An exploration of the coverage of aphasia in the Irish print media

ABSTRACT

Background: International investigations of public awareness of aphasia indicate low levels of awareness and knowledge. Many studies identify the media as a powerful mechanism for increasing public awareness of health conditions. Media coverage of aphasia is lacking compared to other health conditions. To date, no research has investigated media coverage of aphasia in Ireland.

Aims: To investigate the written coverage of aphasia and/or dysphasia in the Irish print media.

Methods and Procedures: The Lexis Nexis database was searched between January 2013–2020 inclusive and all articles with the term “aphasia” and/or “dysphasia” in the headline and/or body of the text were retrieved. Retrieved articles were reviewed by both authors. Included articles were categorised independently using content analysis and the descriptors of aphasia in print media. The principles of thematic analysis supported the identification of themes across the data.

Outcomes and Results: A total of 34 articles were identified; 16 fulfilled the inclusion criteria. Descriptions of aphasia varied across the data with “word only provided” (n =0); “definition provided” (n =8); “content provided” (n =8). The articles (n =16) featured a range of content about aphasia including: Lived experiences (n =6); Definitions (n =5); Information (n =3); Communication training (n =2). Four themes emerged from the data including (1) Language Impairment, (2) Support Structures, (3) Recovery Pathway, and 4) Impacts on Family.

Conclusions: Information about aphasia in Irish print media is sparse. The accuracy and quality of coverage are inconsistent which may be contributing to the limited levels of public awareness and knowledge of aphasia in Ireland. Accurate and increased media coverage has the potential to improve public awareness and knowledge and promote the inclusion of people living with aphasia in Irish society. A co-designed and targeted media aphasia awareness campaign is warranted.

KEYWORDS:

• Aphasia
• public awareness
• print media
• newspaper articles
• Ireland

Introduction

What do we know about aphasia awareness and knowledge internationally?

Investigations of public awareness and knowledge of aphasia have been conducted around the world including, for example, Canada (Patterson et al., 2015), USA (Simmons-Mackie et al., 2002), New Zealand (McCann et al., 2013), Australia (Simmons-Mackie et al., 2002), Sweden (Henriksson et al., 2019), Argentina, Croatia, Greece, Slovenia, and Norway (Code et al., 2016), Serbia and Montenegro (Vuković et al., 2017), the UK (Aphasia Alliance, 2008; Hill et al., 2018; Simmons-Mackie et al., 2002; Speakability, 2000), and Ireland (Mc Menamin et al., 2020) with many studies using the “Awareness of Aphasia Survey” (Code et al., 2001) (e.g., Code et al., 2016; Hill et al., 2018; Mc Menamin et al., 2020; Patterson et al., 2015; Simmons-Mackie et al., 2002) to capture data about public awareness and knowledge of aphasia. In these studies, awareness of aphasia was defined as “having heard the word aphasia” while knowledge was defined as identifying or providing “basic information about aphasia” e.g., aphasia involves speech, language and/or communication problems, etc. (Simmons-Mackie et al., 2002, p. 839). Many researchers have examined variables such as gender, age, occupation, source of aphasia information and aphasia awareness compared to awareness of other conditions, e.g., dyslexia, etc. (e.g., Code et al., 2016; Hill et al., 2018; Mc Menamin et al., 2020; Patterson et al., 2015; Simmons-Mackie et al., 2002; Vuković et al., 2017). Hill et al. (2018) identified some factors that appear to positively influence aphasia awareness and knowledge, i.e., being female, an older person, and working in a profession such as education and/or health care. However, “international studies over time continue to report low levels of aphasia awareness and basic knowledge” (Simmons-Mackie et al., 2019, p. 5). Population size, sample size, culture, and socio-economic status may be contributing factors to the differences in findings across nations and cultures (Code et al., 2016).

