Towards an asset-based approach to promoting and sustaining well-being for people with aphasia and their families: an international exploratory study

Background: There is growing interest in interventions that promote positive outcomes and well-being for people with aphasia (PWA) and their families, but provision is inconsistent. An asset-based approach, based on the theory of salutogenesis, focuses on what makes you well rather than ill. This approach has been used successfully across a variety of research fields, including health and social care research and practice, and has the potential to provide coherent strategies to support people living successfully with aphasia. Aim: To explore the relevance and potential of an asset-based approach to promoting and sustaining well-being for PWA and their families, across contexts and cultures. Methods & procedures: Exploratory case studies were carried out in the United Kingdom (UK), Norway, Israel, Ireland, and Denmark in a variety of settings. Following an interpretative paradigm, we used qualitative methods including: interviews; appreciative inquiry; group discussions; and participatory action research. 95 PWA and 25 family members were asked to identify assets within themselves and their communities that promote, sustain and maintain well-being, by responding to: “What makes you feel good/well/healthy?” Data were analysed using thematic analysis. Outcomes & results: An asset-based approach proved to be a powerful means for PWA and family members to explore what helps them live well with aphasia. Key themes were identified: (1) personal journey; (2) helping others; (3) connecting to self; (4) connecting to others; (5) recreation; and (6) personal attributes. Self-identification of assets, within the person and their community, and connections to these, helped PWA and their family members to maintain well-being, overcome barriers and regain confidence. Using this approach, focusing on the person’s recognition, activation and mobilisation of assets, could enhance the person’s understanding and restore meaning around the stroke and onset of aphasia. Conclusion: This novel exploratory research demonstrates the relevance and potential across diverse cultural contexts of taking an asset-based approach to promoting and sustaining well-being for PWA and their families. Focusing on maintaining connections to these assets and developing meaning around the event, could prevent some of the negative sequela of stroke. The “patient–professional” relationship must transform into a collaborative partnership, with time and flexibility needed to introduce this approach. Further research should examine how service providers and PWA could develop and operationalise an asset-based approach in clinical and community settings and identify if there is an optimum timing for introducing this approach along the stroke pathway

Asset-based approaches for stroke survivors with aphasia and their families: promoting and sustaining well-being in the long-term.

Introduction: The undeniable improvements in acute stroke care over recent years have not been matched by more effective post-hospital support for stroke survivors generally or for people with aphasia (PWA) and their families [1,2]. Researchers have begun to turn their attention to factors which promote more positive outcomes and which are associated with the concept of ‘living successfully with aphasia’ [3,4]. Asset-based or asset-focused approaches to supporting people to live well long-term in the community have become an area of increasing interest [5]. Asset-based approaches, founded on salutogenetic theory [6,7] – ‘what makes you feel well’ rather than ‘what makes you feel ill’ – have the potential to provide coherent strategies for people with aphasia and their families to live well and successfully with aphasia, and to be developed through a fundamental transformation of the patient-caregiver relationship into a collaborative partnership [8]. Methods: We used qualitative methods to explore the potential of asset-based approaches for PWA and family members in different contexts of culture, organisation and stage of aphasia. Interviews, group discussions and participatory action research (PAR) were undertaken by members of COST CATs WG5 in the UK, Norway, Israel, Ireland and Denmark, in a series of case studies. We asked: “What makes you to feel good / well / healthy?” ”Which strengths do you find in yourself?” ”Which are the social connections that make you feel good” ”What else can help you?” Results: Drawing on data across all cases, we found that: ‘Reframing towards assets’ was in some cases hard conceptual work, although many participants connected readily to this approach. Getting the terminology and resources right was key in helping to shift and enhance the quality of asset-focused conversations. These provided a powerful tool for empowering PWA and family members, but facilitators needed to set the scene, be flexible and creative. In response to the key questions, overarching themes were: Social interaction and connections to people, places activities and things Being with family Being proactive: doing things for myself and by myself; making the most of opportunities People with aphasia drew on personal strengths: courage, self-belief, determination, a positive outlook, and a sense of humour. Family members made lifestyle changes and emphasised flexibility. These things helped people overcome barriers, find meaning, regain confidence and make friendships or connections that made further things possible. Conclusions : Our findings indicate the feasibility of taking an asset-focused approach to promoting and sustaining wellbeing for PWA and their families. Further research is needed to examine how service providers (health and social care, 3rd sector etc.) could deploy this approach in clinical or other settings