Persevering through communication challenges: a qualitative descriptive exploration of communication experiences in aphasia

Abstract

ABSTRACT Background People with aphasia often experience activity limitations and participation restrictions despite wanting to engage in communication activities that are satisfying and meaningful. Communication partner support, the complexity of the communication environment, and the thoughts and feelings of people with aphasia have important implications for both language processing and communicative participation. The perspectives of PWA about the role that environmental and personal factors (e.g. thoughts and feelings) play in their communication experiences could inform clinical practice. Aims To qualitatively explore the communication experiences of people with aphasia and how environmental demands and personal factors (especially emotional responses) affect these experiences. Methods & Procedures Fourteen participants with aphasia completed semi-structured interviews immediately following testing sessions for a larger mixed-methods project investigating the relationship between mood, attention, and language function. Interview questions related to their everyday communication experiences and how their communication environment affected their communication and concentration as well as how their emotions affected their communication. Interviews were recorded, transcribed orthographically, then analyzed using a generic qualitative descriptive approach. Coding was completed in two rounds, which included inductive and deductive coding. Codes were synthesized by reflexively analyzing code co-occurrence. Outcomes & Results Key antecedent variables included language deficits associated with aphasia and environmental demands, often leading to communication challenges. Participation was highlighted as the principal outcome, ranging from proactive engagement to withdrawal. Mental rehearsal, feelings, and attitudes mediated participation, but feelings and attitudes were also described as outcomes. Communication partners played a pivotal mediating role, often determining positive or negative outcomes. Supportive partners facilitated engagement, optimism, and contentment, while unsupportive partners led to frustration. Conclusions The results of this study highlight the role of various factors in influencing the communication experience of people with aphasia and indicate that, within the context of communication challenges, communication partners, attitudes, feelings, and participation play critical and interacting roles. Preparatory strategies such as mental rehearsal can also facilitate participation. These findings imply that targeting communication partner support, mental rehearsal focused on social scripts, or psychosocial adjustment could have important effects on participation.