The highest levels of public awareness and knowledge of aphasia are reported in Sweden (Henriksson et al., 2019). Almost half of the sample surveyed (n =372) had awareness of aphasia (n =183) with 17% (n =64) demonstrating knowledge. The authors suggest that the Swedish stroke media campaign may have contributed to the high level of aphasia awareness. In Ireland, approximately 30,000 people are living in the community with stroke-related conditions including aphasia (Irish Heart Foundation, 2013). A recent Irish study investigating public awareness and knowledge of aphasia in the west of Ireland (n =600) indicated 19.7% awareness with only 5.5% knowledge (Mc Menamin et al., 2020). Similar to the Swedish study and other studies (Vuković et al., 2017), the majority of participants identified the media as a primary source of aphasia information.

Aphasia and the media

Internationally, limited aphasia awareness has contributed to participation restrictions in the daily lives of people with aphasia and their families (Manning et al., 2019; Parr, 2007; Simmons-Mackie & Kagan, 2007). Increasing public awareness is essential to promote understanding and social inclusion for people with aphasia and to encourage investment in service provision and aphasia research (Code et al., 2016; Vuković et al., 2017). Many studies recommend (e.g., Henriksson et al., 2019; Mc Menamin et al., 2020; Vuković et al., 2017) that the media should contribute to increasing public awareness and knowledge of aphasia. Participants surveyed across countries appear to consistently report various forms of media (print, television, radio, and social media/internet) as a source of aphasia information (Code et al., 2016; Henriksson et al., 2019; Hill et al., 2018; Simmons-Mackie et al., 2002). Morgan et al. (2005) reported that radio and television are the optimum platforms to raise public awareness of neurological diseases compared to print media. However, in a more recent study, Patterson et al. (2015) recommend utilising a mix of traditional media and social media to increase public awareness of aphasia. Representations of aphasia in the media appear to be sparse compared to the representation of other health conditions including other communication disorders (Sherratt, 2011; Simmons-Mackie et al., 2019). In a study comparing public awareness of aphasia to Parkinson's disease in New Zealand, findings indicated public awareness of aphasia was 11% while awareness of Parkinson’s disease was 96% (McCann et al., 2013) despite the higher incidence and prevalence of aphasia in the population group. Public awareness of other conditions such as dyslexia, stammering, and stroke also appears to be significantly higher than awareness of aphasia (Code et al., 2001; Hill et al., 2018; Mc Menamin et al., 2020) which is interesting since stroke is the primary cause of aphasia and one in three people who have a stroke will experience aphasia (Chapey et al., 2008).

The media is a powerful tool for communicating information about health issues and for impacting public awareness and knowledge (Sherratt, 2011). The evidence suggests that recent efforts to increase public awareness of Autism Spectrum Disorder and Alzheimer’s Disease using media platforms have resulted in improved empathy among the public (Simmons-Mackie et al., 2019). However, the impact of the media is not always positive. In the UK, Happer and Philo (2013) investigated the impact of the media in the construction of public beliefs and attitudes towards disability, economic development and climate change. An interesting finding which highlights the potential of the media to impact public opinion in a negative way was evident in an emerging cynical attitude amongst some members of the public towards people receiving disability benefit payments following media coverage of benefit payment schemes.

The role of the media in influencing public awareness and knowledge of aphasia in Ireland is currently unclear. The authors debated researching the coverage of aphasia across a range of Irish media platforms, e.g., print, audio, and social media. However, the literature suggests that taking a broad approach across many different platforms may make it difficult to identify the nature and effectiveness of each platform (Derzon & Lipsey, 2002). The rationale for selecting print media as the focus for this study is based on the evidence that 84% of the Irish adult population regularly read newspapers (online and/or offline). Approximately 2.9 million people read printed newspapers with 62% of the population reported to read a daily newspaper (News Brands Ireland, 2013). Therefore, newspapers are a well-liked media platform in Irish society (Warren, 2019) particularly in the over 45-year-old age group (News Brands Ireland, 2013). The popularity of print media amongst the population group at higher risk of stroke and aphasia (Kissela et al., 2012) and the evidence of low awareness and particularly knowledge of aphasia in Ireland (Mc Menamin et al., 2020) justifies an investigation of this medium to determine the written coverage if any, of aphasia and/or dysphasia in Irish print media.

