Exploring goal-setting in aphasia rehabilitation within the cultural context of experiencing stroke and aphasia from the viewpoints of people with aphasia, their family members, and speech and language therapists in Saudi Arabia: Advocating a context-sensitive approach to goal-setting

Abstract

Background Research into the experience of stroke and aphasia has highlighted the physical, emotional and social burdens on people with aphasia (PWA) and their family members, with research mainly conducted in Europe, the USA and Australia. Revealing the experience of PWA can inform research and clinical practice. In clinical practice, goals are fundamental aspects to the provision of aphasia therapy. The existing literature in the area of therapeutic goals has revealed the views of PWA, their family members and speech and language therapists (SLTs) on goals and goal-setting in the same geographical regions. However, there is no evidence in the literature of studies that have investigated the experience of stroke and goal-setting in aphasia therapy in Saudi Arabia. Aim This study aims to explore therapeutic goal-setting in aphasia rehabilitation within the cultural context of experiencing stroke and aphasia in Saudi Arabia. Methods In-depth, semi-structured, individual interviews were conducted with 29 participants who constitute 11 triads. Each triad involved a person with aphasia, a family member and the SLT in charge of the case. Data from PWA’s case records were also collected. Thematic analysis and grounded theory techniques were used to analyse the data. Results From the data six major themes emerged which are related to the experience of stroke and aphasia, and goal-setting in aphasia rehabilitation in Saudi Arabia. The major themes are as follows: Stroke occurrence and the social context, The impact of stroke and aphasia, Identifying therapeutic goals, Participation in goal-setting, Expectations in aphasia therapy, and The nature of goals in aphasia therapy. Based on the findings of themes, a conceptualisation of goal-setting in Saudi aphasia rehabilitation is presented. Conclusion Exploring the cultural context of the experience of stroke and aphasia provided a new perspective into goal-setting in aphasia rehabilitation that was not reported previously in the literature. The findings suggest that goal-setting in Saudi aphasia rehabilitation is highly context-based, and that the cultural aspect contributes to the dynamics of that process (Islamic faith and collectivism). The findings also suggest that goal-setting in Saudi aphasia rehabilitation is informal and the complexity of it directs the process to be therapist-led. The findings emphasise the role of SLTs in empowering and supporting PWA and their family members in aphasia rehabilitation in a context-sensitive way. It is suggested that supporting the effective involvement of PWA and their family members in the process of goal-setting facilitates reaching matched expectations; thus, increasing motivation, cooperation, and commitment to aphasia therapy. The current study advocates contextual transparency in research and a context-sensitive approach to goal-setting in aphasia rehabilitation.