Augmentative Communication Research Articles

Spurring Innovation in AAC Technology through Collaborative Dreaming and Needs Finding with Individuals with Developmental Disabilities Who Use AAC.

Millions of individuals who have limited or no functional speech use augmentative and alternative communication (AAC) technology to participate in daily life and exercise the human right to communication. While advances in AAC technology lag significantly behind those in other technology sectors, mainstream technology innovations such as artificial intelligence (AI) present potential for the future of AAC. However, a new future of AAC will only be as effective as it is responsive to the needs and dreams of the people who rely upon it every day. AAC innovation must reflect an iterative, collaborative process with AAC users. To do this, we worked collaboratively with AAC users to complete participatory qualitative research about AAC innovation through AI. We interviewed 13 AAC users regarding (1) their current AAC engagement; (2) the barriers they experience in using AAC; (3) their dreams regarding future AAC development; and (4) reflections on potential AAC innovations. To analyze these data, a rapid research evaluation and appraisal was used. Within this article, the themes that emerged during interviews and their implications for future AAC development will be discussed. Strengths, barriers, and considerations for participatory design will also be described.

Transparency and translucency indices for 1,525 pictograms from the Aragonese Portal of Augmentative and Alternative Communication.

This study investigated the transparency and translucency of 1,525 pictograms from the Aragonese Portal of Augmentative and Alternative Communication (ARASAAC). A total of 521 participants took part in tasks that involved providing the word that best described the meaning of a pictogram or rating the relationship between a pictogram and a verbal label. This process allowed us to obtain indices of transparency (the quality of pictograms that makes their meaning easily "guessable" in the absence of their referent) and translucency (the degree of perceived relationship between the pictogram and its referent when the latter is present) which were further analyzed to assess their reliability and comparability with similar studies. Additionally, the relationship of those indices with various visual and psycholinguistic characteristics was explored, particularly focusing on the match between the original ARASAAC pictogram names and the most frequently provided names by the participants (modal names) for the pictograms. Results showed relatively low levels of transparency, as well as high levels of translucency, with nouns displaying the highest values in both metrics. For transparency and translucency, word imageability and concreteness were the most correlated factors, and, together with age of acquisition, they were the most important features related to the name matching with ARASAAC. The norms derived from this study enhance our understanding of pictogram perception, empowering stakeholders to leverage data-driven insights for the development and implementation of pictographic systems, thus improving cognitive accessibility.

Exploring children's preferences for graphic symbols to represent pain‐related words

AbstractChildren who are hospitalized may sometimes not be able to communicate verbally to self‐report their pain or other symptoms due to medical conditions, medical interventions, or communication difficulties. As such, these children may need other means, such as augmentative and alternative communication (AAC) strategies, in this case, graphic symbols, to express their pain‐related experiences and receive applicable treatment. Choosing suitable graphic symbols to represent pain‐related words contributes to the effective use and implementation of visual support. This study explored the preferences of 6.0–9.11‐year‐old (years; months) children with typical development regarding graphic symbols to represent pain‐related words. These symbols were selected from two commonly used and widespread symbol resources: Picture Communication Symbols (PCS®) and Aragonese Portal of Augmentative and Alternative Communication (ARASAAC) symbols. A descriptive, quantitative study design was employed, including a total of 30 typically developed South African children. Data were collected by means of an electronic questionnaire and analyzed using descriptive and inferential statistics. Probability values were determined and predictions, as well as inferences, were implemented. The results showed that the children preferred ARASAAC symbols to represent most pain‐related words (p < 0.001). It is important to consider stakeholders' (in this case, children's) input on their preferences in designing communication support to enable participation during the clinical decision‐making process.

