Identifying mechanisms of change in a conversation therapy for aphasia using behaviour change theory and qualitative methods.

Fiona M Johnson,Firle Christina Beckley,Jane Maxim,Wendy Best,Suzanne Beeke

doi:10.1111/1460-6984.12279

Abstract

BackgroundConversation therapy for aphasia is a complex intervention comprising multiple components and targeting multiple outcomes. UK Medical Research Council (MRC) guidelines published in 2008 recommend that in addition to measuring the outcomes of complex interventions, evaluation should seek to clarify how such outcomes are produced, including identifying the hypothesized mechanisms of change.AimsTo identify mechanisms of change within a conversation therapy for people with aphasia and their partners. Using qualitative methods, the study draws on behaviour change theory to understand how and why participants make changes in conversation during and after therapy.Methods & ProceduresData were derived from 16 participants (eight people with aphasia; eight conversation partners) who were recruited to the Better Conversations with Aphasia research project and took part in an eight session conversation therapy programme. The dataset consists of in‐therapy discussions and post‐therapy interviews, which are analysed using Framework Analysis.Outcomes & ResultsSeven mechanisms of conversational behaviour change are identified and linked to theory. These show how therapy can activate changes to speakers’ skills and motivation for using specific behaviours, and to the conversational opportunities available for strategy use.Conclusions & ImplicationsThese clinically relevant findings offer guidance about the processes involved in producing behavioural change via conversation therapy. A distinction is made between the process involved in motivating change and that involved in embedding change. Differences are also noted between the process engaged in reducing unhelpful behaviour and that supporting new uses of compensatory strategies. Findings are expected to have benefits for those seeking to replicate therapy's core processes both in clinical practice and in future research.

Highlights

Intervention research is typically focused on the question: Does this treatment work? outcome-focused evidence provides surprisingly little information about how treatment works, and the therapeutic processes that are responsible for producing change
Seven themes were identified in the data, each representing a potential mechanism of conversational behaviour change
The conversational behaviour changes targeted by Better Conversations with Aphasia (BCA) include the active inhibition of barrier behaviours and/or the active adoption, or redirection, of facilitative behaviours—in order to manage strategically the conversational problems caused by aphasia

Summary

Introduction

Intervention research is typically focused on the question: Does this treatment work? outcome-focused evidence provides surprisingly little information about how treatment works, and the therapeutic processes that are responsible for producing change. This study, aims to systematically investigate therapeutic mechanisms of conversational change by exploring participants’ experience within a programme known as Better Conversations with Aphasia (BCA) (Beeke et al 2013b). It will focus on the primary outcomes targeted by BCA, i.e., the adoption of compensatory strategies, and the reduction or termination of conversational barriers. Outcomes & Results: Seven mechanisms of conversational behaviour change are identified and linked to theory These show how therapy can activate changes to speakers’ skills and motivation for using specific behaviours, and to the conversational opportunities available for strategy use. Findings are expected to have benefits for those seeking to replicate therapy’s core processes both in clinical practice and in future research

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Conclusion