Method

Search strategy

A comprehensive search of the Lexis Nexis database (Lexis Nexis, 2020) was conducted to identify the coverage of aphasia in the three leading Irish newspapers between (2013–2020) inclusive (see Figure 1). Lexis Nexis is an online academic database which provides access to journalistic documents, business publications, and legal publications from across the world. Lexis Nexis was utilised to access newspaper articles from the: 1) Irish Times; 2) Irish Independent and 3) Irish Daily Mail. The three target newspapers were selected based on the most recent readership statistics publicly available (National Newspapers of Ireland, 2014/2015) and the corresponding population statistics from the Central Statistics Office (Central Statistics Office (CSO), 2020) in the Republic of Ireland. Of an estimated potential readership of 3 million people the three most popular Irish newspapers were identified as the: 1) Irish Independent 15% (688,000 readers); 2) Irish Times 9.25% (427,000 readers) and 3) Irish Daily Mail 4.7% (217,000 readers).

Figure 1. Database search and article identification.

Inclusion/exclusion criteria

The search terms “aphasia” and “dysphasia” (less frequently cited in the literature) were used to identify relevant articles. These search terms were understood to mean an acquired communication disorder, caused by brain injury and characterised by impairment in any or all language modalities including comprehension, expression, reading, writing, and spelling (Chapey et al., 2008, p. 3). Articles were excluded from further review if the terms “aphasia”/“dysphasia” were used to describe something different from an acquired communication disorder and/or if the term(s) were used to describe primary progressive aphasia (PPA). The primary progressive aphasias (PPAs) are clinical syndromes associated with frontotemporal lobar degeneration or Alzheimer’s disease neuropathology (Croot et al., 2019) and were not the focus of this study.

Data analysis

The articles that met the inclusion criteria were categorised independently by both authors using content analysis (Stemler, 2000; Wilkinson & Birmingham, 2003). This method is often used to examine mass media content (Mayring, 2004) and it allowed the authors to systematically analyse the contents of the identified newspaper articles qualitatively and quantitatively. The corpus of data was reduced to meaningful units including number of articles on a topic; focus of the article; relevant newspaper(s); perspective shared; and finally the number of articles per paper related to the identified perspectives (see Table 1). The data were further categorised using Elman et al. (2000) descriptors of aphasia in print media, i.e., “word only provided”; “definition provided”; “content provided”. Following content analyses, the principles of thematic analysis (Braun & Clarke, 2013) supported the identification of themes across data. Initial codes were generated based on key features of the newspaper articles and data relevant to each code was collated. The emergent themes were reviewed, modified, and developed in relation to the entirety of the data. Quotations from the newspaper articles are included in the results section to elucidate the identified themes.

Table 1. Article overview

Number of articles on a topic (n = 16)	Focus of the article	Relevant newspaper(s)	Perspective shared	Number of articles per paper related to the identified perspectives
6	Living with aphasia	The Irish Independent The Irish Daily Mail The Irish Times	Carer (n = 2) Journalist (n = 1) Person with aphasia (n = 3)	The Irish Independent: Carer (n = 1) The Irish Daily Mail: Carer (n = 1) Person with aphasia (n = 2) The Irish Times: Person with aphasia (n = 1) Carer (n = 1)
5	Definitions of aphasia	The Irish Times The Irish Daily Mail The Irish Independent	Journalist (n = 5)	The Irish Independent: Journalist (n = 1) The Irish Daily Mail: Journalist (n = 1) The Irish Times: Journalist (n = 3)
3	Information about aphasia	The Irish Independent The Irish Times The Irish Daily Mail	Journalist (n = 1) Reader contributor (n = 1) Speech and Language Therapist (n = 1)	The Irish Independent: Journalist (n = 1) The Irish Times: Speech and Language Therapist (n = 1) The Irish Daily Mail: Reader contributor (n = 1)
2	Communication training programme designed by Trinity College Dublin for staff in coffee shops on how to communicate with a person with aphasia	The Irish Independent The Irish Times	Person with aphasia & Journalist (n = 1) Person with aphasia & Speech and Language Therapist (n = 1)	The Irish Independent: Person with aphasia & Speech and Language Therapist (n = 1) The Irish Times: Person with aphasia & Journalist (n = 1)

