Designing Caregiver-Implemented Shared-Reading Interventions to Overcome Implementation Barriers.
OBJECTIVE
This study presents an application of the theoretical domains framework (TDF; Michie et al., 2005), an integrative framework drawing on behavior-change theories, to speech-language pathology.


METHODS
A multistep procedure was used to identify barriers affecting caregivers' implementation of shared-reading interventions with their children with language impairment (LI). The authors examined caregiver-level data corresponding to implementation issues from two randomized controlled trials and mapped these to domains in the TDF as well as empirically validated behavior-change techniques.


RESULTS
Four barriers to implementation were identified as potentially affecting caregivers' implementation: time pressures, reading difficulties, discomfort with reading, and lack of awareness of benefits. These were mapped to 3 TDF domains: intentions, beliefs about capabilities, and skills. In turn, 4 behavior-change techniques were identified as potential vehicles for affecting these domains: reward, feedback, model, and encourage. An ongoing study is described that is determining the effects of these techniques for improving caregivers' implementation of a shared-reading intervention.


CONCLUSIONS
A description of the steps to identifying barriers to implementation, in conjunction with an ongoing experiment that will explicitly determine whether behavior-change techniques affect these barriers, provides a model for how implementation science can be used to identify and overcome implementation barriers in the treatment of communication disorders.
Laura M
LM
Justice
Jessica R
JR
Logan
Laura
L
Damschroder
D000328:Adult; D001364:Awareness; D017028:Caregivers / Q000523:psychology; D002675:Child, Preschool; D004644:Emotions; D030141:Feedback, Psychological; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D007805:Language Development Disorders / Q000628:therapy*; D007808:Language Therapy / Q000379:methods* / Q000523:psychology; D008297:Male; D008962:Models, Theoretical; D016032:Randomized Controlled Trials as Topic; D011932:Reading; D012201:Reward; D012959:Socioeconomic Factors; D013066:Speech-Language Pathology / Q000379:methods; D013997:Time Factors