A Mixed Methods Evaluation of Implementation Outcomes of a Self-Regulation Strategy for Health Education: Perspectives of Clinicians and Older Adults With and Without Traumatic Brain Injury

Purpose: Effective self-management is key for older adults with and without traumatic brain injury (TBI) to maintain their health, safety, and independence. Self-regulation is one method of promoting self-management. However, it is essential to examine effective methods of self-regulation interventions to maximize the use of such health promotion. Method: Forty-one older adults (19 with TBI; 22 without TBI) participated in an in-person or telepractice health education intervention for fall prevention with 15 speech-language pathology student clinicians. The intervention was a self-regulation strategy, mental contrasting with implementation intentions (MCII), for promoting fall prevention. This mixed methods study explored treatment adherence and evaluated implementation outcomes through acceptability, appropriateness, feasibility, modifications to treatment, and therapist adherence and client participation. Results: All participants demonstrated some behavior change. Participants without TBI evaluated the MCII protocol as more acceptable, F (1, 39) = 5.88, p = .018; appropriate, F (1, 39) = 5.34, p = .023; and feasible, F (1, 39) = 9.56, p = .003, than participants with TBI, although all ratings were perceived as neutral or positive. From clinician data, protocol adherence, F (1, 39) = 1.57, p = .22, and client participation, F (1, 39) = 0.10, p = .92, were similar across injury groups, but participants with TBI required more fidelity-consistent modifications to treatment, F (1, 39) = 6.88, p = .012. There were no differences between settings except that those in telepractice had more client participation, F (1, 39) = 21.02, p < .001. Clinicians felt MCII was equally appropriate for both groups in all settings, acceptability: F (1, 48) = 0.082, p = .78; appropriateness: F (1, 48) = 0.554, p = .46; feasibility: F (1, 48) = 0.197, p = .66. Conclusion: MCII may be a feasible tool to provide health education as it offers enough structure and individualization to be considered appropriate and relevant for older adults, and for novice clinicians to administer and modify as needed based on client needs. Supplemental Material: https://doi.org/10.23641/asha.28074443