An intensive eye-tracking intervention in children with dyskinetic cerebral palsy: a multiple case study

This study aimed to explore the effects of a four-week intensive eye-tracking intervention on children with dyskinetic cerebral palsy (DCP), focusing on goal attainment, communication competencies, stress levels, subjective workload, and caregivers’ perception of psychosocial impact. A multiple case study design with non-concurrent, staggered multiple baselines was employed, involving three children aged 7, 12, and 13 years. The study included a randomized baseline period of two or three weeks, an intensive eye-tracking intervention, and a six-month follow-up. Two individual eye-tracking goals were identified and assessed using the Goal Attainment Scale, while communication competencies were evaluated with the Augmentative and Alternative Communication Profile: A Continuum of Learning. Stress levels were monitored through Heart Rate Variability measured by the Bittium Faros 360° ECG Holter during eye-tracking tasks. Subjective workload and psychosocial impact were assessed using pictograms and the Psychosocial Impact of Assistive Devices Scale, respectively. Descriptive statistics were applied for analysis. All participants attained and retained their eye-tracking goals, regardless of their initial functional profiles or prior experience with eye-tracking technology. Post-intervention improvements in communication competencies were maintained at the six-month follow-up. Variations in stress levels, subjective workload, and psychosocial impact were observed among participants across different phases of the study, aiding the interpretation of the results. The study concludes that a structured, tailored, four-week intensive eye-tracking intervention can yield successful results in children with DCP, irrespective of their baseline communication abilities or functional profile. Recommendations for future research, including more robust methodologies and reliable computerized tests, are provided.

‘Because otherwise she’s not doing her job – if she doesn’t listen’: children’s and parents’ views on participation in the assessment process according to the Swedish Disability Act

ABSTRACT Social workers often experience difficulties involving children in the assessment process for disability support, but we know less about how children and their parents experience meeting with social workers in a statutory practicing context. This study examines how increased participation can be possible for children with disabilities throughout the Swedish Disability Act (SDA) assessment process. Eleven children and twelve parents were interviewed, using Talking Mats with the children. Malterud’s phenomenological method was used for analysing the data. Children feel they are listened to, but they need support expressing what they find difficult, and believe Augmentative and Alternative Communication can support their understanding. When planning a meeting, children need information beforehand to be involved in the planning. Parents believe that children should be involved in decision-making; hence, their own involvement is needed. Many children who are eligible for SDA interventions would be able to speak for themselves later in life if introduced to actively participating in assessment processes at a younger age. Accordingly, it becomes important that children with disabilities, together with parents and social workers, also gain experience in talking about sensitive topics. This may, in the long term, alleviate parents’ worries and uncertainty about how to protect their children.

Augmentative and Alternative Communication Assessment for Children on the Autism Spectrum: Protocol Development and Content Validation.

Previous research has shown that many speech-language pathologists (SLPs) lack confidence in conducting augmentative and alternative communication (AAC) evaluations. The AAC Clinical Assessment Project team developed a protocol to help guide SLPs to complete AAC assessments for children with autism spectrum disorder (ASD). This article describes the creation and content validation of the protocol. Two studies were conducted. The first study developed the content of the protocol using information from previous research, observation of two AAC clinical specialists, and interviews with these specialists. In the second study, five specialists in AAC and ASD provided content validation by rating the appropriateness of each item in the protocol. Advisory group meetings were held with the specialists to discuss how to edit the protocol based on the survey results. The final protocol contains a description of each area to be assessed, a rationale for assessing it, and suggested methods to conduct the assessment. The final version of the protocol has excellent content validity. Future research will evaluate the feasibility of using the protocol in clinical practice and whether using the protocol improves the clinical decision making of SLPs when planning AAC assessments. https://doi.org/10.23641/asha.27156207.

Delivering Enhanced Milieu Teaching to Toddlers With Down Syndrome via Hybrid Telepractice: A Single-Case Experimental Design.