Results

Search results

Thirty-four articles were identified from the Lexis-Nexis database search. Thirty-two articles used the term “aphasia” in the headline or the body of the text and two used the term “dysphasia”. Following review, eighteen articles were excluded because they did not meet the inclusion criteria – six articles featured primary progressive aphasia (PPA) and twelve did not use the term “aphasia” or “dysphasia” to mean an acquired language disorder as described by Chapey et al. (2008, p. 3). For example, in the following extract the term “aphasia” was used in a perfume advertisement:

people with aphasia speak words designed by the Military-Perfumery-Complex to evoke smelliness (The Irish Times, August 26^th, 2016, the ticket section, pp. 3, line 22)

In another article, the term “aphasia” was used to describe difficulties experienced by some women during menopause:

aphasia … word finding difficulties … due to receptors in the brain being deprived of oestrogen. (The Irish Daily Mail, March 19^th, 2015, features section, pp.33, line 17)

Categorisation of data

Sixteen articles were included in the final review. Details on the number of articles per topic; the focus of the article; relevant newspaper(s); perspective shared; and the number of articles per paper related to the identified perspectives are presented in Table 1. Most articles were reported in the Irish Times (n =7), followed by the Irish Daily Mail Independent (n =5) with the minority in the Irish Independent (n =4). The perspectives shared in each article had different “voices” including: Journalist (n =7); Carer (n =3); Speech and Language Therapist (SLT) (n =1); Person with aphasia with journalist/SLT (n =4) and Reader Contributor (n =1). The articles featured a range of content about aphasia including: Lived experiences (n =6); Definitions (n =5); Information (n =3); Communication training (n =2).

Elman et al. (2000) descriptors of aphasia in print media, i.e., “word only provided”; “definition provided”; “content provided” were used to further categorise the data (see Table 2). Following independent author review, none of the sixteen articles was identified as “word only provided”. Eight articles were categorised as “definition provided” with the remaining eight categorised as “content provided” (Elman et al., 2000 p. 454-456).

Table 2. Aphasia information included in articles reviewed  (adapted from Elman et al., 2000 p. 454-456)

Word only	0
Definition	8
Some content	8

None of the “definition provided” articles (n = 8) included a citation and some provided inaccurate definitions as illustrated in the following extracts:

He has aphasia which means he cannot communicate. (The Irish Times, January 19^th 2016, Ireland section pp.6, lines 59-60), Aphasia - an inability or refusal to speak … (The Irish Times, October 22^nd, 2014, special reports section, pp.9, line 174)

One article provided a more detailed, accurate description of aphasia:

… a condition acquired usually as a result of stroke. Aphasia affects a person’s ability to use and process language, making it difficult to talk, read, write or interpret what is being said. (The Irish Times, April 25^th, 2013, Ireland section, pp.7, lines 4-5 and lines 6-7)

Eight articles categorised as “definition provided” included a definition of aphasia however on further review, it became apparent that the content of these articles was not focused on aphasia. For example, a reporter in a discussion about Spanish politics used a definition of aphasia to describe a Spanish politician:

Yesterday, the highly regarded Madrid newspaper El País, no friend to Catalan nationalism (though no ally of the PP’s either) diagnosed Rajoy’s position as aphasia, the chronic communications disorder usually caused by a stroke. (The Irish Times, October 3^rd, 2017, Opinion Section, p. 15 lines 4-6). In this extract the definition of aphasia was accurate; however the context had a political rather than an acquired communication impairment focus.

Eight articles provided more in-depth information about aphasia and were categorised as “content provided” (Elman et al., 2000). All provided accurate descriptions and information about aphasia from a range of perspectives. For example, the article entitled “Five things you need to know about aphasia” provided a detailed description of aphasia including five facts:

• The condition can affect speech, reading, and writing.

• Each person with aphasia experiences it differently.

• Some people cannot speak at all.

• Some people have just a few words.

• Others can no longer read, write, or use numbers.

