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. 2025 Oct 25;60(6):e70150. doi: 10.1111/1460-6984.70150

Intersection of Knowledge to Practice: A Purposeful Integration of Communication Partner Training in Aphasia With Adult Learning Principles for Healthcare Students

Catherine Torrington Eaton 1,✉, Madeline McAvoy 1, Selina Morgan 1, Angela Kennedy 1
PMCID: PMC12552832  PMID: 41137483

ABSTRACT

Background

Communication partner training (CPT) for people with aphasia (PWA) is an evidence‐based approach that supports patients’ abilities to effectively communicate with their healthcare providers. Efforts to create efficient training programmes, which aim to instil appropriate practices and attitudes prior to working with patients, have the potential to induce widespread change in communication access in healthcare settings.

Aims

The current study examined the effectiveness of a novel, scalable CPT programme for healthcare students based on andragogical principles.

Methods and Procedures

Fifteen of 18 allied healthcare students completed training that included (1) a three‐part online module consisting of testimonials from individuals with aphasia, didactic content regarding principles of CPT and communication strategies, and discipline‐specific healthcare scenarios with and without communication support; (2) individualised feedback and self‐reflection regarding ways to improve interaction skills; and (3) an opportunity to practice facilitative conversation skills during a psychosocial aphasia group meeting. The research design enabled within‐group comparisons of students’ knowledge, attitudes, and skills pre‐ and post‐completion of the multi‐component training and between‐group comparisons of interaction skills with online versus no training.

Outcomes and Results

Multi‐component training resulted in meaningful changes in knowledge, attitudes, and skills as observed by effect sizes. The group comparison between those who completed online training versus controls demonstrated statistically significant improvements in facilitative skills, specifically verifying the intended message of the PWA and use of gesture.

Conclusions and Implications

Findings suggest that online CPT that capitalises on learning theories and principles for healthcare education is effective and efficient for training supportive techniques in communication with people with aphasia.

WHAT THIS PAPER ADDS

What is already known on this subject

  • Communication partner training (CPT) can equip future healthcare providers with tools to more effectively communicate with patients with aphasia. Studies have shown such training to be effective for improving knowledge and attitudes in healthcare students, although research to date has yet to demonstrate changes in the actual adoption of facilitative conversation skills.

What does this paper add to existing knowledge

  • This study replicates and extends previous research regarding CPT for healthcare students by demonstrating that online training based on adult learning principles is an effective and efficient tool for training knowledge, attitudes, and skills that facilitate communication with individuals with aphasia. In addition, findings indicate the importance of designing training materials that illustrate facilitative conversation skills in discipline-specific contexts.

What are the potential or actual clinical implications of this work?

  • This study provides a foundation for scaling CPT programming in healthcare education. Widespread adoption of such programming will have a direct impact on healthcare access in individuals with aphasia.

Keywords: aphasia, communication partner training, healthcare students

1. Introduction

The deleterious effects of aphasia on individuals’ healthcare outcomes are well documented. Studies have shown the negative consequences of impaired communication on the ability to access patient‐centred care from acute post‐stroke recovery through more chronic phases when living in the community or in long‐term care settings (Boehme et al. 2016; Flowers et al. 2016; Gormley and Kock Fager 2021; Parr 2007; Stransky et al. 2018). The need to improve healthcare access for individuals with impaired communication is recognised in regulatory healthcare requirements (e.g., R3 Report Issue 1: Patient‐Centered Communication 2011), in healthcare initiatives such as patient‐provider communication (Patient‐Provider Communication Network, n.d.), and in the constructive framework Living with Aphasia: Framework for Outcomes Measurement (A‐FROM; Kagan et al. 2008).

Despite these efforts, frustrations and barriers persist for the relevant stakeholders in healthcare. Although people with aphasia (PWA) recognise the need for support due to the nature of their impairment, research findings clearly demonstrate feelings of exclusion from decision‐making, information exchange, goal‐setting and therapeutic partnerships (Clancy et al. 2020; Johansson et al. 2012; Lawton et al. 2020; Leach et al. 2010; Manning et al. 2019). Studies from the perspectives of healthcare professionals, on the other hand, highlight feelings of helplessness, annoyance with the increased time required to care for PWA, and even avoidance (Carragher et al. 2021; van Rijjsen et al. 2021). Commonly reported barriers reported by healthcare providers include lack of knowledge, skills and/or confidence to effectively communicate with patients, and limitations inherent to the environment, such as lack of resources or appropriate tools, time, and support by administration.

