Interviews with people with aphasia: Environmental factors that influence their community participation

Background: Speech-language pathologists have been encouraged to create communication-friendly environments to enable the everyday participation of their clients with aphasia. However, we still do not know the scope of the negative environmental factors (barriers) and positive environmental factors (facilitators) that need to be addressed in order to create these types of environments. Aims: This investigation explores the environmental factors that hinder or support the community participation of adults with aphasia. Specifically, the in-depth interview study asked: (a) What environmental factors are perceived by people with aphasia to hinder their community participation? (b) What environmental factors are perceived by people with aphasia to support their community participation? (c) What themes underlie the environmental factors that are perceived to hinder or support the community participation of adults with aphasia? A companion study (Howe, Worrall, & Hickson, in press) reports the findings of an observational investigation that addressed similar research questions. Methods and Procedures: The study used the research strategy of qualitative description. Semi-structured in-depth interviews were conducted with 25 adults with aphasia. All participants had aphasia caused by a stroke, lived in the community, and were at least 6 months post stroke. Informants were 34 to 85 years old with varied aphasia severity as measured by the Western Aphasia Battery. Qualitative content analysis was used to analyse the data. Outcomes and Results: The study identified 156 barriers and 206 facilitators that were grouped into six types of environmental factors (i.e., Barriers Related to other People, Physical Barriers, Societal Barriers, Facilitators Related to Other People, Physical Facilitators, and Societal Facilitators). In addition, the research revealed seven themes: (a) Awareness of Aphasia; (b) Opportunity for Participation; (c) Familiarity; (d) Availability of Extra Support for Communication; (e) Communication Complexity; (f) Message Clarity; (g) Time Available for Communication. Conclusions: This study has identified a wide range of barriers and facilitators and several themes that speech pathologists and policy makers need to consider in order