(The Irish Independent, January 6^th, 2014, health and living section, pp. 23, lines 4–6)

In another “content provided” article an SLT shared her professional experience of aphasia:

If someone has a problem with language after a stroke, the medical name is aphasia. They will have different strengths and weaknesses. Often people might be able to understand a lot of what you are saying, but not be able to give you a message back.(The Irish Times, March 1^st, 2016, health section, pp.15, lines 24-27)

The majority of “content provided” articles described the lived experience of aphasia from the perspectives of people diagnosed with aphasia (n =2); carers (n =3) and one journalist’s perspective (n =1). In the Irish Daily Mail, a man with aphasia shared his experience:

I suffer from expressive aphasia, which means I know what I want to say, but have trouble getting the words out or even writing what I mean. (The Irish Daily Mail, January 12^th, 2016, news section, pp.26, lines 26-27)

Themes identified

The principles of thematic analysis (Braun & Clarke, 2013) helped the authors to identify emergent themes across the data set. Following analysis, four themes were identified including (1) Language impairment; (2) Supports; (3) Recovery pathway; and (4) Impacts on Family.

Theme 1: language impairment

This theme describes the language impairment caused by aphasia primarily from multiple perspectives (people with aphasia; family members and journalists). In the following extract a lady with aphasia described her language impairment:

where the words are inside a person’s mind but they’re not coming through the mouth. (The Irish Times, July 4^th, 2016, features section, pp.12 lines 42-43)

Similarly, a man with aphasia shared his experience of language impairment:

I know what I want to say, but have trouble getting the words out or even writing what I mean … . there are three other types: receptive, where you hear a voice or see words on a page, but they make no sense; anomic, where you have trouble thinking of the right words in the first place; and global, where you can’t speak, understand speech, read or write. (The Irish Daily Mail, January 12^th, 2016, news section, pp. 26 lines 26-27 and lines 28-30)

Emilia Clarke, a famous actress experienced aphasia post-surgery for two brain aneurysms which she reported left her “muttering nonsense”. The journalist of the article described aphasia as “ … a consequence of brain trauma that confuses language.” (The Irish Daily Mail, May 10^th, 2019, News Section, p. 21 lines 20 & 21).

The wife of a man with aphasia described her husband’s language impairment:

his mind is like a library where all the books have been knocked off the shelves. He goes to look for the right words, but the book isn’t where it’s supposed to be … when he tries to speak, words literally fail him. (The Irish Daily Mail, August 15^th, 2017, news section, pp. 35, lines 15-16 & 55-56)

Theme 2: supports

This theme describes the support people with aphasia can experience in their daily lives from people and interventions. Two articles described the “Aphasia Advocacy for Access Project” (Speech and Language Therapy Department, Trinity College Dublin), a communication training programme for staff working in cafés and restaurants about how to support customers with aphasia:

We wanted to try and remove some of the communication barriers people with communication difficulties face. (The Irish Independent, January 6^th, 2014, health and living section, pp.23, line 33)

Healthcare professionals and others also aim to support people with aphasia. In the following extract, a Speech and Language Therapist described her work and the support she offers people with aphasia through therapy but also emotionally. “A huge part of my role is supporting people to cope with these changes.” (The Irish Times, March 1^st, 2016, health section, pp.15, line 30).

Theme 3: recovery pathway

This theme described the path to recovery from aphasia with the majority of articles reporting that music supports improvement. Three articles referenced “Melodic Intonation Therapy” (MIT) (Albert et al., 1973) a speech and language therapy treatment that uses music. A reader contributor suggested that:

Singing may help patients regain their speech … (The Irish Daily Mail, March 16^th, 2013 features section, pp.51, line 12)

A journalist attributes his recovery from aphasia to listening to songs by the Beatles which he reports helped him to be able to speak:

“As time has passed, I no longer need to sing sentences in my head as much. But it was nine months or so before I could have full conversations with my friends and family” (The Irish Daily Mail, January 12^th, 2016, news section, pp.26, lines 65–66). A lady with aphasia explained that her path to recovery involved writing songs which she reports was: “her form of therapy” and that “in her experience music can reach parts of the brain that speech cannot” (The Irish Times, July 4^th, 2016, features section, pp.12 lines 42–43). An alternative suggestion to support recovery related to the use of sleep talk analysis:

in the study and treatment of speech disorders, such as aphasia … (The Irish Independent, January 21^st, 2019, health and living section, pp.12 line 61)