Communication partner training (CPT) is one viable approach for improving effective communication with PWA in healthcare settings. Instead of solely relying on the individual's language skills during an interaction, CPT is an environmental adaptation that aims to provide conversational supports that increase the PWA's ability to actively participate (Simmons‐Mackie et al. 2018). The literature on CPT is extensive and diverse (Cherney et al. 2013; Isaksen et al. 2022; Simmons‐Mackie et al. 2010, 2016). Studies differ according to the underlying principles and CPT content, methods of delivery, training recipients, and outcome measures (Simmons‐Mackie et al. 2018). Despite these variations, findings demonstrate that CPT is largely effective in changing behaviours and attitudes of conversation partners. Recent reviews, however, have identified the need for well‐described, replicable methodologies to determine key training components to facilitate widespread practice (Cruice et al. 2018; Simmons‐Mackie et al. 2016).

The last decade has witnessed a boom in CPT research targeting various healthcare professions and settings. Findings demonstrate that CPT can be effective for medical, nursing, and allied health professionals and staff in acute, rehabilitation, and long‐term care settings (Cameron et al. 2019, 2017; Eriksson et al. 2016; Hansen et al. 2022; Heard et al. 2017; Shrubsole et al. 2021). Although these studies indicate significant improvements in the understanding of aphasia and knowledge of strategies that facilitate effective communication, findings reveal concerns about permanent, substantive changes in behaviour due to long‐standing beliefs and attitudes. In a study by Loft and colleagues (2022), nurses reported that CPT seemed impractical for their profession because of the largely transactional and transparent nature of patient‐provider communication. van Rijssen et al. (2022) trained healthcare professionals across several rehabilitation settings. Using a model to assess the mechanisms behind behavioural change, significant improvements were found in participants’ capabilities (e.g., knowledge and techniques) as a result of CPT, but mixed results were found in areas related to intrinsic motivation.

One approach to bypassing deeply ingrained institutional resistance is to target pre‐professionals by instilling practices and attitudes before working with patients. A number of studies, which have primarily trained allied health students in CPT, demonstrate successful changes in knowledge, attitudes, and behaviours (Finch et al. 2017; Lin et al. 2022; Power, Falkenberg et al. 2020; Power et al. 2023). The current study was intended to build upon that line of research by creating an effective and efficient theoretically‐driven CPT programme for healthcare learners.

Findings from a pilot study provided a starting point for exploring impactful training. Initiated as an interprofessional educational (IPE) opportunity, Torrington Eaton et al. (2024) designed a small randomised controlled trial to compare outcomes in 12 learners from pharmacy, occupational therapy and physician assistant programmes with and without training in CPT. Training activities were designed to capitalise on experiential learning principles, which aim to shift transactional, instructor‐led methods to semi‐structured approaches where educators facilitate constructed activities with real‐world application while encouraging peer‐influenced learning (A. Y. Kolb and D. A. Kolb 2009). Training components included: (1) completion of the Aphasia Institute's online training for healthcare professionals (Kagan et al. 2025); (2) active engagement in a 3‐h collaborative experience consisting of a 30‐min SCA based lecture (Kagan 1998), interprofessional panel discussion of the roles and responsibilities in patient care for each discipline, and role‐play scenarios in which speech–language pathology (SLP) students represented PWA and family members; and (3) participation in two intensive therapy programme days during which learners observed individual and group therapy sessions then engaged in individual clinically‐based conversations with PWA alongside SLP mentors and IPE faculty.

Outcome measures targeted levels two and three in Kirkpatrick's four‐level assessment model by evaluating changes in learners’ knowledge and behaviours (J. D. Kirkpatrick and W. K. Kirkpatrick 2016). Results from the Aphasia Attitudes, Knowledge and Strategies survey (AASK) (Power et al. 2020) demonstrated statistically significant changes in pre‐/post‐experience knowledge of aphasia and facilitative strategies, but not in attitudes (i.e., levels of comfort and confidence when working with PWA). Data from video‐recorded interactions of learners from each condition demonstrated differences in facilitative strategies used during conversations, though not all were statistically significant. One of the primary limitations of the study was the heavy logistics involved in providing and coordinating training components, including the involvement of interprofessional faculty and interaction with PWA programme participants. Though results were promising, the research team recognised the need to increase the effectiveness and efficiency of training to include more pre‐professionals in the future.

