ACQ Vol 12 No 3 2010

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ACQ Volume 12, Number 3 2010 125
Accessible healthcare makes a difference
to the comprehension of a person with
aphasia
There is evidence that using simplified vocabulary and
syntax, large print, increased white space and pictures can
improve comprehension of written information for people
with aphasia (Brennan et al., 2005; Rose et al., 2003).
However accessible written information may have other
benefits as well. People with aphasia have also reported
feeling more confident responding to health questions after
reading aphasia-friendly patient education materials,
compared to standard written information (Rose et al.,
2003).
People with aphasia need a choice
Rose and colleagues (2003) found that although aphasia-
friendly information assisted people with aphasia to
comprehend information, not all people with aphasia liked
the aphasia-friendly health information. For example, some
people with aphasia commented that the inclusion of several
Microsoft ClipArt images and black and white line drawings
in written health information was disrespectful (Rose et al.,
2003). Therefore, wherever possible people with aphasia
need to be given a choice regarding the type and format of
The National Health and Medical Research Council
(NHMRC) states that different research questions require
different kinds of supporting evidence (NHMRC, 2009). The
issue here concerns the evidence around an intervention,
that is, the effect of modifying written information for people
with aphasia; therefore the NHMRC intervention hierarchy
(NHMRC, 2009) was used to evaluate the 4 articles
identified. Table 2 describes the level of evidence of each of
the four articles and table 3 provides a critical appraisal of
one article in more detail.
Table 2: Research articles identified
Articles Purpose Level of evidence
identified (NHMRC, 2009)
Rose, Worrall Investigated the effect of Level III-2
and McKenna aphasia-friendly written health
(2003) information on people with
aphasia
Egan, Worrall Investigated the effect of an Level IV
and Oxenham accessible training package
(2004) to help people with aphasia
learn how to use the internet
Worrall and Investigated the effect of Level IV
Brennan, specific features of aphasia-
McKenna friendly written information
(2005) on comprehension for people
with aphasia
Worrall and Provides a summary of these N/A
colleagues three studies
(Worrall, et al.,
2005)
Table 3: Critically appraised article
Article title The relationship between specific features of
aphasia-friendly written material and comprehension of
written material for people with aphasia: An exploratory
study
Citation Brennan, A., Worrall, L., & McKenna, K. (2005). The
relationship between specific features of aphasia-
friendly written material and comprehension of written
material for people with aphasia: An exploratory study.
Aphasiology, 19(8), 693–711.
Design Case series pre test post test
Level of IV
evidence
Participants 9 people with mild to moderately severe aphasia
Experimental People with aphasia given 90 different paragraphs to
group read. Each set of 5 paragraphs were at a different level
of complexity and had different aphasia-friendly
features.
Results: Participants’ comprehension at grade 6 level was
increased when paragraphs had a) simplified
vocabulary and syntax or b) had large print or c)
increased white space or d) all four aphasia-friendly
features (simplified vocabulary and syntax, large print,
increased white space and pictures).
Participants’ comprehension of grade 5 and grade 7
level paragraphs was not enhanced with any
modifications to the text. The authors suggested that
this may have been due to ceiling effects at grade 5
level and self-selection bias at grade 7 level where
many participants did not complete reading all the
paragraphs.
Summary: People with aphasia understood significantly more
information when reading paragraphs that were
modified.
Clinical bottom line
The clinical bottom line was drawn from all the research
literature searched and secondary sources. The speech
pathologist could present this information to her manager to
argue the value of a communicatively accessible healthcare
environment.
There is a need for accessible
information
People with aphasia want to receive written information
about their health (Rose, Worrall, Hickson, & Hoffmann,
2010). Family members of people with aphasia also want
information about aphasia (Avent et al., 2005). Despite this,
many people with aphasia are not adequately informed
about their stroke and/or aphasia (Eames, McKenna, Worrall,
& Read, 2003; Knight, Worrall, & Rose, 2006; Parr, Byng,
Gilpin, & Ireland, 1997; Rose, Worrall, McKenna, Hickson, &
Hoffmann, 2009). Those people with aphasia who do receive
written health information often state that the information
they receive is too complex (Rose et al., 2009).
Accessible healthcare is multifaceted
For healthcare information to be accessible it needs to be
easily obtainable (Worrall, Rose, Howe, McKenna, &
Hickson, 2007) and repeatedly provided throughout the
continuum of care (Rose et al., 2010). It also needs to be
available in a range of different formats such as written
information and appropriately formatted DVDs and videos
(Rose et al., 2010).