This pilot study investigated delivering enhanced milieu teaching tailored for children with Down Syndrome (EMT-DS) through hybrid telepractice. In this multiple-baseline design across behaviors study, a speech-language pathologist (SLP) taught EMT-DS to three caregivers and their children with DS (22-40 months) using a hybrid service delivery model. Sessions were conducted in person and via telepractice. The SLP taught caregivers EMT-DS, emphasizing the use of (a) four target EMT strategies: matched turns, expansions, time delays, and milieu teaching episodes; (b) augmentative and alternative communication (AAC; manual signs, speech-generating device); and (c) aided AAC modeling. The SLP provided caregiver instruction following the teach-model-coach-review approach. Caregiver outcomes were the accuracy (primary) and frequency (secondary) of EMT strategy use. Child outcomes were exploratory and included the rate of symbolic communication acts, weighted number of communication acts, and number of different words (NDW). There was a functional relation between the intervention and the accuracy and frequency of EMT strategy use for all three caregivers. All caregivers showed an increase in the accuracy for all four target strategies. Caregivers also increased the frequency of the three EMT strategies: expansions, time delays, and milieu teaching episodes. There were no changes in the frequency of matched turns. Caregiver use of EMT strategies maintained for 6 weeks post-intervention. After caregivers learned EMT strategies, gradual increases in the rate of symbolic communication acts and NDW occurred for all three children. Results demonstrate the preliminary efficacy of using a hybrid service delivery model to teach caregivers EMT-DS. https://doi.org/10.23641/asha.27115252.

Socio-Communicative Behaviors Involving Minimally Speaking Autistic Preschoolers and Their Typically Developing Peers: Effects of an Augmentative and Alternative Communication Intervention Package.

The purpose of this study was to examine the effectiveness of an augmentative and alternative communication (AAC) intervention package consisting of systematic instruction and aided AAC modeling with speech-output technology on the acquisition, maintenance, and generalization of socio-communicative behaviors in four minimally speaking, preschool-aged, autistic children. A multiple-probe design across behaviors (i.e., initiating a request for a turn, answering questions, and commenting) replicated across participants was implemented to evaluate the effects of the intervention package on socio-communicative behaviors. Furthermore, a pretreatment and posttreatment multiple-generalization-probe design was used to assess generalization across typically developing peers who were not a part of the intervention. Maintenance data were collected 3 weeks post intervention. Visual analysis, corroborated by nonoverlapping of all pairs statistics, established a strong functional relationship between the AAC intervention package and all targeted socio-communicative outcomes for two participants. For the other two participants, inconsistent intervention effects were observed. In terms of generalization from interacting with the researcher to typically developing peers, a functional relationship between the intervention and generalization outcomes for all targeted behaviors was established for only one participant (i.e., Aiden). The outcomes of this study suggest that aided AAC modeling and systematic instruction using a speech-output technology may lead to gains in socio-communicative behaviors in some minimally speaking, preschool-aged, autistic children. https://doi.org/10.23641/asha.27091879.

Adapting and Validating a Patient Prompt List to Assist Localized Prostate Cancer Patients with Treatment Decision Making.

Effective communication between patients and healthcare providers is essential for informed decision making in cancer care. Communication aids that can help prostate cancer patients optimize their involvement in treatment care planning are not widely used in the U.S. This research details the adaptation and validation process of a patient prompt list for localized prostate cancer patients undergoing treatment decisions. This process occurred in three steps: Step 1 involved gathering usable questions from the literature; in Step 2, we evaluated the tool's content via expert (N = 6) feedback; and in Step 3, we assessed the usefulness of the prompt list with patients (N = 30). Sixty percent of candidate questions (20/33) were retained for inclusion after achieving acceptable item-level content validity index (range: 0.83-1.00) and scale-level content validity index (S-CVI = 0.96) scores. The final 20 questions were classified into 5 domains (1: Treatment Options and Information, 2: Side Effects, Risks, and Recovery, 3: Emotional and Social Support, 4: Logistical and Practical Concerns, and 5: Future Health Considerations) through a card sorting exercise with a subset of patients (N = 3) and providers (N = 2). Most patients rated the prompt list as "useful or very useful" both to themselves (80%, N = 24) and to other men presenting with prostate cancer (83%, N = 25). The participatory process used to develop and validate the prompt list offers insights for the development of similar tools.

European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit.

The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.