The identification of effective and efficient training components in CPT for the healthcare environment is underway, but a number of facets are inconclusive or underexplored (Cruice et al. 2018). Evidence to date has demonstrated that online and hybrid (online followed by in‐person training) formats are as effective as face‐to‐face instruction in inducing changes in knowledge and attitudes, although changes in behaviour have not been assessed (Cameron et al. 2019; Heard et al. 2017; Power et al. 2023). Results also highlight the necessity of a lecture component to provide a framework for the use of facilitative strategies, as compared to a purely experiential learning experience (Finch et al. 2018; Kagan et al. 2018). No strong conclusions can be drawn about the nature of educational content, which varies by training principles or focus; more detailed descriptions of training methods have been encouraged to address this issue (Cherney et al. 2013; Simmons‐Mackie et al. 2016). Other training components requiring further exploration include the importance of hands‐on application (i.e., role play, direct experience with a PWA, or no interaction), feedback provided to the learner (i.e., through an outside observer or PWA, or no feedback), and cumulative intensity (Cameron et al. 2019, 2017; Hansen et al. 2022; Johnson et al. 2021; Power et al. 2020). Other researchers have also pointed out that CPT studies frequently neglect the inclusion of explicit theories of learning to explain expected and achieved outcomes (Fitzmaurice et al. 2024; Horton and Pound 2018).

The purpose of the current study was to create an effective and scalable CPT programme for healthcare students by refining pilot study methodologies and replicating findings. The study was designed to address insufficiencies in the CPT literature as identified in systematic reviews by providing detailed descriptions of training methods and rationales based on principles of andragogy (Cherney et al. 2013; Cruice et al. 2018; Simmons‐Mackie et al. 2016). Specifically, we tested the effectiveness of a multi‐component training model that included online training, tailored feedback and opportunities for experiential learning, as well as the effectiveness of the online training modules as a stand‐alone component. Outcome measures, similar to those used in the pilot study, evaluated changes in knowledge, attitudes and application of skills (J. D. Kirkpatrick and W. K. Kirkpatrick 2016). Specific research questions were as follows:

  1. Will a multi‐component CPT protocol grounded in adult learning principles increase IPE learners’ knowledge, attitudes, and use of facilitative strategies with PWA?

  2. Will completion of the online training modules alone be sufficient for inducing behavioural change (e.g., the use of facilitative strategies) when communicating with PWA?

2. Methods

2.1. Study Design Overview

The research questions were addressed using a pre‐/post‐intervention experimental design including both across‐ and within‐group comparisons (Figure 1). In Month 1 of the study, a baseline measure was administered—the AASK (Power et al. 2020)—to assess participants’ knowledge of aphasia and supported communication strategies as well as attitudes towards the patient population. Next, half of participants were pseudo‐randomly allocated (i.e., randomised within respective healthcare disciplines) to one of two conditions: (1) group 1: pre‐test data collection followed by online training, or (2) group 2: online training followed by pre‐test data collection. In Month 2, half of the participants were video‐recorded while engaging in a one‐on‐one semi‐structured clinical interaction with a PWA to assess baseline facilitative conversation skills (i.e., pre‐test data collection). All participants then completed online training modules. In Month 3, the remaining half of participants were video‐recorded engaging in a semi‐structured clinical interaction with a PWA. Data from recorded interactions were used for a between‐group comparison of facilitative conversation skills with and without the completion of online CPT modules. In Month 4, participants were given individualised feedback by an experienced SLP about their facilitative skills during the initial recorded interaction, to which learners were asked to self‐reflect. In Months 5, 6 and 7, small groups of participants practised their facilitative communication skills alongside SLP student mentors during one psychosocial aphasia group meeting. A month after this experience (Months 6, 7, and 8), participants completed post‐intervention video‐recorded interactions and the AASK, which comprised the data used for within‐group (pre‐/post‐training) comparisons.

FIGURE 1.

FIGURE 1

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Timeline for research questions, study phases, and outcome measures.

2.2. Participants

Research participants included first‐year healthcare students across three disciplines in the School of Health Professions: occupational therapy (OT), physical therapy (PT), and physician's assistant (PA). Participants were recruited through flyers, emails, and in‐class announcements that provided pertinent details about the study. Incentives for participation included a $50 gift card as well as credit towards required or voluntary‐but‐encouraged extracurricular IPE participation. For each discipline, the first six students to respond were invited to participate. Written information approved by the university's Institutional Review Board concerning research activities and timelines was emailed to each participant, and students signed an agreement acknowledging their commitment to each stage of the project. Although 18 students were enrolled in the study, five OT, six PT, and four PA students completed all requirements. Attrition by three participants was due to unanticipated scheduling conflicts in the spring semester; none of their data were coded or included in analyses.

