Achieving 'coherence' in routine practice: a qualitative case-based study to describe speech and language therapy...

Area of Science:

• Implementation Science
• Healthcare Management
• Speech-Language Pathology

Background:

• Successful intervention implementation hinges on healthcare professionals integrating new practices with their routines, a process termed 'coherence work' in Normalisation Process Theory.
• Existing intervention description frameworks lack implementation theory insights, failing to address the complexities of maintaining routine aspects while adapting others.
• Speech and language therapy (SLT) serves as an exemplar to explore practice change and develop a framework for achieving coherence in child speech interventions.

Purpose of the Study:

• To explore therapists' experiences with practice change in child speech interventions.
• To develop a framework illustrating how coherence is achieved in SLT practice.
• To inform the implementation of non-routine interventions by addressing coherence challenges.

Main Methods:

• A retrospective, case-based qualitative study was conducted across three NHS SLT services and private practice in Scotland.
• Forty-two therapists participated through in-depth interviews or focus groups.
• A coherence framework was developed through iterative engagement with empirical data and Normalisation Process Theory.

Main Results:

• Therapists reported diverse practice changes necessitating varied coherence work, with non-traditional interventions posing intellectual challenges to established linguistic assumptions.
• Implementation was logistically demanding, with limited therapist agency to alter service conventions, and required substantial relational effort in explaining interventions to families and tailoring them to individual needs.
• Non-traditional interventions often involved repetitive drills and culturally sensitive elements, increasing the complexity of coherence work.

Conclusions:

• The developed intervention coherence framework offers practical and theoretical utility for anticipating and mitigating implementation barriers, particularly for non-routine interventions.
• The framework aids therapists, services, and researchers in managing the coherence work essential for successful practice change.
• This study exemplifies the use of theory to create user-centered and implementation-friendly intervention descriptions.