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Global collaborations in aphasia care need a common language: secondary analysis of organizational and system-level barriers and facilitators to the implementation of best practices
Journal article   Peer reviewed

Global collaborations in aphasia care need a common language: secondary analysis of organizational and system-level barriers and facilitators to the implementation of best practices

Marie-Christine Hallé, Carla Tierney-Hendricks, Megan E. Schliep, Robyn Gibson, Natalie F. Douglas and Kirstine Shrubsole
Aphasiology, Vol.First online, pp.1-27
21/07/2026
DOI: https://doi.org/10.1080/02687038.2026.2703137
Appears in  Recent Faculty of Health Publications

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Abstract

aphasia implementation research secondary analysis organizational factors system-level factors
Background and aims: Barriers and facilitators (e.g. determinants) to the uptake of best practices in aphasia rehabilitation exist at various levels, such as the clinician (e.g. knowledge, skills, and attitudes), the practice to be implemented, and the context in which it is implemented. However, efforts to support implementation of best practices often prioritize targeting individual-level characteristics and less frequently address those related to organizations and systems. This study therefore aimed to identify organizational and system-level barriers and facilitators in implementation science aphasia research; synthesize barriers and facilitators using an implementation framework to map these to a common language; and describe reported implementation strategies and outcomes using established implementation science taxonomies. Methods: A secondary analysis of the most recent and comprehensive scoping review of research in communication sciences and disorders was conducted. Publications related to aphasia rehabilitation were included. Study characteristics, organizational and system-level barriers and facilitators, and implementation strategies and outcomes were extracted from each article. Identified barriers and facilitators were then mapped to the Outer Setting (system-level) and Inner Setting (organizational) constructs of the Consolidated Framework for Implementation Research (CFIR 2.0). Implementation strategies and outcomes were categorized using the Expert Recommendations for Implementing Change and Proctor’s Outcome taxonomies. Results: A total of 15 studies were included in the secondary analysis. Organization-level determinants were present in all studies and predominately related to the CFIR constructs of “Work Infrastructure”; “Available Resources – Materials & Equipment”; “Relative Priority”; “Access to Knowledge & Information”; “Compatibility”; and “Relational Connections”. System-level determinants were documented less frequently (13.3% of studies) and related to the CFIR construct of “External Pressure”. The majority of studies (73.3%) tested an implementation strategy, the most common of which was “Train and Educate”, used in 90.1% of these studies. Organization and System-level implementation outcomes were evaluated less frequently in studies (63.6% and 9%, respectively) compared to individual-level outcomes (100% of studies). Conclusion: The results of this secondary analysis, which uses common language to synthesize organizational and system-level determinants as well as implementation strategies and outcomes measures, could support future coordinated global efforts to overcome these broader barriers in order to accelerate the international adoption of best practices in aphasia.

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