2.3. Procedures

2.3.1. Training Components

Training components of this study incorporated experiential learning methods as described for the pilot study (A. Y. Kolb and D. A. Kolb 2009; Torrington Eaton et al. 2024). Additional learning principles and frameworks used to design training materials included sequential learning (i.e., formative questions that provide opportunities for learners’ to practice knowledge; Varkey et al. 2023), Bandura's social learning theory (i.e., simulated interactions between healthcare providers and PWA to model desired behaviours; Bethards 2014), Mayer's 12 multimedia principles (e.g., designing redundancy in online materials through simultaneous presentation of sound, graphics; Mayer and Fiorella 2014), and real‐time feedback (e.g., enhanced learning through spoken feedback based on performance; Fiorella et al. 2012). Training activities, which will be detailed below, consisted of online training (lectures, scenarios, and application of content), personalised feedback followed by self‐reflection, and an opportunity to practise skills during an aphasia community event. Activities extended over two semesters, but the total training time per participant was approximately 3.5 h.

Online Training. The online training consisted of three distinct learning modules developed by the authors and filmed through collaboration with creative media personnel. The first module, entitled ‘Living with Aphasia’, was a 15‐min collection of testimonials from PWA offering perspectives on how to define the impact of living with aphasia, individual anecdotes about communication access in healthcare, and recommendations on conversational supports that facilitate interactions with healthcare providers based on personal experiences (e.g., be patient, speak slowly).

The second module, ‘How to Support Patients with Aphasia,’ was an 18‐min lecture that included characteristics of aphasia and concomitant symptoms, the A‐FROM (Kagan et al. 2008), SCA‐adapted content describing the principles of acknowledging and revealing competence, recommended communication tools by setting along with the acronym SAVE (Slow and simple sentences, Allow time to respond, Verify, Ensure comprehension), and suggestions when encountering complex emotions in PWA. The module ended with a short quiz intended to enhance important information.

The final module, ‘Conversational Support in Action,’ consisted of two contrasting patient‐provider scenarios per discipline (i.e., six total, 4 to 8 min in duration). The first scenario illustrated an interaction of the provider violating SCA principles or not utilizing communication supports. In the parallel scenario, the provider used facilitative conversation strategies to include acknowledging communication and mental health challenges related to aphasia, adopting slow but natural speaking rates, writing or providing aphasia‐friendly material, and offering options for responding to questions. After viewing each scenario, participants completed a short reflection to highlight relevant content (e.g., ‘Provide two examples of how the patient was not given the opportunity to demonstrate his competence,’ ‘How does the clinician acknowledge the patient's competence?’). The total time to complete all three modules was approximately 90 min.

Real‐Time Feedback and Self‐Reflection. Each participant's initial video‐recorded conversation with a PWA was used as a means for providing personalised, real‐time feedback and opportunity for self‐reflection. In preparation for this training component, a private practice SLP, who specialises in aphasia, viewed the online training modules. Afterwards, she met with the first author, who reinforced principles and vocabulary to align with trained content. Next, using a software platform that allows time‐linked spoken comments to be attached to a video file (i.e., Searchie), the SLP provided tailored feedback to each participant during their recorded interaction to include providing explicit observations (e.g., ‘I see the gesture you used to highlight what you're asking’), using positive reinforcement (e.g., ‘Good use of multiple choice here’), and offering constructive suggestions (e.g., ‘Here was a missed opportunity to verify the intended message’). After receiving the SLP's feedback, participants submitted written reflections about effective strategies they intended to continue using as well as strategies they planned to adopt or improve in future conversations with PWA. Training activities in this phase took approximately 30 min to complete.

Mentored Interactions With PWA. The final phase of training provided a forum to practise facilitative conversation skills in a non‐structured social setting. Specifically, groups of four to five participants joined a 90‐min aphasia group meeting. The purpose of the group, which includes individuals with acute aetiologies and primary progressive aphasia and also family members, is to foster social connection through a supportive community. During the evening event, participants were gently encouraged by faculty to interact with various PWA alongside SLP graduate student clinicians who provided additional models of facilitative conversation strategies.

2.3.2. Outcome Measures

AASK Survey. The AASK (Power et al. 2020) is a standardised tool designed to assess conversation partners’ familiarity with aphasia, facilitative conversation strategies, and levels of comfort and confidence when working with PWA. The total raw score on the AASK is 37, which consists of the following scores by subsection: aphasia knowledge = 7, strategy knowledge = 10, attitudes towards a patient without aphasia = 10, and attitudes towards a patient with aphasia = 10 points.

