Creating communicatively accessible environments

6.3 Communicatively accessible environments should be provided for people with aphasia.

Reference: Casey et al., 2023: Qualitative study; D’Souza et al., 2021a,b,c,d; Howe et al., 2008a: Qualitative study; Howe et al., 2008b: Qualitative study; Kagan et al., 2023: Descriptive report of implementation study; O’Halloran et al., 2011: Qualitative study; O’Halloran et al., 2012: Qualitative metasynthesis; Parr et al., 2006: Descriptive report; Simmons-Mackie et al., 2007: Qualitative study; Stans et al., 2017: Scoping review

NHMRC level of Evidence: Qual

Rationale: Environmental communication barriers exist in the physical environment, in the knowledge, skills and attitudes of communication partners, and at the system, service and policy levels (Parr et al., 2006; Howe et al., 2008a; Howe et al., 2008b; O’Halloran et al., 2011, 2012; Stans et al., 2017; Casey et al., 2023; D’Souza et al, 2021d). Reducing these barriers improves communicative access for people with aphasia (Simmons-Mackie et al., 2007; Kagan et al., 2023; D’Souza et al, 2021a,b,c). 

In establishing communicatively accessible environments in healthcare settings, it is recommended that consideration be given to:

•   working at a systems level,
•   working in collaborative teams of people with lived experience of aphasia, healthcare providers and senior management staff, 
•   learning from the experiences people with aphasia and their family members,
•   building long term relationships (Kagan et al., 2023).

Communication partner training is one way of making environments communicatively accessible – see statement 2.7.

References:

1. Casey, K., O'Halloran, R., van den Berg, M. E. L., & Rose, M. L. (2023). "We got there in the end…. somehow, we got there": a qualitative study of healthcare professionals providing care in the community to people with chronic aphasia, and how technology could assist. Disability and Rehabilitation, 1–10. https://doi.org/10.1080/09638288.2023.2256666
2. D’Souza, S., Hersh, D., Godecke, E., Ciccone, N., Janssen, H., & Armstrong, E. (2021a). Patients’ Experiences of a Communication Enhanced Environment model in an acute/slow stream rehabilitation ward and a rehabilitation ward following stroke: A Qualitative Description Approach. Disability and Rehabilitation, 44(21), 6304–6313 https://doi.org/10.1080/09638288.2021.1965226
3. D’Souza, S., Godecke, E., Ciccone, N., Hersh, D., Armstrong, E., Tucak, C., & Janssen, H. (2021b). Investigation of the implementation of a Communication Enhanced Environment model in an acute/slow stream rehabilitation and a rehabilitation ward: A before-and-after pilot study. Clinical Rehabilitation, 36(1), 15–39. https://doi.org/10.1136/bmjopen-2020-043897
4. D’Souza, S., Ciccone, N., Hersh, D., Janssen, H. Armstrong, E., & Godecke, E. (2021c). Staff and volunteer perceptions of a Communication Enhanced Environment model in an acute and a rehabilitation hospital ward: A qualitative description study within a before-and after pilot study. Disability and Rehabilitation, 44(23), 7009–7022. https://doi.org/10.1080/09638288.2021.1977397
5. D’Souza, S., Godecke, E., Ciccone, N., Hersh, D., Janssen, H. Armstrong, E., & (2021d). Hospital staff, volunteers’, and patients’ perceptions of barriers and facilitators to communication following stroke in an acute and private perceptions of a Communication Enhanced Environment model in an acute and private rehabilitation hospital ward: A qualitative description study. BMJ Open, 11(5), doi.org/10.1136/bmjopen-2020-043897.
6. Howe, T., Worrall, L., & Hickson, L. (2008a). Observing people with aphasia: Environmental factors that influence their community participation. Aphasiology, 22(6), 616-643. https://doi.org/10.1080/02687030701536024
7. Howe, T., Worrall, L., & Hickson, L. (2008b). Interviews with people with aphasia: Environmental factors that influence their community participation. Aphasiology, 22(10), 1092-1120. https://doi.org/10.1080/02687030701640941
8. Kagan, A., Simmons-Mackie, N., Villar-Guerrero, E., Chan, M., Turczyn, I., Victor, C.J., Shumway, E., Chan, L., Cohen-Schneider, R., & Baylye, M. (2024) Improving communicative access and patient experience in acute stroke care: An implementation journey. Journal of Communication Disorders, 107:106390 doi: 10.1016/j.jcomdis.2023.106390.
9. O'Halloran, R., Worrall L, Hickson L. (2011). Environmental factors that influence communication between patients and their healthcare providers in acute hospital stroke units: An observational study. International Journal of Language and Communication Disorders, 46 (1), 30-47. DOI: 10.3109/13682821003660380 
10. O’Halloran, R., Grohn, B., & Worrall, L., (2012). Environmental factors that influence communication for patients with a communication disability in acute hospital stroke units: A qualitative metasynthesis. Archives of Physical and Medical Rehabilitation, 93(1), 77-85. DOI: 10.1016/j.apmr.2011.06.039
11. Parr, S., Pound, C., & Hewitt, A. (2006). Communication access to health and social care services. Topics in Language Disorders,, 26, 189–198. 
12. Simmons-Mackie, N., Kagan, A., O’Neill Christie, C., Huijbregts, M., McEwen, S. & Willems, J. (2007). Communicative access and decision making for people with aphasia: Implementing sustainable healthcare systems change. Aphasiology,21(1), 39-66. https://doi.org/10.1080/02687030600798287
13. Stans, S., Dalemans, R., de Witte, L.P., Smeets, H.W.H., & Beurskens, A.J. (2017). The role of the physical environment in conversations between people who are communication vulnerable and health-care professional: a scoping review. Disability and Rehabilitation, 39(25), 2594-2605. doi: 10.1080/09638288.2016.1239769

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 RESOURCES: These resources links are currently being updated 

1. The  Scope  website asks the question "Are you communication accessible?" [broken link]- Visit their site for more information.