Theme 4: impacts on family

The final theme identified described the impact of aphasia on family members. In an article featured in The Irish Times, a wife of a man with aphasia describes the day-care hospital her husband attended as a “lifeline” because it gave her some time away from her role as a carer (The Irish Times, January 19^th, 2016, Ireland section, pp.6, line 43). Aphasia impacts the person post-stroke but also the family members. In the following extract the wife of a man with aphasia describes her husband after his stroke:

“The Russell I brought home wasn’t the Russell I knew” (The Irish Daily Mail, August 15^th, 2017, news section, pp.35, line 39). The emotional impact of aphasia is reported in an article featured in the Irish Independent when a man who cared for his father (who had aphasia post-stroke) until his father required 24-hour care described it as “heart-breaking” for himself and his brother to see his father “institutionalised” (The Irish Independent, August 9^th, 2014, review section, pp.19, line 16 & 17).

Discussion

The aim of this study was to investigate the written coverage of aphasia and/or dysphasia in the Irish print media. All articles related to aphasia and/or dysphasia published in the three most popular Irish newspapers (2013–2020) inclusive were retrieved. Of the 34 identified, 16 met the inclusion criteria and were included in the final review. The articles (n = 16) featured a range of content about aphasia including: Lived experiences (n = 6); Definitions (n = 5); Information (n = 3); Communication training (n = 2). The majority of articles (n = 6) reported the emic experiences of people living with aphasia and the experiences of their family members. Family members’ experiences of a reduction in free time, the importance of respite and changes in their partner with aphasia resonate with previous findings in the literature, e.g., Shiggins et al. (2018). The impacts of aphasia are well documented in the literature, e.g., Manning et al. (2019); however, these impacts and the insider experiences of people with aphasia are largely absent in Irish print media. This study identified a lack of detail and explanation of aphasia in Irish newspapers which is consistent with previous research in other countries, e.g., Sherratt (2011). Unfortunately, inaccurate and incomplete descriptions of conditions may have the unintentional effect of increasing public misunderstandings and misperceptions. Happer and Philo (2013) following an investigation of the impact of the media in the construction of public beliefs and attitudes towards disability, economic development, and climate change in the UK concluded that the information people are given by the media can facilitate change at a collective level both in a positive and negative way depending on the content provided. This highlights the importance of providing accurate and consistent information about aphasia to the public.

Medical opinion and sensational stories about aphasia have featured in print media in the United States (Elman et al., 2000). Interestingly, several articles in this study suggested Melodic Intonation Therapy (MIT) (Albert et al., 1973) as a transformative intervention for people with aphasia with the “power of song” aiding “stroke recovery” (The Irish Daily Mail, March 16^th, 2013, features section, pp. 51, headline). MIT is a music-based intervention for the rehabilitation of oral language production in aphasia. People living with aphasia are often able to sing words they cannot say during normal conversation. The treatment involves repetitive singing of short sentences, while hand tapping the rhythm (Van der Meulen et al., 2014). The literature suggests that MIT may be a valuable treatment option for people presenting with non-fluent types of aphasia (Zumbansen & Tremblay, 2019) and while this particular treatment may not be suitable for everyone, MIT was a positive intervention reported by some people with aphasia featured in this review. There are, of course, a range of evidenced-based aphasia rehabilitation interventions to maximise the communication abilities and life participation of people living with aphasia, e.g., Semantic Feature Analysis (Antonucci, 2014); LUNA (Dipper & Cruice, 2018); Aphasia LIFT (Rodriguez et al., 2013), etc. Aphasia management options differ in terms of the therapy regimen (intensity, dosage, and duration), delivery models (group, one-to-one, volunteer, computer-facilitated), and approaches; however, the evidence suggests that Speech and Language Therapy is effective for people with aphasia following stroke in terms of improved functional communication, reading, writing, and expressive language (Brady et al., 2016, p. 2).