Measure of Supported Conversation (MSC). The MSC (Kagan et al. 2008) is a tool that provides a holistic evaluation of a communication partner's skills. Specifically, the individual conversing with a PWA is scored across four domains using a nine‐point rating scale, ranging from 0 to 4, with 0.5 ratings accepted (i.e., low ratings signified absent or minimal skill): (1) conversation manner (e.g., slow but natural rate and prosody, acknowledgement of aphasia); (2) adoption of strategies that facilitate expression (e.g., gesture, multiple‐choice options); (3) adoption of strategies that facilitate comprehension (e.g., writing, gesture); and (4) use of verification to confirm and/or clarify the PWA's intended message (e.g., So you do like to watch sports?). In summary, domain 1 reflected how the participant acknowledged a PWA's competence through their communication style (i.e., MSC‐A), whereas the average of domains 2–4 provided a measure of skills used to enable a PWA to reveal their competence (i.e., MSC‐R).

Facilitative Strategy Frequencies. Similar to the pilot study, a second outcome measure was used to specify types and frequencies of facilitative behaviours used to support PWA's communication (Cunningham and Ward 2003; Croteau et al. 2017; Torrington Eaton et al. 2024). Facilitative strategies included use of environmental props (e.g., holding a pen when asking about writing), use of transparent gestures (e.g., thumbs up or down), use of writing (i.e., writing down key content words from a spoken message), use of drawing (e.g., symbols, stick figures), asking yes/no questions (i.e., verbal or written), and providing multiple‐choice options (i.e., verbal or written). Certain episodes from the interaction could be included in multiple categories. For example, providing a PWA three written responses while holding up one, two or three fingers to signify each option would be included under gesture, writing, and multiple‐choice.

Assessment Procedures. The three evidence‐based tools were used to measure Kirkpatrick's levels two—changes in learners’ knowledge, attitudes, and confidence—and three—changes in learners’ behaviours (Figure 1; J. D. Kirkpatrick and W. K. Kirkpatrick 2016). To assess level two outcomes, participants completed the AASK survey prior to beginning content learning, and immediately after the post‐test, the recorded interaction. Level three outcomes (i.e., MSC and facilitative strategy frequencies) were derived from data using pre‐ and post‐training recorded conversations with PWA. In these interactions, participants were instructed to converse for 10 min using a series of prompts to guide the conversation (see Appendix A for prompts and Table 1 for demographic, etiological, and standardised testing information of PWA). Participants were randomly partnered with PWA, with the stipulation that no participant could converse with the same individual both pre‐ and post‐training. Pre‐training interactions took place either before or after online training according to pseudo‐random allocation. Post‐training interactions took place 1 month after participating in the aphasia group meeting.

TABLE 1.

Demographic, etiological and standardised testing information of the six individuals with aphasia who conversed with study participants.

Age Sex Edu Aetiology/clinical diagnosis WAB AQ/severity
24 M 13 TBI/global aphasia 57.6/moderate
70 M 18 CVA/Broca's aphasia 86.3/mild
67 M 16 CVA/global 61.8/moderate
65 M 14 CVA/global 9.7/severe
85 F 14 nvPPA 79.8/mild
75 F 18 mixedPPA 88.7/mild
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Abbreviations: CVA = cerebral vascular accident, Edu = number of years of education, mixedPPA = mixed variant primary progressive aphasia, nvPPA = nonfluent variant primary progressive aphasia, TBI = traumatic brain injury, WAB‐R AQ = Western Aphasia Battery, Revised Aphasia Quotient (Kertesz 2007).

2.3.3. Coding and Statistical Analyses

The AASK was administered via the school's learning management system to enable automated scoring of multiple‐choice responses. Accuracy of open‐ended responses (e.g., ‘identify four features of aphasia’) was scored through consensus among three of the authors.

The behavioural measures of learners’ pre‐ and post‐training recorded interactions with PWA were coded by two hospital‐based SLPs experienced in neurogenic language disorders. Prior to scoring, coders participated in a 2‐h training session that included an overview of both tools, scoring criteria and procedures, hands‐on practice and discussion, and finally demonstration of greater than 80% reliability with the first author on a sample video. After completing training, the coders, who were blinded to timepoint and discipline, scored the 30 semi‐structured interactions (15 participants pre‐ and post‐training).

Inter‐rater reliability was assessed for both behavioural measures using Cohen's kappa. For the MSC, a consensus approach between the two coders and first author was used to resolve discrepancies greater than 0.5 (e.g., Coder 1 = 1.0, Coder 2 = 2.0). For discrepancies equal to 0.5, the higher score was used in the final dataset (e.g., Coder 1 = 1.0, Coder 2 = 1.5, final score = 1.5). For frequencies of facilitative behaviours, the mean score between the two raters was used in the final dataset (e.g., Coder 1 = 15, Coder 2 = 20, final score = 17.5).

