{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:32:25Z","timestamp":1788849145456,"version":"build-2803163510"},"reference-count":52,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007731","name":"ZNS - Hannelore Kohl Stiftung","doi-asserted-by":"publisher","award":["202204"],"award-info":[{"award-number":["202204"]}],"id":[{"id":"10.13039\/501100007731","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,11,6]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Clinical guidelines recommend high-frequency speech therapy for people with aphasia. Little is known about the experiences of people with aphasia with high-frequency speech therapy, why they do not receive it, what they expect from it and their general wishes and requirements for therapy. The aim of this qualitative study was to investigate the reasons for refusing high-frequency speech therapy and therapy preferences of patients with aphasia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>An interview study with people with aphasia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Interviewees were recruited via snowball sampling in different settings of healthcare system (eg, speech and language practices, self-help groups, clinics of neurorehabilitation).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Twenty-one people with aphasia and one relative participated in semi-structured interviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified five categories of not using high-frequency speech therapy: patient-related factors, health system-related factors, disease-related factors, social-economic factors and organisational factors. Most reasons for non-utilisation are within the domain of the healthcare system and are partly attributable to personnel shortages in care provision and knowledge deficits among healthcare practitioners. Patient therapy preferences notably pertain to the enhancement of speech therapy services, encompassing sessions both inclusive and exclusive of family members as well as the facilitation of information dissemination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>As expected, there were indications of a lack of staff, poor care in rural areas and the influence of being affected by aphasia for a longer period on utilisation behaviour. These factors in the healthcare system and organisational factors are not unknown to those with practical experience, and some of them must and could be changed quickly. This would require a change from the established face-to-face setting in presence to sufficient digital therapy adjuvants. The results of patient-related factors could be a further reason to reflect on speech therapy and its settings and to view and treat people with aphasia in a more holistic, less language-focused way.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-085849","type":"journal-article","created":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T22:20:54Z","timestamp":1733264454000},"page":"e085849","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["<i>\u2018But I have a cat, I have to talk to her now\u2019<\/i>\n                    : a qualitative study on reasons for not participating in guideline-based aphasia therapy from the perspective of patients in German-speaking countries"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3847-4861","authenticated-orcid":false,"given":"Susann","family":"May","sequence":"first","affiliation":[{"name":"Center for Health Services Research, Brandenburg Medical School Theodor Fontane, R\u00fcdersdorf, Brandenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"M\u00fchlensiepen","sequence":"additional","affiliation":[{"name":"Center for Health Services Research, Brandenburg Medical School Theodor Fontane, R\u00fcdersdorf, Brandenburg, Germany"},{"name":"AGEIS, Universit\u00e9 Grenoble Alpes, Saint-Martin-d'Heres, Auvergne-Rh\u00f4ne-Alpes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8422-2151","authenticated-orcid":false,"given":"Laura","family":"Plotho","sequence":"additional","affiliation":[{"name":"FH Joanneum - University of Applied Sciences, Health Studies, Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Darkow","sequence":"additional","affiliation":[{"name":"FH Joanneum - University of Applied Sciences, Health Studies, Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,12,3]]},"reference":[{"key":"2025121514403876000_14.12.e085849.1","unstructured":"Huber W , Poeck K , Springer L . Klinik Und Rehabilitation Der Aphasie (1.Auflg). Stuttgart: Thieme, 2006."