Evaluating the feasibility of an aphasia-friendly electronic Patient-Reported Outcome intervention: assessing reach, appropriateness, acceptability, and fidelity in post-stroke care – a multimethod study
Year: 2025
Type: article
Abstract: Background: Stroke is a leading cause of disability, often causing cognitive and communicative challenges such as aphasia, which affects one-third of stroke survivors. Aphasia limits people’s ability to express needs and participate in healthcare consultations, exacerbating health inequities. While electronic Patient-Reported Outcome (ePRO) tools can enhance patient engagement, their accessibility for individuals with aphasia remains a challenge. The Aphasia-Customised electronic Patient-Reported Outcome (ACe-PRO) tool was developed to address these barriers using aphasia-friendly design principles. Aims: This study aimed to evaluate the feasibility of ACe-PRO in post-stroke care by examining its reach, appropriateness, acceptability, and fidelity. Key questions included whether the tool could be accessed and completed by people with aphasia and how it integrated into clinical workflows. Methods & Procedures: A multi methods feasibility study was conducted at two Danish stroke ward, outpatient clinics with differing follow-up protocols. Quantitative data were collected from Site A, where 994 ACe-PRO questionnaires were distributed over a year. Completion rates and respondent demographics were analysed using descriptive statistics. Qualitative data were gathered at Site B through semi-structured interviews with 10 individuals with aphasia, 5 relatives, and healthcare professionals, as well as field observations of post-stroke consultations at Site A. Qualitative data were analysed using deductive content analysis. Outcomes & Results: A total of 994 ACe-PRO questionnaires were distributed at Site A, with a completion rate of 36.5% (363 completed). Younger patients showed higher completion rates, while severe cognitive or communicative challenges hindered accessibility for some participants. Interviews with people with aphasia, relatives, and healthcare professionals at Site B revealed that relatives often played a key role in enabling access to and completion of the questionnaire. Participants appreciated the questionnaire as a preparatory tool, but some found it lengthy or emotionally taxing. Nurses noted that ACe-PRO was particularly beneficial for younger, resourceful patients but less effective for individuals with more severe difficulties. Implementation fidelity varied across sites due to differences in clinical workflows. Conclusions: ACe-PRO shows promise as a tool in stroke care but faces challenges related to accessibility, inclusivity, and implementation fidelity. Adjustments are needed to improve structural accessibility, involve relatives, and make the tool more aphasia friendly. Further research should explore barriers faced by people with cognitive and communicative difficulties. Clearer implementation guidelines and stakeholder involvement throughout development are essential to enhance usability and reduce health inequities.
Source: Aphasiology
Language: English
Subfield: Sociology and Political Science
Field: Social Sciences
Domain: Social Sciences
Open Access status: hybrid
OpenAlex ID: W7127580890
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