Identifying mechanisms of change in a conversation therapy for aphasia using behaviour change theory and qualitative methods.
Fiona M Johnson, Wendy Best, Firle Christina Beckley and 2 others
PMID 27882642WHAT IT FOUND
Conversation partners and people with aphasia described several ways conversation therapy may change behaviour.
Awareness alone was not enough; partners also judged the impact of their behaviour, replaced barriers with facilitators, and shifted priorities from accuracy to communication.
Key findings
01Participants described seven possible mechanisms of conversational change across opportunity, capability and motivation.
02Awareness of one's own conversational behaviour was not enough for change; speakers also needed to evaluate the impact of that behaviour.
03Changing barrier behaviours and adding facilitator behaviours appeared to involve different processes, with facilitator change more complex and variable.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study reports participants' explanations of change, not measured changes in conversation, so it cannot show which mechanisms caused behavioural change. The paper states that the relative strength, importance or universality of the mechanisms cannot be deduced from these data. The post-therapy interviews happened 6 to 24 months after the project, so recollection may be incomplete or reconstructed. More data came from conversation partners than from people with aphasia, and not all people with aphasia were interviewed separately. The during-therapy discussions were partly therapeutic conversations guided by advice and feedback, not neutral research interviews. Coding excluded partner or therapist speculation and ambiguous person-with-aphasia contributions, which may remove important accounts. The paper states it lacks crucial information about which therapy ingredients activated these mechanisms. The paper states that identifying mechanisms does not equate to evidence that they are effective.
The easy way to misread this
Do not read these mechanisms as proof that Better Conversations with Aphasia works or that any one mechanism caused change. The study reports participants' explanations and did not link them to objectively measured conversational outcomes.