A Provisional Theory of Change and Basic Logic Model for Intensive Comprehensive Aphasia Programs

People with aphasia have a comprehensive range of needs due to their language impairment and its resulting impact on everyday life. Aphasia can be compounded by environments and contexts that are not aphasia friendly. This calls for a range of speech and language interventions targeting the language impairment and its consequences, as modeled by the International Classification of Functioning, Disability and Health. Intensive Comprehensive Aphasia Programs (ICAPs) aim to tackle this issue by providing a range of interventions in a time-limited schedule. However, when this service delivery model was developed, the rationale and evidence base for each component of the model was not clearly defined or mapped out. Applying theory of change (TOC) may be helpful in detailing how the therapeutic input is hypothesized to produce a desired change. A TOC is coconstructed with key stakeholders, people with aphasia in this instance. This process can be mapped on a logic model (LM), and potential negative or adverse outcomes (dark logic) can also be considered. This article provides an overview of ICAPs, key gaps in the literature, and provides a methodological example of how TOC, logic modeling, and dark logic can be applied to an ICAP despite some limitations with the approach.

An extensive scoping of the literature and discussion with aphasia researchers produced an initial TOC, which was then refined by people with aphasia (n = 8) using focus group methodology. The focus group explored potential adverse outcomes of an ICAP using dark logic modeling. The TOC was mapped onto an LM.

A provisional TOC and LM with dark logic for an ICAP was produced, though inclusion of other stakeholder groups is required for thorough application of a TOC to ICAPs.

There are challenges in applying TOC, LM, and dark logic modeling to a service delivery model. However, this approach was useful in mapping an ICAP in a methodological manner and in identifying how the theoretical underpinning, design, outcome measurement, and evaluation of an ICAP including a consideration of risks might be enhanced.

https://doi.org/10.23641/asha.31478488.