Saudi Cultural Missions Theses & Dissertations
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Item Restricted Exploring Communication Confidence in Stroke Survivors with Aphasia(Saudi Digital Library, 2025) AlFraih, Sarah Sulaiman; Conroy, Paul; Patchwood, EmmaCommunication confidence is a vital yet underexplored outcome in stroke rehabilitation, particularly for individuals with aphasia. Conceptualised as a psychosocial construct shaped by self-efficacy, autonomy, participation, and contextual factors, it plays a critical role in enabling stroke survivors to apply therapeutic gains in everyday life. This PhD thesis aimed to better understand, measure, and support communication confidence in people living with aphasia post-stroke. Three studies were conducted. Study 1 was a published systematic scoping review that synthesised 26 studies addressing confidence-related outcomes in stroke rehabilitation. Interventions were grouped into self-efficacy, self-management, impairment-based, technology-assisted, and novel approaches (e.g., drama therapy). The review revealed a lack of targeted interventions and consistency in outcome measurement for communication confidence. Study 2 was a cross-sectional, longitudinal online cohort study with 27 participants at least six months post-stroke and interested in exploring their communication confidence. Standardised outcome measures were administered at baseline and re-administered six months later. While language abilities and communication confidence remained relatively stable over time, confidence after stroke and well-being significantly improved, highlighting the independent trajectories of psychosocial and linguistic recovery. Building on this, Study 3 involved the co-development of an online group intervention - CoCA (Confident Communication with Aphasia) - informed by public and patient involvement. A proof-of-principle observational study using a case series design and repeated measures explored feasibility, acceptability, and potential benefit. Five participants (four with moderate non-fluent/Broca’s aphasia and one with mild conduction aphasia) engaged in the group intervention as well as having tailored sessions targeting their individual communication confidence goals, which varied widely. Strong adherence was observed, and feedback suggested that group sessions fostered a supportive environment. Quantitative outcomes were mixed: communication confidence scores remained stable while confidence after stroke scores and well-being scores showed numerical gains. Collectively, these findings conveyed the potential value in targeting psychosocial constructs post-stroke, especially confidence. The observed chain-like pattern of correlations between language and communication confidence, communication confidence and confidence after stroke, and confidence after stroke and well-being highlights the interconnectivity of these constructs. Furthermore, gains in psychosocial domains despite the stability of language measures may suggest that these psychosocial constructs progress independently from linguistic ones. This provides a different perspective into addressing potential therapy goals and ways to tap into them in post-stroke interventions. Finally, the CoCA intervention shows promise as feasible and acceptable for communication confidence in stroke survivors with aphasia and may be the first intervention specifically to address this need.7 0