explore the efficacy and costs of this model.