Listen up! perspectives of people of color who use augmentative and alternative communication in the United States

Every individual has a fundamental right to communicate and access equal opportunities to fully participate in society. However, this right may not be fully manifested for individuals with communication access needs especially those from underrepresented groups. This project had two aims, to determine 1) the specific experiences, challenges, and aspirations related to the cultural identities of people of color (POC) who use augmentative and alternative communication (AAC) and 2) how AAC service providers and manufacturers can support POC AAC users in a culturally and linguistically responsive manner. We conducted an online, asynchronous focus group with seven participants over eight weeks. The participants’ responses were coded qualitatively. Seven major themes were identified: AAC is a Culture, AAC System Features, Self-Identity as a Person of Color who uses AAC, Experience with Service Providers, Improvements to the Field of AAC, Racial Inequities in AAC Support, and Future Research. Suggestions are provided regarding how service providers and manufacturers can serve as better allies to support POC who use AAC.

Patient involvement in fall prevention in an acute care hospital: A survey study

ObjectivesInpatient falls are a major patient safety issue in acute care hospitals. Multifactorial in-hospital fall prevention programs have shown reductions in falls and related risks. One common element of successful programs is active patient involvement. This study objective was to explore patients’ and nurses’ experiences with a structured intervention to foster patient involvement. MethodsThis observational pre-post study was conducted between September 2020 and April 2021 in a university hospital neurological ward. The studied intervention consisted of a falls information leaflet, and a structured nurse-patient conversation about fall risk-reduction activities. Nurses were trained to deliver the intervention and supported throughout the study. Nurses’ and patients’ experiences regarding personal involvement, satisfaction, and confidence were surveyed and analyzed quantitatively and qualitatively. ResultsFifty-six patients recruited by ward nurses received the intervention. After receiving the intervention, patients reported high levels of satisfaction with the in-hospital fall prevention conversation. 21 nurses indicated that they would use the leaflet and communication aid. 21 nurses commented on intervention facilitators and barriers. More specific facilitators included their shared perception that “handing out the leaflet to patients was not problematic” and that the leaflet was seen as “applicable in many patient situations.”Their comments indicated two particularly prominent barriers to conducting the intervention in clinical practice: 1) “finding the time for the implementation in the daily clinical routine and workload” and 2) “environmental factors like a noisy and busy atmosphere on the ward.” ConclusionsThis study provides insights into a patient involvement intervention featuring a structured nurse-patient discussion about fall risks. The accompanying information leaflet and communication guide require adaptations to facilitate sustainable implementation into the hospital’s fall prevention program, but proved useful.

Frequency of Hebrew word usage by children with intellectual and developmental disabilities: implications for AAC core vocabulary

Appropriate vocabulary selection for augmentative and alternative communication (AAC) intervention is crucial to support communication and language development in children with intellectual and developmental disabilities (IDD). Core vocabulary lists are commonly used to guide this process, and there is a need for language-specific consideration. This paper aimed to develop a wordlist for selecting the core vocabulary for AAC intervention for young Hebrew-speaking children with IDD. Five children (age 3;5–8;4) were audio-recorded in naturalistic interactions with an interviewer and family members. Using Levy’s clinical corpus in the Child Language Data Exchange System (CHILDES) and Child Phonology Analyzer (CPA) tools and preestablished codes, wordlists with usage frequencies were extracted and coded for lexeme, lexical categories and functions or content. The percentages of the 20, 50, 100, and 200 most frequent lexemes were calculated for each child and for the five children combined. The top 200 most frequently used lexemes constituted 85% of the composite lexicon. A comparison was made between this study list and a previous list derived from language samples of typically developing (TD). Lexemes representing function words dominated, albeit with a slight preference for content words in children with IDD. Among the content words, children with IDD used more adverbs, while children with TD used more verbs. Implications for AAC core vocabulary are discussed.

In dialogue with the body: a phenomenological exploration of the interrelationship between people who use AAC and their AAC devices

This paper explores the intricate relationship between people who use Augmentative and Alternative Communication (AAC) and their AAC devices. Drawing upon insights from phenomenology, I conducted a modified systematic review to explore the enduring phenomenon of low AAC device adoption and as a means to unravel the moments of embodiment and disembodiment experienced by people who use AAC with their devices. The discussion begins with an introduction to phenomenology as a philosophical inquiry and the guiding principles I employed to explore the phenomenon, namely, parte extra parte and object embodiment. Subsequently, I analyze the hegemony of a device-centric approach within the AAC landscape and delve into the first-person experiences of people who use AAC in living with their devices. Lastly, I discuss the embodiment and disembodiment of people who use AAC with their devices, conceptualize the interrelationship between them, and provide future directions for a more holistic and participatory AAC development and investigation that centers on the lived experiences of people who use AAC.

