Using the Medical Research Council Framework for the development of a communication partner training intervention for people with primary progressive aphasia (PPA): Better Conversations with PPA

Background: Primary Progressive Aphasia (PPA) is a language-led dementia resulting in a gradual dissolution of language. PPA has a significant psychosocial impact on both the person and their families. Speech and language therapy (SLT) is one of the only available management options, and communication partner training (CPT) interventions offer a practical approach to identify strategies to support conversation. The aim of this study was to define and refine a manual and an online training resource for speech and language therapists to deliver CPT to people with PPA and their communication partners (CPs) called Better Conversations with PPA (BCPPA). Methods: The BCPPA manual and training program were developed using the Medical Research Council framework for developing complex interventions. The six-stage development process included 1. Review of existing literature, 2. Consultation and co-production 3. Development of an initial draft 4. Review by a group of speech and language therapists, using consensus methods 5. Two focus groups to gather opinions of people with PPA and their families 6. Refinement.Results: The BCPPA manual and training program comprises seven modules, and four CPT intervention sessions. Eight important components of CPT were identified in the consensus work undertaken with speech and language therapists, including use of video feedback to focus on strengths as well as areas of conversation breakdown. Three themes arose from the focus groups with people with PPA and their families 1) Timing of intervention, 2) speech and language therapists’ understanding of types of dementia, and 3) Knowing what helps. Refinements to the manual included additional practice activities and useful strategies for the future. Conclusions: Using the MRC framework to develop an intervention that is underpinned by a theoretical rationale based on a review of the literature, increases the likelihood of behaviour change. Co-development of the manual and training materials ensures the intervention will meet the needs of people with PPA and their CPs. Gathering further data from speech and language therapists and people living with PPA and their families to refine the manual and the training materials enhances the feasibility of delivering this in preparation for a phase II NHS-based randomised controlled pilot-feasibility study, currently underway.