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Journal ArticleDOI

Environmental factors that influence the community participation of adults with aphasia: The perspective of service industry workers

01 Jan 2006-Aphasiology (Psychology Press)-Vol. 20, Iss: 7, pp 595-615

TL;DR: Service industry employees were able to identify a range of factors that would act as barriers and facilitators for people with aphasia, and some of the more significant findings include the lack of other people's awareness about aphasic, the willingness of service industry workers at the individual level to accommodate people withAphasia and the difficulty in making the necessary system, policy, and procedural changes at the organisational level.
Abstract: Little research has identified the environmental facilitators and barriers to participation for people with aphasia in the community, and little research focusing on the perspective of service industry workers. This study aimed to identify barriers and facilitators to community participation for adults with aphasia from the perspective of service industry workers. Eight focus groups were conducted with 24 service industry employees. Three categories of barriers and facilitators were identified: 1) People Environmental Factors, such as people’s awareness and assumptions about aphasia, 2) Physical Environmental Factors, such as written information and forms, and 3) Business or Organisational Environmental Factors, such as the communicative demands of the business transaction.
Topics: Aphasia (53%), Focus group (51%)

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The World Health Organization (WHO, 2001) views disability as a dynamic interaction between the person and their environment.
Environmental factors include the physical world and its features, the human-made physical world, other people in different
relationships and roles, attitudes and values, social systems and services, and policies, rules, and laws” (WHO, 2001, p. 213).
Negative environmental factors (barriers) hinder the participation of individuals with aphasia, while positive environmental factors
(facilitators) support their participation.
This study, aims to identify the environmental factors (barriers and facilitators) that influence the community participation of adults
with aphasia, from the perspective of service industry workers in shopping centres.
Multiple focus groups were conducted in two different settings: 1) a suburban shopping centre which had 106 specialty shops, 4
major retailers, a range of banks, a library, and health services, and 2) through personal contacts of the researchers.
Twenty-four participants were recruited for this study. The inclusion criteria for participants were 1) currently employed in a part-
time or full-time position in one of the service industries defined by the Australian and New Zealand Industrial Classification
(Australian Bureau of Statistics, 2004), 2) at least six months experience in their current position, 3) aged between 18 and 65 years
and 4) an English proficiency level adequate enough for focus group discussions, as judged by the investigators. Table 1 shows that
the participants consisted of 17 females and 7 males with a mean age of 38.5 years. Participants had an average 5.7 years of work
experience in their respective service industry.
Table 1 about here.
Participants were first shown a video about aphasia.. The key questions asked in the focus group discussion were 1) What barriers
do you think a person with aphasia might face in your shopping centre? 2) What facilitators are there in your shopping centre that
might make it easier for a person with aphasia to shop? 3) What barriers do you think a person with aphasia might face in your
specific shop? 4) What facilitators are there in your specific shop that might make it easier for a person with aphasia? 5) Within
your workplace, what other facilitators could be introduced to make it easier for a person with aphasia? All focus group interviews
were audiotaped and transcribed verbatim. Data was analysed using the qualitative content analysis procedures as described by
Graneheim and Lundman (2004).

Analysis of the focus group transcripts revealed three categories of barriers and facilitators: 1) people environmental factors, 2)
physical environmental factors, and 3) business/organisational environmental factors (see Tables 2 and 3). Barriers identified within
these categories and the facilitators suggested by participants to overcome these barriers are reported below.
Table 2 about here
Table 3 about here
1) People Environmental Factors
The most common barriers identified by all groups were factors relating to other people, including a lack of awareness about
aphasia, misassumptions about the cause of the communication difficulties experienced by individuals with aphasia, and other
people’s attitudes and actions.
Lack of awareness
Almost every group cited a lack of awareness about aphasia as a significant barrier.
As one participant said, “I’d never heard of that word ‘aphasia’ until I came here today”. In addition to a general lack of awareness
about aphasia, some participants also referred to the lack of physical symptoms associated with the disorder as an added barrier.
The most common misconception cited by shopping centre personnel was the presumption that the individual suffered from an
intellectual disability. Several participants made comments such as:
“They (employees) may think they have mental problems, if someone speaks like that, they may think they are not all there.”
Negative attitudes
Negative attitudes towards disabilities was also a commonly identified barrier:
“The only problem that I see for these people, are other people’s attitudes.” Attitudes included prejudice, lack of tolerance, empathy
and understanding, and impatience. Conversely, positive attitudes were listed by a large number of participants as a major facilitator
to communication for people with aphasia. Positive attitudes included receptiveness, friendliness, tolerance, understanding, and
Strategies used by individuals
A number of focus group participants identified the barrier of strategies taken by personnel interacting with individuals with
aphasia. The most commonly mentioned strategy was people attempting to guess what the individual with aphasia was saying or