Repeated measures t‐tests were used to analyse pre‐ versus post‐changes in knowledge, attitudes, and skills as a result of the entire training experience; because research hypotheses predicted improvements due to training, results were interpreted as one‐sided tests. Analyses of variance (ANOVAs) were run on all three measures to rule out performance differences based on discipline; pre‐test scores for behavioural measures were not analysed since half of participants from each discipline received one of two conditions (group 1 without online training versus group 2 with online training). Independent samples t‐tests were used to compare behavioural differences in students who had received the online training component as compared to the no training condition.

3. Results

3.1. Changes in Knowledge and Attitudes After Training

The first research question asked whether there would be an increase in IPE learners’ knowledge of aphasia and useful facilitative conversation strategies and attitudes as a result of the multi‐component intervention. Findings from the repeated measures t‐test comparing group mean AASK scores pre‐ and post‐intervention demonstrated a statistically significant difference with a large effect size (Table 2), t(14) = −6.460, p < 0.001, d = −1.67. Results of an ANOVA indicated no statistical differences in pre‐ or post‐test group means across disciplines: pre‐training F(2) = 0.115, p = 0.893; post‐training F(2) = 0.122, p = 0.886.

TABLE 2.

Descriptive statistics of pre‐ and post‐training scores.

Measure Time‐point Mean SD Range
AASK total Pre 16.87 4.15 11–25
Post 27.20 3.34 21–32
MSC‐comp Pre 1.97 0.88 0–3.5
Post 2.63 0.52 2–3.5
MSC‐exp Pre 2.03 0.72 0.5–3.0
Post 2.57 0.53 2–3.5
MSC‐ver Pre 2.20 0.80 0.5–3.5
Post 2.87 0.48 2–3.5
MSC‐R Pre 2.07 0.76 0.3–3.3
Post 2.69 0.47 2–3.5
MSC‐A Pre 2.23 0.73 1–3.5
Post 2.63 0.55 1.5–3.5
Props Pre 1.60 2.13 0–8
Post 3.87 3.11 0–9
Gesture Pre 5.13 6.05 0–18
Post 8.07 10.41 1–44
Writing Pre 0.60 1.18 0–4
Post 2.33 3.90 0–13
Drawing Pre 0.00 0.00 0
Post 0.13 0.35 0–1
Y‐N questions Pre 14.33 7.28 4–29
Post 19.00 9.45 5–35
Multiple choice Pre 1.80 2.24 0–9
Post 2.07 2.22 0–8
Total behaviours Pre 23.47 15.23 6–61
Post 35.47 21.3 6–92
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Abbreviations: comp = enabling comprehension, exp = enabling expression, MSC‐A = acknowledging competence, MSC = measure of supported conversation, MSC‐D = allowing to demonstrate competence, ver = verifying intended message.

Similar to Power et al. (2020), analyses were run to examine changes in learners’ knowledge and attitudes by subsection (Figure 2). As a result of the training, there were statistically significant differences in group means for participants’ knowledge of aphasia, t(14) = −3.003, p = 0.005, d = −0.78, and knowledge of facilitative strategies, t(14) = −7.416, p < 0.001, d = −0.73. Scores measuring participants’ attitudes towards both patients with and without aphasia improved across timepoints: without aphasia t(14) = −3.850, p < 0.001, d = −0.99; with aphasia t(14) = −5.350, p < 0.001, d = −1.38. Because attitudes regarding patients without aphasia were not predicted to change significantly as a result of training, a secondary analysis was conducted using change scores pre‐ and post‐intervention as the dependent variable. There was a statistically significant difference between change scores according to the type of patient, without aphasia group mean = 1.20 (1.2), with aphasia = 2.60 (1.9), t(14) = −4.176, p < 0.001, d = −1.08, indicating that the training changed participants’ attitudes more towards patients with aphasia than patients with unimpaired communication.

FIGURE 2.

FIGURE 2

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Group mean raw scores pre‐/post‐intervention on the AASK by total and subsection.

3.2. Changes in Behaviours After Training

3.2.1. Within Group Comparisons Pre‐ and Post‐Training

In the first research question, we also asked whether the multi‐component training experience would result in observable increases in the use of facilitative communication strategies during semi‐structured interactions with PWA as measured by two different tools (Table 2). Results using Cohen's kappa showed fair agreement between the two coders: MSC k = 0.26, total facilitative behaviours k = 0.31. The dataset for subsequent analyses used consensus and mean scores as described in the methods section.