},{"key":"2025121514403876000_14.12.e085849.2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2010.201"},{"key":"2025121514403876000_14.12.e085849.3","doi-asserted-by":"crossref","unstructured":"Brady MC , Kelly H , Godwin J , et al . Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev 2016;2016. doi:10.1002\/14651858.CD000425.pub4","DOI":"10.1002\/14651858.CD000425.pub4"},{"key":"2025121514403876000_14.12.e085849.4","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2017-315962"},{"key":"2025121514403876000_14.12.e085849.5","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1016\/S0140-6736(17)30067-3","article-title":"Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting","volume":"389","author":"Breitenstein","year":"2017","journal-title":"Lancet"},{"key":"2025121514403876000_14.12.e085849.6","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.32.7.1621"},{"key":"2025121514403876000_14.12.e085849.7","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000062343.64383.D0"},{"key":"2025121514403876000_14.12.e085849.8","article-title":"Speech and language therapy for aphasia following stroke","volume":"5","author":"Kelly","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121514403876000_14.12.e085849.9","doi-asserted-by":"publisher","DOI":"10.1044\/jslhr.4101.172"},{"key":"2025121514403876000_14.12.e085849.10","first-page":"24","article-title":"Wieder richtig sprechen lernen","volume":"4","author":"Korsukewitz","year":"2013","journal-title":"AP Neurologie Psychiatrie"},{"key":"2025121514403876000_14.12.e085849.11","unstructured":"Neubauer G , Niedermeier C . Wirtschaftlichkeitsanalyse ambulanter therapiepraxen (wat) bericht logop\u00e4die\/sprachtherapie. Institut f\u00fcr Gesundheits\u00f6konomie; 2020. Available: https:\/\/logo-deutschland.de\/wp-content\/uploads\/WAT-Kurzfassung.pdf"},{"key":"2025121514403876000_14.12.e085849.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0263397","article-title":"Guideline adherence in speech and language therapy in stroke aftercare. A health insurance claims data analysis","volume":"17","author":"Schindel","year":"2022","journal-title":"PLoS ONE"},{"key":"2025121514403876000_14.12.e085849.13","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1080\/02687038.2019.1602860","article-title":"Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries","volume":"33","author":"Trebilcock","year":"2019","journal-title":"Aphasiology"},{"key":"2025121514403876000_14.12.e085849.14","doi-asserted-by":"crossref","unstructured":"Monnelly K , Marshall J , Dipper L , et al . Intensive and comprehensive aphasia therapy-a survey of the definitions, practices and views of speech and language therapists in the United Kingdom. Int J Lang Commun Disord 2023;2077\u2013102. doi:10.1111\/1460-984.12918","DOI":"10.1111\/1460-6984.12918"},{"key":"2025121514403876000_14.12.e085849.15","doi-asserted-by":"crossref","unstructured":"Babbitt EM , Worrall L , Cherney LR . \u201cIt\u2019s like a lifeboat\u201d: stakeholder perspectives of an intensive comprehensive aphasia program (ICAP)\". Aphasiology 2021;36. doi:10.1080\/02687038.2021.1873905","DOI":"10.1080\/02687038.2021.1873905"},{"key":"2025121514403876000_14.12.e085849.16","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1177\/2396987317698327","article-title":"Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study-3)","volume":"2","author":"Nouwens","year":"2017","journal-title":"Eur Stroke J"},{"key":"2025121514403876000_14.12.e085849.17","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.55.1.68"},{"key":"2025121514403876000_14.12.e085849.18","unstructured":"Darkow R . Aphasiatherapy: status quo. In: Gorsler A , Dohle C , Liepert J , et al , eds. Curriculum Neurorehabilitation. Hippocampus publishing, Bad Honnef, 2023."},{"key":"2025121514403876000_14.12.e085849.