Qualitative Insights on Preventive Group Training in LTC Facilities: Key Influencing Factors

The cluster randomised controlled trial OrkA (Orofaciopharyngeal and linguistic-communicative activation in older age) aims to evaluate the efficacy of a preventive group programme for older adults in long-term care (LTC) facilities. The programme objective is to support the maintenance of swallowing, speech and communication skills in later life. Group therapy and preventive services are two options that could help to counteract the current shortage of specialists and long waiting times for speech and language therapy (SLT). However, these strategies are rarely chosen to meet outpatient SLT needs in Germany. Group interventions in LTC facilities for older adults are diverse and have already been researched in various areas. Group interventions that promote language and communication in LTC facilities lead to an increase in well-being. However, group interventions delivered by speech and language therapists in LTC facilities are topics that have received little research attention to date.

The present evaluation was conducted to investigate: (1) the conditions required for a successful group intervention in an LTC setting, and (2) the skillset needed by trainers.

The study involved multiple stakeholders: LTC facilities (including staff and residents) and speech and language therapists (as group trainers). Seven semi-structured interviews were conducted with four group trainers following each intervention. Both the transcription and the qualitative content analysis based on Mayring's approach were carried out using MAXQDA. Categories were developed both deductively and inductively.

The success of preventive intervention programmes for older adults in LTC settings is influenced by external and internal factors. External factors include the institutional conditions of the facilities, room environments and the effectiveness of communication among the different stakeholders (nursing staff, trainers, project administration, residents). Internal factors comprise group characteristics and dynamics, participants limitations and group-related challenges. This interplay necessitates a comprehensive trainers' skill-set, including: (1) disruption management, (2) manual-based programme implementation and adaptation, (3) empathic and appreciative behaviour, (4) self-reflective competencies, and (5) effective facilitation of group processes.

Preventive measures concerning swallowing, speech and communication abilities among older adults in LTC facilities must consider a range of critical conditions. External and internal factors are interdependent and should not be considered in isolation. The trainer's role is pivotal, requiring attentiveness to training objectives, external support structures and the individual needs of group members. Leading a group differs markedly from conducting individual therapy, demanding a wide array of trainer competencies, encompassing methodological, interpersonal and personal skills. Thus, group-based approaches should be incorporated into SLT training programmes.

What is already known on this subject Although prevention measures and group offer can counteract the growing shortage of skilled workers, such programmes are rarely used in outpatient speech and language therapy settings in Germany. In 2023, only 0.2% of speech therapy services were provided in group therapy. There are several reasons for the underuse of group offers. These relate to organisational and financial factors. Other reasons may include speech and language therapists not feeling adequately prepared. Therefore, further evaluation of group therapy settings is required. Especially in combination with prevention it is relevant to evaluate the factors that contribute to success. This may be because speech and language therapists do not feel adequately prepared. In psychology and pedagogy, group phases are known that necessitate management and supervision by group leaders. What this study adds to existing knowledge For further insight into group formats within SLT, a preventive group training aimed at maintaining swallowing, speech and communication skills for older adults in long-term care (LTC) facilities was evaluated. The present findings revealed several factors that influence the implementation of preventive group training for the target group. These factors emphasise the importance of trainers possessing specific methodological and social-communicative competencies to effectively address various internal and external influences. What are the potential or actual clinical implications of this work? Group offers are greater than the sum of their parts. As the group itself is an effective factor, its composition is also important. Trainers and therapists need a wide range of skills to handle different situations. While therapists' knowledge and skills concerning group management are highly relevant, they are not necessarily covered in the training curriculum.