This is test MS 21 Feb 2023 (Preprint)

Abstract

BACKGROUND Acquired brain injuries (ABI), such as stroke and traumatic brain injury, affect more than 135 million people globally. Cognitive-communication disorders, in which underlying cognitive difficulties impair communication, are common sequelae of ABI. Cognitive-communication disorders also affect close others who are described as ‘communication partners’. It is internationally recommended best practice for speech-language pathologists to provide communication support to people with ABI and their communication partners. Current research also identifies social media communication as clinically relevant for neurorehabilitation support. The ‘Social Brain Toolkit’ is a novel suite of 3 web-based interventions to support the digital and face-to-face communication rehabilitation of people with ABI amidst growing global burden. However, digital health implementation is complex, and minimal guidance exists for ABI. OBJECTIVE This study aimed to support the implementation of the Social Brain Toolkit by coproducing implementation knowledge with people with ABI, communication partners, clinicians, and leaders in digital health implementation. Specific aims were to (1) prioritize theoretically-informed implementation targets for the Toolkit, (2) understand the identified implementation considerations, (3) coproduce targeted implementation strategies to address them and (4) explore potential interrelationships between implementation considerations and strategies as a complex, adaptive system. METHODS Study participants were a maximum variation sample (N=35) of individuals with living experience of ABI, communication partners, clinicians, and digital health implementation leaders. In an explanatory, sequential, mixed methods design, participants prioritized the top 4 of 7 theoretical domains of the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, for perceived importance to Toolkit implementation. Interview and focus group data were collected and deductively analyzed together with stakeholder co-authors to identify implementation considerations and strategies within each domain and subdomain of the NASSS framework. A collaborative autoethnography of the research was conducted, and relationships between implementation considerations and strategies were identified through posthoc network analysis. RESULTS Across the 4 prioritized domains of ‘Condition’, ‘Technology’, ‘Value Proposition’ and ‘Adopters’, 48 digital health implementation considerations and 52 tailored strategies for both developers and clinicians were generated. Benefits and challenges of coproduction were identified. A posthoc network analysis revealed 172 unique relationships between identified implementation considerations and strategies, with user and persona testing and responsive design identified as the potentially most impactful strategies. CONCLUSIONS People with ABI, close others, clinicians, and digital health leaders coproduced new knowledge of digital health implementation considerations for adults with ABI and their communication partners, as well as strategies tailored to address them. Although the study focused on 4 NASSS domains and was limited by the underrepresentation of some participant demographics, the wealth of actionable implementation knowledge produced supports the coproduction of implementation research with mutually beneficial outcomes for stakeholders and researchers. Complexity-informed approaches may help researchers to understand, prioritize and address digital health implementation needs. INTERNATIONAL REGISTERED REPORT RR2-10.2196/35080

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