finishing their sentences for them. Strategies involving an individual staff member adapting their communication style and
providing more time were seen as facilitators.
2) Physical Environmental Factors
A number of factors relating to the physical environment were also identified as potential barriers. These included the use of written
information (especially forms), the use of technology interfaces, auditory factors, and shop layout.
Written information and forms
The most notable barrier identified by participants relating to the physical environment was the reliance on written material to
disseminate information to customers within shopping centres.
Use of technology
Specific barriers included the use of voice recognition in accessing automated telephone
services, the dependence on online access for services such as banking, and the lack of user-
friendly interfaces on automated service machines.
Auditory factors and shop layout
Other physical environment barriers referred to included auditory factors such as noise and interruptions, and factors relating to
shop layout/organisation.
3) Business/Organisational factors
The final category of barriers to participation related to factors associated with the nature of an organisation or business and the way
in which it is managed.
Communicative demands of business transactions
It was reported by a number of participants that accessing services requiring more communicatively intensive interaction than
others, would act as a barrier.
Business attitudes
Another barrier highlighted by a number of groups was the potential attitudes/ethos of the organisations or businesses providing
services to individuals with aphasia. Barriers identified related to both perceived industry attitudes (e.g.,“I think in retail you’re
more geared to sell”) and to more specific business conventions entrenched in staff training: (e.g., “With banks…in the training for

the branch staff… it is ‘get them in, get them out’ as quickly as possible. It’s make money. As much as banks say ‘we give personal
service,’ we don’t. It’s ‘get them in, get them out’”).
Shop size and staff numbers
The size of a business or shopping centre, numbers of staff, and workload levels were also cited as potential barriers. It was
suggested that larger shopping centres or businesses would offer less personalised services, making it more difficult to provide “one-
on-one” service and for staff to become familiar with regular customer’s needs. Also contributing to a lack of personalised service
was inadequate staff numbers and workload levels.
The present study identified a number of environmental factors that influence the community participation of adults with aphasia
from the perspective of service industry workers. The findings suggest that the lack of awareness about aphasia is a major barrier to
community participation for people with aphasia. Genuine willingness on the part of service industry workers to accommodate
people with aphasia is clearly present. However, service industry workers and organisations need education and training about how
to make their environments more aphasia-friendly.
This research highlights the need for speech pathologists to broaden their scope of practice to include education and training about
aphasia to the general public.
It is imperative that speech pathologists demonstrate strong leadership in supporting organisations and people with aphasia to
identify and remove the barriers that impede the rights of people with aphasia to participate in the community.
Australian Bureau of Statistics (2004). Year Book Australia; Service Industries.
Retrieved September 1, 2004 from
Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing
research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105-112.
World Health Organisation (2001). International classification of functioning,
disability and health: ICF. Geneva: World Health Organisation.

Table 1 Demographic Information According to Industrial Classification
Industrial Classification Age Gender Length of time in
Self-reported contact
with people with
Retail Trade
19 years
37 Male 2 ½ years None
58 Female 4 years None
39 Female 1 year None
24 Female 1 year None
21 Female 5 ½ years Little
20 Female 2 years None
19 Female ½ year None
Accommodation, Cafes
& Restaurants
1 year
24 Female 7 years Little
Transport & Storage
½ year
35 Female 8 years Little
Finance & Insurance
1 ½ years
47 Female 6 years None
Property & Business
20 years
62 Male 10 years None
26 Female 1 year Some
Health & Community
1 ½ years
38 Female ½ year Little

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