Design Innovation for Engaging and Accessible Digital Aphasia Therapies: Framework Analysis of the iReadMore App Co-Design Process

Abstract

Background iReadMore is a digital therapy for people with acquired reading impairments (known as alexia) caused by brain injury or neurodegeneration. A phase II clinical trial demonstrated the efficacy of the digital therapy research prototype for improving reading speed and accuracy in people with poststroke aphasia (acquired language impairment) and alexia. However, it also highlighted the complexities and barriers to delivering self-managed therapies at home. Therefore, in order to translate the positive study results into real-world benefits, iReadMore required subsequent design innovation. Here, we present qualitative findings from the co-design process as well as the methodology. Objective We aimed to present a methodology for inclusive co-design in the redesign of a digital therapy prototype, focusing on elements of accessibility and user engagement. We used framework analysis to explore the themes of the communications and interactions from the co-design process. Methods This study included 2 stages. In the first stage, 5 in-person co-design sessions were held with participants living with poststroke aphasia (n=22) and their carers (n=3), and in the second stage, remote one-to-one beta-testing sessions were held with participants with aphasia (n=20) and their carers (n=5) to test and refine the final design. Data collection included video recordings of the co-design sessions in addition to participants’ written notes and drawings. Framework analysis was used to identify themes within the data relevant to the design of digital aphasia therapies in general. Results From a qualitative framework analysis of the data generated in the co-design process, 7 key areas of consideration for digital aphasia therapies have been proposed and discussed in context. The themes generated were agency, intuitive design, motivation, personal trajectory, recognizable and relatable content, social and sharing, and widening participation. This study enabled the deployment of the iReadMore app in an accessible and engaging format. Conclusions Co-design is a valuable strategy for innovating beyond traditional therapy designs to utilize what is achievable with technology-based therapies in user-centered design. The co-designed iReadMore app has been publicly released for use in the rehabilitation of acquired reading impairments. This paper details the co-design process for the iReadMore therapy app and provides a methodology for how inclusive co-design can be conducted with people with aphasia. The findings of the framework analysis offer insights into design considerations for digital therapies that are important to people living with aphasia.

Co-design for stroke intervention development: Results of a scoping review

“…Most data sources (n = 73/89, 82%) conducted co-design with multiple participant types (e.g., individuals with stroke, stroke family members/caregivers, stroke clinicians). Of the included data sources, nearly all (n = 87/89, 98%) involved people with stroke, and some specifically targeted individuals with aphasia (e.g., [ 43 , 46 , 57 , 65 , 67 , 92 , 94 ]), with a loss of visual field (e.g., [ 70 ]), current or former hospital inpatients (e.g., [ 32 , 45 , 49 , 50 , 66 , 79 , 86 , 87 ]), with cognitive and/or physical impairments (e.g., [ 85 ]), with certain levels of physical or functional impairments (e.g., “severe upper-limb deficits” [ 91 ] and “mild to moderate level of disability” [ 55 ]), First Nations community members with stroke [ 64 ] and Aboriginal and/or Torres Strait Islander Peoples with stroke [ 43 ]. A few researchers specified that cognitive ability was determined through clinical judgement and/or based on whether an individual could provide informed consent and participate in the study activities [ 74 , 104 ].…”

“…Prioritization was described as an essential part of co-design. Various approaches were used across studies to reach a consensus on priorities for the co-designed stroke intervention, such as focus group discussions and end-users ranking or voting using surveys or other engagement tools (e.g., [ 29 , 35 , 43 , 45 , 49 , 65 , 79 , 94 , 109 ]). Within one study, people with stroke had the final say in resource design if the prioritization results differed between the perspectives of a clinician and a person with stroke [ 65 ].…”

“…More than half of the included data sources (n = 52, 59%) reported an evaluation of the interventions (e.g., sustainability, resources, and feasibility of implementation). Finally, due to the COVID-19 pandemic, some researchers completed online co-design sessions (e.g., [ 46 , 94 ]).…”

“…Strategies used by researchers in our review included adapted or accelerated approaches to co-design [ 45 , 69 ] and the use of asynchronous data collection [ 29 ] or providing travel reimbursements [ 43 ]. In addition, some researchers conducted virtual co-design due to the COVID-19 pandemic [ 46 , 51 , 94 ]. While virtual co-design has benefits, such as reducing the impact of location and functional and cognitive disability on participant engagement in co-design and may require fewer resources [ 152 , 153 ], researchers must consider the unique challenges of conducting co-design virtually, particularly if participants have low digital skills or have cognitive, communication and/or visual challenges [ 149 , 153 , 154 ].…”

“…Virtual hand and arm rehabilitation following stroke (Gameball) Kingsley, 2011 [92] To describe the co-design of solutions to create awareness of aphasia Tools to co-create awareness about aphasia Kjork, 2021 [93] To evaluate a digital tool (the last step in their co-design) Digital tool to support follow-up after stroke (Strokehealth) Kjork, 2022 [51] To describe the development of a digital previsit tool and explore perceptions of people with stroke Pre-visit preparation digital tool (Strokeha ¨lsa [Strokehealth] version 1.0) Langford, 2022 [94] To describe the methodology used to co-design a digital therapy prototype Digital therapy for people with aphasia (iReadMore) Lee, 2022 [95] To describe the iterative design of a physical stroke rehabilitation intervention 1) human-AI collaborative decision-making on rehabilitation assessment for therapists and (2) human-robot collaborative stroke rehabilitation therapy (Continued )…”