Implementation of Augmentative and Alternative Communication for People with Severe Intellectual Disabilities: Specialist Perceptions

This study aimed to identify the perceptions of specialists working with people with severe intellectual disabilities regarding the implementation of augmentative and alternative communication. A qualitative approach was used to analyse semi-structured interviews with nine specialists working with people with severe intellectual disabilities at the Comprehensive Rehabilitation Centres in Saudi Arabia. The main results indicated that all specialists had some knowledge of the use of augmentative and alternative communication methods for facilitating communication with people with severe intellectual disabilities, and a diversity of means and methods were discussed. Visual methods were the most widely used at these centres, however, while technological means were the least commonly used by specialists, despite their acknowledged importance. Near consensus also emerged among the specialists regarding the effectiveness and success of such methods in terms of communicating with people with severe intellectual disabilities. The results of the study also indicated that specialists faced numerous challenges in terms implementing augmentative and alternative communication from the people with severe intellectual disabilities themselves, as well as other specialists and centre procedures and staff. The most important proposed solutions for overcoming these challenges was the implementation of training courses to enable specialists to develop their capabilities regarding the use of more diverse methods and the implementation of augmentative and alternative communication with people with severe intellectual disabilities in a manner that allowed them to identify and select those augmentative and alternative communication methods that best align with the capabilities and needs of the relevant persons with severe intellectual disabilities.

Validated patient reported outcome measures in speech-language pathology: A scoping review of adult practice

Purpose Patient reported outcome measures (PROMs) are increasingly used to inform value-based healthcare. Within speech-language pathology (SLP), there is no synthesis of validated PROMs to guide professional practice. This scoping review systematically identifies and evaluates condition-specific PROMs across adult SLP practice. Method A literature search was performed to identify studies published until 18th February 2022 from MEDLINE, Embase, CINAHL, PsycInfo, Scopus, Cochrane Collaboration, and Web of Science. s and full texts were screened in Covidence. Relevant studies that validated PROMs in English were extracted and assessed using the “Checklist to operationalise measurement characteristics of PROMs” by two independent reviewers. Result Ninety-seven articles provided validation data for 71 PROMS across seven SLP practice areas. These included voice (n = 18), swallowing (n = 14), language (n = 11), fluency (n = 8), speech (n = 4), laryngectomy (n = 3), and cognitive-communication (n = 2). No PROMs were identified for augmentative and alternative communication (AAC) (n = 0). Quality ratings were variable on the Francis et al. checklist. Conclusion A range of validated PROMs were identified to guide SLP practice in measuring patient perceptions across a range of practice areas in adults. Opportunities for further development in SLP practice areas with limited PROMs, such as speech, cognitive-communication, and AAC are also highlighted.

Combining low-technology augmentative and alternative communication with regular aphasia treatment: interim findings of a hospital-based RCT in post-stroke patients

