Johnson, FM; (2015) What works in conversation therapy for aphasia, and how? Searching for mechanisms of change and active ingredients using tools and theory from behaviour change research. Doctoral thesis , UCL (University College London).

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Abstract

While there is a growing evidence base to suggest that conversation therapies for aphasia produce beneficial changes to conversation (Simmons-Mackie, Raymer, Armstrong, Holland & Cherney 2010; Wilkinson & Wielaert 2012) the process and tasks by which these changes are produced have yet to be formally investigated. The Medical Research Council (2008) recommends that developing a theoretically-grounded account of how an intervention creates change should be a key task when designing and evaluating complex interventions. This thesis investigates pathways to change within conversation therapy for people with aphasia and their partners. In order to formally examine processes of change, tools and theoretical models developed to help describe and understand behaviour change interventions within the field of health psychology are drawn on. The primary data for this thesis consist of interviews and discussions held with 16 participants in the Better Conversations with Aphasia programme (Beeke, Sirman Beckley, Maxim, Edwards, Swinburn & Best 2013). Data are analysed using the qualitative method of Framework Analysis (Ritchie & Spencer 1994). Study 1 explores the influences that determine speakers’ behaviour in conversation, with a view to identifying possible routes and obstacles to change. Study 2 then considers participants’ accounts of how and why their behaviour changed as a result of therapy. Study 3 codes the content of therapy using a recently published taxonomy of Behaviour Change Techniques (Michie, Richardson, Johnston, Abraham, Francis, Hardeman, Eccles, Cane & Wood 2013), while Study 4 considers participants’ perceptions of BCA’s most and least successful content. Clinically-relevant outputs include a theory-linked account of how BCA is expected to create change in conversational behaviour, identification of the intervention’s proposed ‘active ingredients’ and recommendations for optimising the therapy. In addition, the benefits and challenges of applying behaviour change theory and research methods to intervention for conversation will be evaluated.

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