Blogging about research: What makes a successful peer-led aphasia support group?

A brief review of:

Tregea, S., & Brown, K. (2013). What makes a successful peer-led aphasia support group? Aphasiology, 27(5), 581-598.

Motivations

Peer-led aphasia groupFirstly, the reasons I opted to review this article as my inaugural Blog about research were principally: a) my primary interest in speech pathology is working with people with aphasia; b) I’ve had a reasonable amount of direct experience planning and delivering group therapy for adults with aphasia in clinician-delivered groups; and c) I’m currently delivering clinical education for undergraduate students taking placements within as a community rehabilitation service and there has been some discussions about extending the ‘group-type’ approach outside of the clinical situation.

So from just reading the title (which was basically how I chose this article to review) I was hoping to get some sense of what a speech pathologist/therapist might consider doing in order to facilitate successful and sustainable peer-led aphasia support groups.

Aims of the article

The aims are very well represented in the title, but to elaborate in more detail the article sets out to identify:

1) The ‘core components of a successful peer-led aphasia support group, from the perspective of people with aphasia and their family members’ (p584)

2) The information and support needs of group leaders

How the article sets out to achieve these aims

The research adopted a ‘focused ethnographic’ approach, i.e. it sought to understand behaviors, experiences, and perceptions of a focused group of individuals (i.e. those taking part in peer-led aphasia support groups). It did this by utilizing four complementary qualitative aspects which were cross-checked in order to validate the themes that emerged as ones that may identify some of the core components of successful peer-led aphasia support groups. These aspects were:

1) Participants in peer-led groups were observed in these groups on one occasion equating to approximately two hours.

2) Ten members of peer-led groups participated in facilitator-led semi-structured focus groups probings aspects of how their group operate, what they like about the group, what they would like to change, and issues that may arise around the setting up and running of similar groups.

3) Semi-structured interviews with two ‘leaders’ of peer-led support groups for people with aphasia probing aspects around how the group was started, their role as leader, barriers and facilitators to leading the group, and perceptions around the qualities of a successful leader.

4) Written artefacts – written materials that were related to the peer-led groups that could be obtained were reviewed (including information pamphlets and emails from group leaders to group members).

What were the findings?

In identify the core components of a successful peer-led aphasia support group, five primary themes were extracted by the researchers following the qualitative analysis of the four sources of information:

Friendship that group members had developed close friendships as the result of ‘shared experience and mutual understanding’ and that groups were centred around talking about “anything and everything”

Informality – described as a sense of casualness of non-obligation which was observed to promote a feeling of more genuine conversation among group members. This was contrasted to speech pathology delivered group sessions (which some group members were also receiving) where there was greater structure within a ‘controlled’ environment.

A supportive communication environment – – the feeling of a mutually supportive environment where group members were sensitive to the needs of others.

Provision of support – the feeling that the group offers support both to people with aphasia and also their family/carers.

Practical/logistical considerations – the knowledge that practical issues were recognized and dealt with (e.g. a mutually agreed upon time and location that is accessible, with appropriate facilities, no- or low-cost, and a quiet environment)

In identifying the qualities of leaders of peer-led support groups for people with aphasia, the themes identified were:

Informational support – all peer group leaders had received some form of guidance when setting up the group (e.g. from speech pathologists, from members of existing groups)

Practical support – group leaders reported receiving initial practical support and ongoing support, for example in helping to spread the word about the group’s existence, and on organizational issues (e.g. arranging locations and contacting group members). This support came from family members of the leader and/or from speech pathologists.

Attracting new members – leaders reported that they had taken active steps to recruit new members to the group by spreading awareness of the group to local stroke groups and health professionals, and through advertisements on community notice boards and newspapers.

Time and organization – leaders were responsible for contacting group members to remind them of times and locations of meetings. Leaders also reported that they were the main point of contact for new group members.

Personal qualities – leaders reported that confidence and motivation were important qualities in addition to being friendly and ability to facilitate inclusion of all group members.

What are the implications?

As a general conclusion to respond to the question that I was hoping to have addressed in this article, the authors conclude that:

“Speech-language pathologists can play an important role in facilitating the community reintegration of people with aphasia, by providing information about the benefits of peer-led aphasia support groups, as well as assisting people with aphasia to development and sustain more peer-led aphasia support groups in the community” (p596-597)

This is all reasonable given the themes that the authors identified in the research as my own personal thoughts were that speech-pathologists would be most useful in the early stages of setting-up a peer-led aphasia support group.

Then this led me to question: ‘if these are the qualities that represent successful peer-led aphasia support groups, then what are the qualities of unsuccessful peer-led aphasia support groups?’, and then I started to question, ‘how exactly do you define ‘success’ in this context?’

To me it appears that a peer-led support group can be judged to be successful if it exists in the first place, and secondly that it is sustainable, or in other words it has continued to exist for an extended period of time. So this therefore leads to the suggestion that maybe there are no unsuccessful examples of peer-led aphasia support groups as they simply would not be able to sustain themselves, if they can even set-up in the first place. This doesn’t preclude the possibility that previously successful groups may occasionally run into difficulties, for example if the group leader happens to move out of the area. However, such research provides information that can be also be useful to support such groups in addition to newly established or establishing groups.

So, for my own selfish purposes, this research gives me food for thought for when I next happen to be working clinically, or working with clinicians who are working clinically. This is primarily because we all know that real improvements, whether these be in relation to impairment, function, or quality of life, can only really be achieved and maintained if there is continued support outside of the clinic room. This is why such peer-led groups are a good target to aim for as they: a) work towards improving quality of life and potentially other areas; and b) are relatively time-efficient from the clinician’s perspective as they are not directly involved, perhaps other than helping the initial establishment and occasional ongoing organizational support. I’m aware that this final point does suggest that the clinician is ‘taking some credit’ from something they may actually not be directly responsible for, however, the existence of such groups could be invaluable from a service delivery perspective for instance when making prioritization decisions. Simply knowing that continued support exists in the community can make potentially difficult discharge decisions easier for the over-worked speechie.

Note. I’m intending this to be a review and reflection of how this research may impact on the clinical setting as opposed to an in-depth critical appraisal of the research. Therefore, I’m only aiming to give the necessary details in order to give a general idea of what is reported in the research article and not a full-blown critique. This is also my excuse for not leaving sufficient time to do a proper review (but you didn’t hear me say that)

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About chrissp1980
Currently a lecturer in speech pathology in North Queensland, Australia. I'm lecturing in acquired disorders of speech and language and also attempting to enthuse students in conducting clinically-relevant projects using principles of Evidence-Based Practice. Wish me luck!

3 Responses to Blogging about research: What makes a successful peer-led aphasia support group?

  1. Pingback: Blogging about Research #SLPBloggers June Edition | "Talks Just Fine"

  2. Abby says:

    Interesting! I was a co-leader for an aphasia social/support group for people with aphasia and their families while I was in graduate school. But the group was led by student clinicians. What a great concept to have the SLPs take more of a supportive role and have the group actually be led by the “people who know”. I really like the 5 theme outcomes.

    Abby
    Schoolhouse Talk!

    • chrissp1980 says:

      Yes I think things like this are great. It’s a shame there aren’t more of them around. From my experience there may be some geographic areas where there are numerous groups such as this whereas in other areas there’s be nothing. So that’s possibly the gap that speech therapist/pathologists could be working towards filling.

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