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(00)00065-4"},{"key":"2025121514403876000_14.12.e085849.20","doi-asserted-by":"crossref","DOI":"10.3389\/fresc.2023.1236534","article-title":"Person-centered care for people with aphasia: tools for shared decision-making","volume":"4","author":"Hinckley","year":"2023","journal-title":"Front Rehabil Sci"},{"key":"2025121514403876000_14.12.e085849.21","doi-asserted-by":"publisher","DOI":"10.1007\/BF02879918"},{"key":"2025121514403876000_14.12.e085849.22","unstructured":"Stoycheva K . Intolerance, uncertainty, and individual behaviour in ambiguous situations. In: A Place, a Time and an Opportunity for Growth:Bulgarian Scholars at NIAS. Faber, Veliko Tarnovo, 2011: 63\u201373."},{"key":"2025121514403876000_14.12.e085849.23","first-page":"12","article-title":"Therapiefrequenz in der ambulanten logop\u00e4dischen Praxis","volume":"27","author":"Asmussen","year":"2013","journal-title":"Forum Logop\u00e4d"},{"key":"2025121514403876000_14.12.e085849.24","doi-asserted-by":"publisher","DOI":"10.1080\/02687038.2010.508530"},{"key":"2025121514403876000_14.12.e085849.25","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1093\/brain\/aww002","article-title":"Electrical stimulation of the motor cortex enhances treatment outcome in post-stroke aphasia","volume":"139","author":"Meinzer","year":"2016","journal-title":"Brain (Bacau)"},{"key":"2025121514403876000_14.12.e085849.26","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1007\/s00115-016-0213-y","article-title":"Aphasie: evidenzbasierte Therapieans\u00e4tze","volume":"87","author":"Darkow","year":"2016","journal-title":"Nervenarzt"},{"key":"2025121514403876000_14.12.e085849.27","unstructured":"Darkow R , Faust J , Kroker C . Elektrotherapie in Der Logop\u00e4die. Idstein: Schulz-Kirchner-Verlag, 2024."},{"key":"2025121514403876000_14.12.e085849.28","doi-asserted-by":"crossref","first-page":"3577","DOI":"10.1080\/09638288.2020.1871519","article-title":"What are the factors that may influence the implementation of self-managed computer therapy for people with long term aphasia following stroke? A qualitative study of speech and language therapists\u2019 experiences in the Big CACTUS trial","volume":"44","author":"Burke","year":"2022","journal-title":"Disabil Rehabil"},{"key":"2025121514403876000_14.12.e085849.29","doi-asserted-by":"crossref","first-page":"106111","DOI":"10.1016\/j.jcomdis.2021.106111","article-title":"Telerehabilitation for people with aphasia: A systematic review and meta-analysis","volume":"92","author":"Cacciante","year":"2021","journal-title":"J Commun Disord"},{"key":"2025121514403876000_14.12.e085849.30","unstructured":"Darkow R . Aphasietherapie: status quo. In: Mokrusch T , Gorsler A , Dohle C , et al , eds. Curriculum Neurorehabilitation. Bad Honnef: Hippocampus-Verlag, 2023."},{"key":"2025121514403876000_14.12.e085849.31","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1055\/s-0029-1242743","article-title":"Supervidierte computergest\u00fctzte Benenntherapie mit randomisierten Items: Zwei Einzelfallstudien bei Aphasie","volume":"33","author":"Darkow","year":"2009","journal-title":"Sprache Stimme Geh\u00f6r"},{"key":"2025121514403876000_14.12.e085849.32","unstructured":"Creswell JW . Research Design: Qualitative, Quantitative, and Mixed Method Approaches. California: SAGE, 2003."},{"key":"2025121514403876000_14.12.e085849.33","unstructured":"Kuckartz U . Qualitative Inhaltsanalyse. Beltz Juventa: Weinheim, 2018."},{"key":"2025121514403876000_14.12.e085849.34","unstructured":"IEGUS\/wifor\/iaw 2017: entwicklung der angebotsstruktur, der besch\u00e4ftigung sowie des fach\u2010 kr\u00e4ftebedarfs im nicht\u00e4rztlichen bereich der gesundheitswirtschaft; studie im auftrag des bun\u2010 desministeriums f\u00fcr wirtschaft und energie. Available: www.bmwi.de\/Re\u2010 daktion\/DE\/Publikationen\/Studien\/entwicklung\u2010angebotsstruktur\u2010beschaeftigung\u2010fachkraef\u2010 tebedarf\u2010im\u2010nichtaerztlichen\u2010bereich\u2010der\u2010gesundheitswirtschaft.pdf?__ blob=publication\u2010 File&v=18 [Accessed 15 Sep 2024]."},{"key":"2025121514403876000_14.12.e085849.35","unstructured":"Bundesagentur f\u00fcr arbeit, statistik\/arbeitsmarktberichterstattung, berichte: blickpunkt arbeitsmarkt \u2013 fachkr\u00e4fteengpassanalyse 2023. N\u00fcrnberg, Juni; 2024."