Aphasia and Spirituality: the feasibility of assessment and intervention using WELLHEAD and SHALOM

Abstract

Background: Spiritual aspects of aphasia rehabilitation are poorly understood, though identified within adjustment. Existing spiritual health assessments have not been used with people with aphasia, and no structured program to facilitate intervention has been documented, despite acknowledgments that spirituality is important in health and wellbeing and distinct from quality of life and mental health.
Aims: Mixed methods were used to investigate the accessibility and acceptability of a spiritual health assessment (SHALOM) and WELLHEAD, a toolkit originated by Mumby for spiritual health assessment and intervention, using the religiously neutral dimensions of ‘WIDE, LONG, HIGH and DEEP’.
Method: A Steering group (five people with aphasia) shaped the feasibility study cyclically, agreeing that ‘Meaning and purpose’ defined spirituality, and selecting SHALOM. WELLHEAD was modified collaboratively with the Steering group and Hospital Chaplain. A convenience sample of 10 people with aphasia (discharged from therapy) represented diverse aphasia histories, ages and religious backgrounds. Participants completed a two-hour session using SHALOM, the WELLHEAD toolkit and a feedback questionnaire within video-recorded interviews. Quantitative results from all three components were integrated with a qualitative thematic analysis in NVivo 11 including numerical and descriptive summaries verified by the participants, feedback interview transcripts and field notes with reflections. The thematic analysis was systematically and independently verified by a co-researcher. Feedback from participants was further verified by incorporating their comments from reviewing the overall findings.
Results: Quantitative and qualitative feedback evaluated the materials positively. Thematic analysis provided evidence of the accessibility, acceptability and positive impact of WELLHEAD irrespective of aphasia severity or aetiology, and religious background. ‘Belief’, ‘Faith’ and ‘Religion’ were disambiguated. SHALOM was also linguistically and cognitively accessible with communication support even for those with severe aphasia. Scores from WELLHEAD and SHALOM were compared and set into the context of wider standardisation of SHALOM, providing the first evidence of spiritual health measures in participants with aphasia.
Conclusions: This preliminary work lays foundations for spiritual assessment and intervention in aphasia. Establishing the psychometric properties of SHALOM and WELLHEAD in people with aphasia requires a larger sample. Additional study of intervention is proposed, with clear potential for wider application of WELLHEAD in diverse settings and populations.