For the MSC (Figure 3), clinically impactful differences were found in pre‐ versus post‐training group means on allowing PWA to reveal competence as indicated by large effect sizes: ensuring comprehension (MSC‐comp), t(14) = −2.935, p = 0.005, d = −0.758; ensuring a means of expression (MSC‐exp), t(14) = −2.874, p = 0.006, d = −0.716; and verifying the PWA's intended message (MSC‐ver), t(14) = −3.568, p = 0.002, d = −0.921. Statistical differences in pre‐/post‐training scores were greater for allowing individuals to reveal their competence (MSC‐R) than for acknowledging that the individual is competent (MSC‐A), t(14) = −3.251, p = 0.003, d = −0.829 versus t(14) = −2.037, p = 0.031, d = −0.526, respectively.

FIGURE 3.

FIGURE 3

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Group mean MSC ratings of pre‐/post‐training skills.

Differences in the group means of observed facilitative behaviours before and after training were less remarkable than for the MSC (Figure 4). The difference in the total number of behaviours approached but did not achieve statistical significance, t(14) = −1.657, p = 0.061, d = −0.428, though the effect size was moderate. Per category, one type of facilitative behaviour showed a statistically significant difference in group means as a result of training: use of props, t(14) = −2.099, p = 0.027, d = −0.542. Use of writing also approached significance, t(14) = −1.646, p = 0.061, d = −0.425.

FIGURE 4.

FIGURE 4

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Mean group totals for facilitative behaviours pre‐ and post‐training.

There were no differences in post‐training group means across disciplines in terms of revealing, F(2) = 1.52, p = 0.258, or acknowledging competence, F(2) = 0.87, p = 0.443. There were, however, differences observed between disciplines on mean numbers of facilitative behaviours, specifically use of writing, F(2) = 18.02, p < 0.001, η 2 = 0.750, and total number of behaviours, F(2) = 4.62, p = 0.032, η 2 = 0.435. Pairwise comparisons indicated that PA students outperformed their counterparts in the use of writing and overall quantity of strategies adopted (mean occurrences of writing by discipline post‐training: OT = 0.4 [0.5], range 0–1; PT = 0.33 [0.5], range 0–1; PA = 7.8 [4.1], range 4–13; mean total observed behaviours: OT = 31 [16.4]; PT = 25 [11.8]; PA = 58 [21.3]).

3.3. Between‐Group Comparisons With and Without Online Training Only

The second research question examined whether the newly developed online training modules would result in observable changes to facilitative conversation strategy use. The analysis compared behavioural measures of learners with no training and those who completed online training prior to the semi‐structured clinical interaction. Despite the small sample size, there were observable between‐group differences for both measures (Figure 5 and 6); however, only two independent samples t‐tests were statistically significant: verifying the intended message, t(13) = 2.30, p = 0.019, d = 1.190, and use of gesture (equal variances not assumed), t(6.49) = −2.51, p = 0.022, d = −0.918.

FIGURE 5.

FIGURE 5

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Mean MSC ratings with and without online training.

FIGURE 6.

FIGURE 6

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Mean group totals for behaviours with and without online training.

4. Discussion

This study contributed to the evidence base on CPT for healthcare students by replicating and extending previous findings. Training components consisted of a variety of experiences based on adult learning principles. The overall training experience resulted in improved knowledge of aphasia and conversational strategies as well as positive changes in pre‐professionals’ attitudes regarding PWA. The use of facilitative strategies also increased after participants completed the training experience. Notably, increased use of gesture and verification was observed after just 90 min of online training.

As mentioned, training methodology and outcome measures were based on a pilot study for IPE (Torrington Eaton et al. 2024). Methods were condensed to increase the efficiency of training—3.5 compared to 9 h—and to improve the delivery of content related to CPT without the additional IPE focus. The same outcome measures were used in both studies, although coding methods were better described in this study to promote systematic replication and investigate issues related to inter‐rater reliability (the latter is explored in a companion paper). Outcomes from the current study showed significantly greater changes in knowledge reflected in effect sizes as well as facilitative behaviours as compared to the pilot project, which found significant changes in allowing PWA to reveal competence and only positive trends in facilitative behaviours.

One of the most promising findings from this study was the effectiveness of the stand‐alone online training. Previous studies have found that online CPT modules were effective in improving knowledge and attitudes (Cameron et al. 2019; Heard et al. 2017; Power et al. 2023). To our knowledge, this is the first study with healthcare students to report specific changes in learners’ behaviours—Kirkpatrick's level 3—from online training alone. Although only two outcome measures were statistically significant, based on trends in the data, it is possible that greater statistical power would have resulted in more robust results.

