Implementing synchronous telehealth with people with dementia: exploring the perspectives of UK speech and language therapists

Abstract

Background Communication difficulties are the main and leading symptom in primary progressive aphasia (PPA), and a common major symptom in all dementia types. Speech and language therapy is the principal treatment for communication difficulties in dementia. However, access is dependent on individual factors (e.g. carer support, travel), service availability and contextual factors (e.g. socio-cultural). One way to increase access is via synchronous telehealth. Despite telehealth becoming increasingly common, there is a paucity of literature investigating implementation factors, or probing the views of therapists using telehealth with people with dementia.Aims To identify contextual factors and determinants to implementing synchronous telehealth with people living with dementia (e.g. PPA) from the perspectives of UK-based speech and language therapists.Methods & Procedures This qualitative study employed focus group methodology to explore UK speech and language therapists’ (SLTs) experiences and perspectives of working with people with dementia via telehealth. Three 90-minute video recorded focus group meetings were transcribed. Utilising content analysis, data were coded deductively using the Theoretical Domains Framework and the Context and Implementation of Complex Interventions framework.Outcomes & Results Ten SLTs were recruited representing the National Health Service and charity sectors. Reported implementation determinants related to therapists’ beliefs about their own professional role and their clients’ capabilities, beliefs about the consequences of using telehealth, environmental context and resource, and emotion. SLTs’ decisions on whether to use telehealth with people with dementia was influenced by macro-level socio-economic, ethical, and epidemiological factors, and by meso-level socio-cultural and political factors.Conclusions This study highlights individual and contextual factors influencing telehealth implementation and sustainability when working with people with dementia. Using theoretical frameworks to investigate UK speech and language therapists’ delivery of telehealth for people with dementia can reveal challenges and value to guide future practice, policy and research.