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

Area of Science:

• Speech and Language Therapy
• Rehabilitation Science
• Health Services Research

Background:

• People with aphasia face significant challenges in daily life due to language impairments.
• Aphasia-unfriendly environments exacerbate these difficulties, necessitating tailored speech and language interventions.
• Intensive Comprehensive Aphasia Programs (ICAPs) offer a structured approach to address these needs.

Purpose of the Study:

• To apply theory of change (TOC), logic modeling (LM), and dark logic to the Intensive Comprehensive Aphasia Program (ICAP) service delivery model.
• To clarify the hypothesized mechanisms of change and potential adverse outcomes within ICAPs.
• To provide a methodological example for enhancing the theoretical underpinning, design, and evaluation of ICAPs.

Main Methods:

• An extensive literature review and expert discussions informed an initial TOC.
• People with aphasia (n=8) co-constructed the TOC and explored adverse outcomes using focus groups and dark logic modeling.
• The refined TOC was mapped onto a logic model (LM).

Main Results:

• A provisional TOC and LM, incorporating dark logic, was developed for ICAPs.
• The co-construction process highlighted the importance of including people with aphasia in program development.
• Potential risks and adverse outcomes associated with ICAPs were identified.

Conclusions:

• Applying TOC, LM, and dark logic presents challenges but offers a valuable framework for understanding and improving ICAPs.
• This approach enhances the methodological mapping of ICAPs, clarifying theoretical foundations and evaluation strategies.
• Further inclusion of diverse stakeholder groups is recommended for comprehensive TOC application to ICAPs.