These findings are quite encouraging for efforts intended to efficiently scale CPT so that a greater number of professionals enter healthcare settings with tools needed to work effectively with PWA (Shrubsole et al. 2021; Wielaert et al. 2017). On the other hand, questions remain regarding the mechanisms behind the observed changes (Fitzmaurice et al. 2024). Why were gesture use and verification the two facilitative conversation strategies that showed the most improvement as a result of online training? It is possible that learning methods or principles used in the online modules were particularly effective in targeting these strategies, or perhaps they are simply easier to train without additional experiential learning. Future research should examine the effects of particular CPT approaches on the adoption of specific facilitative behaviours used by healthcare professionals (Cruice et al. 2018).

A compelling and unanticipated finding was the difference between professions in post‐training outcomes. We anticipated and found no differences across disciplines in knowledge and behavioural outcomes on the MSC; however, PA students far outperformed their OT and PT peers in the number of facilitative behaviours used, specifically in writing to support communication. The statistically significant difference in writing use post‐training could be attributable to the online PA scenario in which the provider illustrated the effectiveness of using written materials to supplement oral information for PWA. Although this conclusion may be premature based on the small sample size, it implies an impact of discipline‐specific models in CPT materials that warrants further research. Bandura's social learning theory (1977), which provides a framework for how learners use modelled behaviour to create their own representations, may be an important concept when designing CPT content for healthcare students and professionals (Bethards 2014; Hean et al. 2012; Mukhalalati and Taylor 2019).

Finally, it is important to acknowledge limitations of the research design that can be mitigated in future studies. The small sample size was an obvious limitation that affected the power of statistical comparisons and generalisability of findings. Because allocation procedures were only pseudo‐randomized, the study was not a true experimental design. There may have been unexplored participant characteristics that contributed to results, such as previous personal or vocational experience with individuals with communication impairments; in this study, no additional participant information was gathered aside from basic demographics. A collaborative effort among institutions (i.e., a multi‐site study) would enable a stronger research design, support more extensive data collection, and yield greater statistical power.

5. Conclusions

The call to action for the next phase of CPT research asks investigators to identify and capitalise on specific training methods that induce knowledge and behavioural change to support communication with PWA. This study describes a novel CPT programme that purposefully integrates an evidence‐based CPT framework with principles of andragogy. As incorporated in the research design, within subject comparisons showed changes in knowledge, attitudes, and behaviour from the multi‐component programme, while across‐group comparisons demonstrated changes in specific facilitative behaviours from online modules only. These encouraging findings can be used to design effective and efficient delivery models for pre‐professional healthcare learners with the goal of improving communication for PWA in healthcare environments.

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgements

Funding for this study was graciously provided through the Association of Schools Advancing Health Professions (ASAHP) Interprofessional Collaboration Research Grant. We would like to express our gratitude to Ray Tovar, Russell Williams, Annette Sellers, Dan Scarborough, Dora San Miguel, Michael Maddison, Charles Syms, Autumn Clegg, Leticia Bland, and Lynn Parsons and team for their time and expertise in the development and production of the online CPT modules. We would also like to thank Genevieve Richardson, Hilary Corona, and Alison Cox for feedback and coding assistance. Finally, our sincere thanks to the six individuals with aphasia who participated in the recorded interactions and the San Antonio Network for Aphasia (SANA) members who warmly welcomed these healthcare learners into their community.

Appendix 1. Semi‐Structured Provider‐Patient Interaction Instructions

 

Aim for a 10‐min interaction. You will be notified when 2 min remain.

  1. Introduce yourself.

  2. Explain your professions’ role in evaluating and/or treating patients with a history of stroke or primary progressive aphasia.

  3. Explain your progression in your programme (i.e., how long before you graduate).

 

Obtain the following information from the patient. You may complete in any order. For any item, indicate if the patient is unable to provide the information.

  1. Ask about how the patient prefers to communicate.

  2. Find out about the patient's important medical or surgical history.

  3. Find out about the aetiology of the patient's aphasia.

  4. Find out about how the patient spends their day.

  5. Ask about what the patient would like to be able to do but cannot.

  6. Ask about what the patient enjoys doing.

  7. When indicated, provide a closing statement.

Torrington Eaton, C. , McAvoy M., Morgan S., and Kennedy A.. 2025. “Intersection of Knowledge to Practice: A Purposeful Integration of Communication Partner Training in Aphasia With Adult Learning Principles for Healthcare Students.” International Journal of Language & Communication Disorders 60, no. 6: e70150. 10.1111/1460-6984.70150

Funding: Funding for this study was graciously provided through the Association of Schools Advancing Health Professions (ASAHP) Interprofessional Collaboration Research Grant.

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