ABSTRACT Background Previous research indicates that low-technology (low-tech) augmentative and alternative communication interventions (AACT) can enhance communication skills in individuals with post-stroke aphasia in China. However, there is limited evidence for low-tech AACT in inpatient settings. Aim This study aims to evaluate the impact of low-tech AACT combined with speech-language therapy (SLT) on communication skills related to basic needs, quality of life, and spoken language function among individuals with post-stroke aphasia in an inpatient setting. Methods & Procedures Twelve participants with aphasia having difficulty in daily communication were randomly assigned to an experimental group, receiving 30 minutes of SLT and 30 minutes of low-tech AACT per session (AACT + SLT), or a control group, receiving 60 minutes of SLT per session (SLT), over ten sessions in two weeks. Primary outcomes were measured using the basic needs (CBN) domain of the functional assessment of communication skills for adults (FACS). Secondary outcomes included scores from the Chinese version of the stroke-specific quality of life scale (SS-QOL) and subtests of spoken language production and comprehension from the aphasia battery of Chinese (ABC). The study was registered in the Chinese clinical trial registry (ChiCTR2000028870). Results The results indicated a significant improvement in the CBN domain of FACS in the AACT + SLT group, with larger clinically significant changes compared to the SLT group. The AACT+ SLT group also showed significantly higher overall scores on the SS-QOL and more significant improvements in the content of spontaneous speech than the SLT group after intervention. Comparable improvements were observed in other subtests of the ABC between the two groups. Conclusions Incorporating low-tech AACT into regular SLT in inpatient settings can improve communication for basic needs in an in-patient setting, facilitate language recovery, and potentially support the overall quality of life, compared to SLT alone, for people with post-stroke aphasia. This combined approach demonstrates preliminary feasibility in hospital settings, suggesting the value of low-tech AACT in aphasia rehabilitation.

Together We Can Do Great Things! AAC Teams From the Perspective of Special Education Teachers

Collaborative teams are vital in the service provision for students with complex communication needs. Professional competencies in augmentative and alternative communication (AAC) practices are an essential consideration in the distribution of roles and responsibilities each team member will hold within teams. However, it is unclear to what extent special education teachers consider themselves having a key role within teams that provide AAC services. To better understand their perspectives, an anonymous, web-based survey was disseminated across the United States to gather special education teachers’ views on AAC collaborative teams. A total of 888 special education teachers shared their views on their practices, roles, and responsibilities within AAC teams. Findings indicated that special education teachers agreed they should be part of the AAC team and have specific roles and responsibilities within the team. Practical implications, recommendations, and future research directions are discussed.

Communication Partners' Perceptions of Their Roles and Responsibilities in the Design, Planning and Use of Augmentative and Alternative Communication With Individuals With Severe or Profound Intellectual Disability: A Qualitative Descriptive Study

ABSTRACTBackgroundThis study explores communication partners' perceptions of their roles and responsibilities in the design, planning and use of augmentative and alternative communication (AAC) with individuals with severe/profound intellectual disability.MethodsA qualitative descriptive approach was used. Purposive sampling, data collection and qualitative content analysis were undertaken simultaneously. Data were collected from nine participants, four parents and five professionals over 4 months through audio or video‐recorded, semi‐structured, open‐ended interviews.FindingsAn overarching theme ‘Maximising Communication through AAC’ emerged, capturing participants' unanimous agreement that their shared goal was to optimise individuals' communication through AAC. This was influenced by three themes: ‘Developing a Communicative Environment’, ‘The Act of Communicating; Attempting to Realise the Individuals' Ability’ and ‘Living with Uncertainty’.ConclusionsThese findings contribute to enhancing understanding of AAC use with individuals with severe/profound intellectual disability and their communication partners.

Augmentative and Alternative Communication Interventions in Critical and Acute Care With Mechanically Ventilated and Tracheostomy Patients: A Scoping Review.

Communication with nonspeaking patients is a critical challenge of person-centered care. This scoping review aimed to map the literature on augmentative and alternative communication (AAC) interventions for nonspeaking mechanically ventilated and tracheostomy patients in critical and acute care settings. Electronic database, ancestry, and forward citation searches were conducted using eligibility criteria established a priori. Data were extracted, synthesized, and summarized according to scoping review methodology. Studies were categorized by type of intervention and summarized in terms of purpose, participants, design, quality appraisal (including validity and reliability of selected efficacy measures), and efficacy. Small-to-large treatment effect sizes indicated demonstrable impact on patient health and communication efficacy with high-tech and no-tech visual interface-based interventions and systematic nurse training interventions. Treatment effects primarily pertained to dependent variables of patient anxiety, communication satisfaction, comfort, symptom self-reporting, and nursing practice changes. There is a paucity of high-quality AAC intervention research for mechanically ventilated and tracheostomy patients in critical and acute care settings. Emergent evidence suggests that select visual interface and nurse training interventions can impact efficacy of patient-provider communication and patients' overall health. https://doi.org/10.23641/asha.26506102.