The sustainability of Intensive Comprehensive Aphasia Programs: Perspectives of international ICAP leaders

Background: Intensive Comprehensive Aphasia Programs (ICAPs) are considered a complex intervention because they provide a variety of intensive therapies in individual and group settings for cohorts of individuals with aphasia. While ICAPs have been shown to improve patient outcomes, the factors that contribute to the sustainability of this service delivery model are unknown. Aims: This study aimed to understand the characteristics of sustained ICAPs from the perspective of international aphasiologists actively leading and implementing ICAPs. Methods: Seven international ICAP program leaders participated in semi-structured interviews. A four-stage qualitative content analysis, decontextualization, recontextualization, categorization, and compilation, was conducted by three trained independent raters to identify key themes from the transcribed interviews. The Consolidated Framework for Implementation Research was applied to systematically identify multilevel factors influencing sustainability across diverse international contexts. Results: Two structural factors, program setting and the infrastructure of the staffing model, were central to programmatic sustainability. Three major themes that facilitate sustainability emerged: (1) operationalizing program procedures, (2) making continual intentional programmatic improvements, and (3) having passionate and committed leadership. Four major barriers to sustainability emerged: (1) limitations of the evidence base, (2) resource limitations and restrictions, (3) program accessibility, and (4) programmatic funding challenges and the economics of healthcare. Conclusions: Findings support the classification of ICAPs as complex interventions. Contextualizing the supports and barriers to ICAP implementation offers insight into factors that contribute to program sustainability. Program leaders are deeply committed to the ICAP model and report that securing consistent funding sources and facilitating program access are key factors to connecting patients to this efficacious but resource demanding service delivery model.