The advantages and limitations of aphasia media awareness campaigns require careful consideration. In a recent study, Simmons-Mackie et al. (2019) examined the literature on aphasia awareness and aphasia awareness campaigns. The authors reported that international aphasia awareness campaigns have had little impact on public awareness and knowledge of aphasia (Simmons-Mackie et al., 2019, p. 3). Marketing and advertising experts suggest that the intention-behaviour gap must be considered in any campaign aimed at raising public awareness of any condition. This means that while the public might have a positive attitude or even intention to perform a behaviour, e.g., learn about aphasia, they may ultimately fail to enact this intention (Godin et al., 2005). A well-cited marketing model – the “Elaboration Likelihood Model” (Petty & Cacioppo, 1984) identifies two different routes to public persuasion using media campaigns (Dahl, 2018)

1) The Central route which advocates active engagement with the source/message meaning. This type of engagement with the message is more likely to lead to central processing. Therefore, to increase awareness and knowledge of aphasia in Ireland and other countries strong and consistent levels of information with persuasive interaction attempts must be used by the relevant media platform. A good example of a successful social media campaign targeting the central route was the recent “Amyotrophic Lateral Sclerosis (ALS) Ice Bucket Challenge”. This campaign involved public engagement with a specific message and action which increased ALS awareness internationally and raised approximately 1 million US dollars for the charity (Vaidya, 2014). Famous celebrities linked with charities, e.g., the Michael J. Fox Foundation (Fox, 2020) is committed to funding Parkinson’s Disease research and to improving the lives of people living with Parkinson’s Disease, or with personal experience of health conditions can also increase public awareness (Emmers-Sommer & Terán, 2020). Emilia Clarke’s recent experience of brain aneurysm was featured across various media platforms including in the Irish Print media. The Irish Daily Mail newspaper may have contributed to increasing public awareness of aphasia through their coverage of this story (Clarke, 2019; The Irish Daily Mail, May 10^th 2019). Involving celebrities to raise awareness about health conditions has potential risks particularly when the personal life of the celebrity overshadows the message of the campaign to the public (Keller et al., 2012).

2) The Peripheral route for public persuasion involves using repetition and numerous persuasions attempts, i.e., People engage with the message fleetingly, e.g., a healthy eating radio and/or television advertisement which requires no active engagement from the target audience which may not be optimum for increasing aphasia awareness and knowledge.

To increase public awareness and knowledge of aphasia through the Irish print media and other platforms the Public and Patient Involvement (PPI) literature which has grown significantly over the last decade (Oliver et al., 2008) should be considered. The Experiential knowledge of the public is increasingly valued as an important contribution to PPI activities. Conducting research “with” or “by” members of the public rather than “to”, “about” or “for” them (INVOLVE, n.d.) enhances the quality and the implementation of services, addresses population concerns, and promotes shared decision-making (Boivin et al., 2010; O’Shea et al., 2019). There are examples of PPI initiatives successfully involving people with aphasia as co-researchers in design, delivery, and evaluation in a range of activities, e.g., research and education (Horton et al., in press; Mc Menamin & Pound, 2019).

In Ireland, we have an exciting opportunity to learn from the aphasia and PPI literatures and from experts in the disciplines of marketing, advertising, psychology, and behavioural science (Christiano & Neimand, 2017) to co-create co-implement and co-evaluate a targeted national media campaign using the central route of public persuasion. Given the popularity of print media in Irish society particularly amongst the population group with the highest incidence of stroke and aphasia, the authors suggest that this platform would be a good starting point for an aphasia media campaign. The Irish effort will make a valuable contribution to an international comprehensive research agenda as proposed by Simmons-Mackie et al. (2019). Future research should explore the coverage of aphasia across other media platforms including social and visual media.

Conclusion

The main finding of this study is clear; representation of aphasia in the Irish print media is limited and often inaccurate. There were only 16 articles related to aphasia across the three most popular newspapers in the last 7 years. Given that up to 10,000 new people are diagnosed with stroke annually in Ireland, with up to one third experiencing aphasia and a growing elderly population, increasing public aphasia awareness and knowledge is an important mission. Informed communities generate opportunities to improve services and awareness through focused petitioning (Hopkins & Rippon, 2015). Harnessing print media and other platforms to increase public awareness and knowledge of aphasia will promote inclusion and contribute to empowering people with aphasia and their families to live successfully with aphasia in Irish society.

Disclosure statement

No potential conflict of interest was reported by the authors.