The role of the physical environment in conversations between people who are communication vulnerable and health-care professionals: a scoping review

Figures & data

Figure 1. This Figure illustrates the number of publications included during each phase of this review.

Table 1. Descriptive summary of studies included in the scoping review (in alphabetical order).

Author, year, & country	Aim of the study	Study design	Study population	Setting	Factors
Ball, Beukelman, & Pattee [31] 2004 USA	To study the relationships between speech intelligibility and communication effectiveness as rated by speakers with ALS and their listeners.	Quantitative research: descriptive quantitative design. Measures of: speech intelligibility (“SIT”), self-perceptions of communication effectiveness (“CETI-M”), and listener perceptions of communication effectiveness (“CETI-M”)	People with ALS and communication partners N = 25 people with ALS N = 29 communication partners	Regional medical centre specialty clinic for people with ALS	Acoustic environment
Bruce, Brush, Sanford, & Calkins [26] 2013 USA	To report on effectiveness of the ECAT in meeting the practice needs of SLPs for determining environmental barriers to communication among clients with dementia, and developing strategies for environmental modifications to facilitate communication.	Quantitative research: time series design Questionnaires at four points in time, information about clients collected twice.	Clinicians, i.e. SLPs, nurses, physical and occupational therapists providing services for clients with dementia N = 71 clinicians	Long-term care settings	Lighting, acoustic environment, setting and furniture placement, low tech AAC
Day, Carreon, & Stump [28] 2000 USA	To analyze and review existing studies of design and well-being for people with dementia to enhance the design of dementia facilities and to provide direction for future research.	Review of empirical research	People with dementia	Dementia facilities in different settings both short- and long-term facilities	Lighting, acoustic environment
Garrett, & Huth [37] 2002 USA	To examine differences in conversational parameters when: contextual support (i.e. graphic topic setters) was available; personal events versus current events were discussed; interactions with two conversational partners were compared; and an instructional protocol was introduced during interactions with the second partner.	Quantitative case study: Single subject reversal-withdrawal design. Observational measures under three conditions (no graphic context, graphic context, graphic context plus instruction) in 24 sessions.	Participants with aphasia and research communication partners Participants with aphasia: N = 1 Communication partners: N = 2	Not defined	Low tech AAC
Ho, Weiss, Garrett, & Lloyd [38] 2005 USA	To determine whether participants with global aphasia were more successful at initiating and maintaining social interactions with familiar conversational partners when remnants, pictographic symbols, or no symbols were available.	Quantitative research: combination of ABA (before, during and after treatment) and alternating treatment. Single subject design, based on observations.	Participants with global aphasia N = 2	Acute rehabilitation hospital	Low tech AAC
Howe [50] 2008 Australia	To discuss why contextual factors are important for speech-language pathologists to address in their clinical practice, describe how environmental factors are coded in the ICF, identify environmental factors that are relevant for people with communication disorders, and identify personal factors that are relevant for people with communication disorders.	Literature review	People with communication disorders	Not defined	Lighting, acoustic environment, humidity and temperature, setting and furniture placement, written information, low tech AAC, high tech AAC, professional awareness of physical environment
Howe, Worrall, & Hickson [17] 2004 Australia	Define aphasia friendly environments, critically evaluate the relevant literature, and highlight the gaps in research in this area.	Literature review	People with aphasia	Not defined	Acoustic environment, written information, low tech AAC, high tech AAC
Hull [49] 1989 USA	Discuss the impact of the environment on vision and auditory, and present suggestions for improving those environments so that communication can be facilitated for older adults.	Book chapter	Hearing impaired older adults	Not defined	Acoustic environment, setting and furniture placement
Jensen, Løvholta, Sørensena, Blüdnikowc, Iversena, Hougaarda, Mathiesena, & Forchhammer [36] 2015 Denmark	(1) To develop a procedural guideline for interdisciplinary staff to communicate with in-patients with aphasia, (2) to develop an interdisciplinary training course and educate all staff members, and (3) to make available a set of shared communication tools.	Mixed-methods research qualitative and quantitative outcomes Questionnaires before and after Semi-structured interviews	Nursing staff members N = 31 In-hospital patients with aphasia	Hospital	Written information, low tech AAC
O'Halloran, Hickson, & Worral [20] 2008 Australia	Review the literature on the environmental factors that influence communication between adults with communication disabilities and their healthcare providers in the acute hospital setting within the framework of the ICF.	Literature review	Adults with communication disabilities	Acute hospital environment	Setting and furniture placement, written information, low tech AAC, high tech AAC
O'Halloran, Grohn, & Worrall [30] 2012 Australia	Integrate and synthesize the findings of three separate studies conducted within a larger program of research, to develop a new taxonomy of the range of environmental factors that influence communication between patients with communication disabilities and their health-care providers.	Qualitative meta synthesis (three studies)	Patients with communication disabilities (dysarthria, aphasia, visual, auditory) Metasynthesis: 1st study N = 10 patients, 2nd study N = 10 professionals, 3rd study N = 65 patients	Acute hospital stroke unit	Acoustic environment, setting and furniture placement, written information, low tech AAC
O’Halloran, Worrall, & Hickson [27] 2011 Australia	Identify the environmental factors that create barriers and/or facilitate a patient’s ability to communicate everyday health-care needs and analyze these environmental factors in order to develop a descriptive list of the environmental factors that influence a patient’s ability to communicate.	Qualitative research: Participant observations	Patients in acute stroke units N = 65 patients	Acute stroke unit	Lighting, acoustic environment, written information, low tech AAC, high tech AAC
Park, & Song [33] 2005 South-Korea	Determine and then compare the communication barriers perceived by older in-patients and nurses caring for them, with the aim of identifying the disparities between the perceptions of the two parties.	Quantitative research: Descriptive survey design “Communication-Barriers Questionnaire”	Nurses and older hospitalized patients N = 100 patients N = 136 nurses	Hospital	Acoustic environment, humidity and temperature, setting and furniture placement
Ruan, & Lambert [32] 2008 China	Identify the major communication barriers perceived both by nurses and elderly patients and to determine the differences in the level of importance on the communication barriers between nurses and elderly patients.	Quantitative survey research “Demographic Characteristics Questionnaire for Nurses, “Demographic Characteristics Questionnaire for Elderly Patients, and “Communication-Barriers Questionnaire”	Nurses and older hospitalized patients N = 75 patients N = 84	Hospital	Acoustic environment, humidity and temperature, setting and furniture placement
Waller, Dennis, Brodie, & Cairns [39] 1998 UK	Describe the design and evaluation of a computer-based communication system called “TalksBac” with four non-fluent adults with aphasia.	Quantitative research: Uncontrolled before and after design. Measures of: language impairment (“The Western Aphasia Battery”), semantic knowledge (“The Pyramids and Palmtrees Test”), functional communication (“Revised Edinburgh Functional Communication Profile”). Comparison of: observations of aided and unaided conversations.	People with non-fluent aphasia N = 4	Speech and language therapy practice, & home environment	High tech AAC
Weitzel et al. [51] 2011 USA.	Describe the special care needs of hospitalized patients with dementia and provide recommendations for health-care providers to meet those needs.	Discussion report	Hospitalized people with dementia	Hospital	Acoustic environment, setting and furniture placement, low tech AAC

Figure 2. Factors in the physical environment which play a role in conversations between people who are communication vulnerable and healthcare professionals.

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