Oral Presentation Australian and New Zealand Stroke Organisation Conference 2026

Beyond single-site implementation: Insights from adapting the CHAT implementation strategy at scale (138959)

Kirstine Shrubsole 1 2 , Emma Power 3 , Natasha Lannin 4 5 , Woon Ki Chew 1 2 , Jade Dignam 1 2 , Emma Caird 1 2 , Hannah Wedley 1 2 , David Copland 1 2
  1. Queensland Aphasia Research Centre, The University of Queensland, Brisbane
  2. STARS Education and Research Alliance, Metro North Hospital and Health Service, Brisbane
  3. Graduate School of Health , University of Technology Sydney, Sydney
  4. Alfred Health, Melbourne, VIC, Australia
  5. Department of Neurosciences, Monash University, Melbourne, VIC, Australia

Background/Aims: The Comprehensive, High-dose Aphasia Treatment (CHAT) program is a modified Intensive Comprehensive Aphasia Program designed for Australian health services. While ICAPs demonstrate improved language and communication outcomes for people with aphasia¹, implementation remains constrained by clinician- and organisational-level barriers. A theoretically-informed implementation strategy previously addressed CHAT barriers within a single service². This study examined the adaptation of that strategy across diverse health services.

Methods: This multicentre non-randomised before-and-after trial is underway across five geographically and contextually diverse sites. Following usual care, all sites received a multi-component implementation strategy comprising: i) executive and stakeholder engagement; ii) web-based training; iii) interactive workshop; iv) resource provision; v) ongoing implementation support; and vi) site champions. Local barrier assessments and readiness checklists informed strategy tailoring, with site-specific action plans guided by a Theoretical Domains Framework³-based survey. Implementation support was recorded using the COST-IS tool⁴ and analysed using descriptive statistics.

Results: To date, 87 clinicians and service managers have completed CHAT training, with all core strategy elements enacted across sites (mean 27.2 actions per site). The site champion component was adapted into a monthly online Community of Practice to accommodate staffing constraints, receiving positive feedback. Implementation has required ongoing alignment with local service models, patient pathways, and workforce demands, with approximately 950 hours of support provided by the research team.

Conclusion: Theory-informed implementation strategies can facilitate new service delivery models when flexibly adapted to end-user and organisational contexts. Systematic documentation of adaptations is critical to understanding their function and informing future scale-up across stroke services.

  1. Dignam, J., et al. (2025). Clinical Effectiveness of the Comprehensive, High-Dose Aphasia Treatment Program for People with Poststroke Aphasia. JSLHR, 68(12), 5938–5949.
  2. Dignam, J., et al. (2025). Implementation of the Comprehensive High-dose Aphasia Treatment (CHAT) program: “A different way of operating”. Aphasiology, 39(1), 64-92.
  3. Cane, J., O'Connor, D., & Michie, S. (2012). Validation of the Theoretical Domains Framework for use in behaviour change and implementation research. Implementation Science, 7, 37.
  4. Donovan, T., et al. (2025). Development of an instrument (Cost-IS) to estimate costs of implementation strategies for digital health solutions. Implementation Science, 20(1), 13.