},{"key":"2025121514403876000_14.12.e085849.36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.11648\/j.ajtas.20160501.11","article-title":"Comparison of Convenience Sampling and Purposive Sampling","volume":"5","author":"Etikan","year":"2016","journal-title":"AJTAS"},{"key":"2025121514403876000_14.12.e085849.37","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1007\/s00115-023-01572-7","article-title":"Transcranial direct current stimulation to enhance training effectiveness in chronic poststroke aphasia-A challenge for recruiting participants","volume":"95","author":"Unger","year":"2024","journal-title":"Nervenarzt"},{"key":"2025121514403876000_14.12.e085849.38","unstructured":"Sabat\u00e9 E , ed. Adherence to Long-Term Therapies: Evidence for Action. World Health Organization, 2003."},{"key":"2025121514403876000_14.12.e085849.39","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2025121514403876000_14.12.e085849.40","first-page":"22","article-title":"The effectiveness of phonemic and semantic cues on confrontation naming in individuals with aphasia","volume":"4","author":"Monish","year":"2023","journal-title":"Int J Speech Audiol"},{"key":"2025121514403876000_14.12.e085849.41","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1080\/02687038.2019.1686748","article-title":"Phonological cueing of word finding in aphasia: insights from simulations of immediate and treatment effects","volume":"35","author":"Roelofs","year":"2021","journal-title":"Aphasiology"},{"key":"2025121514403876000_14.12.e085849.42","doi-asserted-by":"publisher","DOI":"10.1080\/02687030500268902"},{"key":"2025121514403876000_14.12.e085849.43","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1080\/02687038.2011.599364","article-title":"A comparison of drill- and communication-based treatment for aphasia","volume":"25","author":"Kempler","year":"2011","journal-title":"Aphasiology"},{"key":"2025121514403876000_14.12.e085849.44","doi-asserted-by":"publisher","DOI":"10.1080\/02687030444000714"},{"key":"2025121514403876000_14.12.e085849.45","doi-asserted-by":"publisher","DOI":"10.3310\/hta24290"},{"key":"2025121514403876000_14.12.e085849.46","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1161\/STROKEAHA.123.045183","article-title":"High-Intensity Aphasia Therapy Is Cost-Effective in People With Poststroke Aphasia: Evidence From the COMPARE Trial","volume":"55","author":"Kim","year":"2024","journal-title":"Stroke"},{"key":"2025121514403876000_14.12.e085849.47","unstructured":"Marsh K , Bertranou E , Suominen H , et al . An economic evaluation of speech and language therapy. final report. 2010. Available: https:\/\/samanthaochse.wordpress.com\/wp-content\/uploads\/2013\/05\/matrix_report.pdf [Accessed 15 Sep 2024]."},{"key":"2025121514403876000_14.12.e085849.48","first-page":"400","article-title":"Reframing Clinician Distress: Moral Injury Not Burnout","volume":"36","author":"Dean","year":"2019","journal-title":"Fed Pract"},{"key":"2025121514403876000_14.12.e085849.49","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzr066"},{"key":"2025121514403876000_14.12.e085849.50","doi-asserted-by":"publisher","DOI":"10.1111\/j.1369-7625.2012.00795.x"},{"key":"2025121514403876000_14.12.e085849.51","unstructured":"Ryan M , Patrick H , Deci E , et al . Facilitating health behaviour change and its maintenance: Interventions based on Self-Determination Theory. Eur Health Psychol 2008;2\u20135. Available: https:\/\/www.ehps.net\/ehp\/index.php\/contents\/article\/view\/ ehp.v10.i1.p2"},{"key":"2025121514403876000_14.12.e085849.52","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1002\/j.2048-7940.2006.tb00008.x","article-title":"Outcomes among family caregivers of aphasic versus nonaphasic stroke survivors","volume":"31","author":"Bakas","year":"2006","journal-title":"Rehabil Nurs"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-085849","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T22:40:47Z","timestamp":1765838447000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-085849"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":52,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12,3]]},"published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1136\/bmjopen-2024-085849"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-085849","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12]]}}}