An exploration of participant experience of a communication training program for people with traumatic brain injury and their communication partners

Abstract

Purpose: To investigate the experiences of participants who attended communication training programs for people with traumatic brain injury (TBI) and their everyday communication partners (CP) as part of a non-randomised controlled trial. Method: The participants were people with TBI and their CP, who were family members or carers of the people with TBI. Twenty-six participants (13 participants with TBI and 13 CP) completed the JOINT program, which involved participants with TBI and CP attending the program together. Fourteen participants with TBI completed the TBI SOLO training program, which did not involve the participation of a CP. Semi-structured videotaped interviews were completed by all participants at the end of the training. Using a six-step generic analysis procedure, data were categorised into topics and then subtopics to identify conceptually discrete units. Results: Participants described improvements in communication skills, the impact of improved communication skills, valuable components of the programs and components that needed changes. Conclusion: The accounts of participants provided additional evidence for the effectiveness of the training programs, assisted with identifying helpful components of the training and demonstrated the usefulness of a qualitative research methodology as part of evaluating the outcomes of the clinical trial.

Implications for Rehabilitation

• Participants in social communication skills training programs for people with traumatic brain injury report positive outcomes.

• Including communication partners in training programs is reported to be beneficial, although there are some challenges.

• Qualitative methodologies are a useful way of understanding the processes and outcomes of complex interventions such as communication skills training programs.

Keywords::

• Communication
• communication partners
• qualitative research
• semi-structured interviews
• training
• traumatic brain injury

Acknowledgements

We would like to acknowledge the contributions of the study participants, Dr. Bronwyn Hemsley for early discussions on qualitative design, Dr. Belinda Kenny for independent review of study data coding and Dr. Angela Dew and Professor Nina Simmons-Mackie for valuable comments on previous versions of the manuscript.

Declaration of Interest: This study was supported by a National Health and Medical Research Council (NH&MRC) project grant.

Appendix 1.Group training program overview

Session 1

Introductions

Introductory session where the purpose of training, group guidelines and home practice expectations are established and members introduced to each other and clinicians.

Session 2

Brain injury and communication

An educational component on TBI and communication including how cognitive, physical and behavioural symptoms that may impact on communication using video case studies.

Session 3

Effective communication – 1

Explores the forms and purposes of communication, different contexts and communication structures used in each context, different roles in communication and how communication role affects outcomes of interactions.

Session 4

Effective communication – 2

Extends Session 3 and examines general communication facilitation strategies, and explores barriers and facilitators to good communication in everyday life.

Session 5

Collaboration (titled “starting and participating in conversations” for the TBI SOLO group)

Focuses on techniques that help conversations to be a collaborative, more equal and organised process. For the JOINT group, it also helps communicative partners provide structure and support to the person with TBI for their conversations.

Session 6

Elaboration (titled “Extending Conversations” for the TBI SOLO group)

Focuses on the concept of keeping conversations going by exploring techniques that help to organise and link topics, with use of both questions and comments. For the JOINT group, this session assists communication partners (CP) to scaffold conversations for the person with TBI without taking over the conversation.

Session 7

Asking questions

Explores the use of appropriate and helpful questions to start and keep conversations going. For the CP in the JOINT group, this session also suggests how to avoid negative, or “testing” questions and instead focus on a positive questioning style.

Sessions 8–10

Improving skill and confidence

These sessions then revise the information and practise each technique learnt in previous sessions with actual conversations. Session 10 also celebrates group member’s achievements and outcomes with a group lunch.

Each group session contains session handouts, a mix of role plays, information content, conversational practice and each pair is encouraged to play recorded home practice tapes to discuss with the other group members. A morning tea break each week allows people to socialise with and get support from group members. Individual participant sessions follow the same protocol with a client-specific focus.

Appendix 2. Interview probe statements

The interview contained a general opening statement requesting information about the participants’ experience of being involved in the program, i.e. “Tell me about your experiences with the social skills communication program” to obtain participants’ preliminary reflections. The following probe questions were then used throughout the interview as necessary to ensure all topics of interest were addressed.

Probe topics included “Tell me about …”

1.	Your communication (family/friends/strangers)
2.	The CP communication skills (JOINT only)
3.	Relationship between person with TBI and the CP
4.	Relationship with family
5.	Relationship with friends
6.	Social life
7.	Confidence with communication/social skills
8.	Your communication goals at the end of the program
9.	Elements of the program that should be kept
10.	Changes that could be made
11.	Experience of attending the program with a CP (JOINT only).
12.	What it would have been like to attend the program with a CP (TBI SOLO only)

Member checking was used during interviews to confirm that participants’ responses had been understood accurately.