Aphasia is an acquired language disorder resulting from damage to the brain; typically as a result of cerebrovascular accident or other neurological injury. Although figures vary internationally, studies on the incidence of aphasia suggest that approximately one quarter to one third of all individuals admitted to hospital with acute stroke will present with aphasia [1–4]. Aphasia creates a substantial barrier to communication, frequently leading to social isolation and an inability to discuss or negotiate issues related to daily life including healthcare [5–9].
Previous research suggests that only 1.5 to 7.6% of the general population has basic knowledge about aphasia . Kagan  reported that many people are often unaware of the cognitive and social competence of people with aphasia (PWA) and as a consequence avoid conversations with PWA. This can result in the exclusion of PWA from decisions about daily life and healthcare, and can have detrimental effects on the psychosocial wellbeing and quality of life of PWA [5, 6, 11–13]. Involving PWA in their treatment planning can lead to increased patient motivation, increased effectiveness of health professional time use, and the achievement of more holistic management programs . Equipping health professionals with the skills and confidence to communicate effectively with PWA is, therefore, an important step towards optimizing patient involvement in rehabilitation.
In the healthcare setting, language barriers often prevent PWA from being involved in the design of their treatment programs or identification of rehabilitation goals . PWA may also be unable to ask questions about their medical condition or treatment . Evidence from an observational study in an acute stroke unit suggests that health professionals’ level of knowledge, communication skills and attitudes can act as barriers to effective communication with individuals with aphasia in hospital . Knight et al.  found that when communicating with stroke patients without aphasia, 22% of health professionals‘ time was devoted to the dissemination of health information; however, when communicating with stroke patients with aphasia, only 7% of the health professionals’ time was spent on information dissemination. It was also found that health information was only provided to people with aphasia when a significant other was present . Two possible reasons for this observation proposed by the researchers were that health professionals may have reduced confidence when communicating with PWA, or secondly that many health professionals may not be aware of the competence and value of communicating with PWA . Patient-centred or client-centred care is now widely recognised as a foundation principle of appropriate healthcare and there is evidence that increased patient involvement in rehabilitation leads to better outcomes. The studies by Leach et al. , Knight et al. , and O’Halloran et al.  all included speech-language pathologists (SLPs) in their health professional cohorts suggesting that communicating with PWA may be problematic even amongst SLPs. However the extent of the problem has not been investigated specifically for SLPs or SLP students.
Speech and language pathologists are viewed as communication experts in hospital settings. However, while all students receive theoretical foundation knowledge about communicating with PWA through academic coursework, not all SLP students receive practical training during their coursework lectures in techniques to communicate with PWA prior to clinical education placements (where practical training refers to hands on experience communicating with PWA). The combination of the pressure of a novel clinical environment and unfamiliarity with the practical application of strategies to effectively communicate with PWA has the potential to create anxiety for novice students. In other health disciplines including medicine and nursing, clinical educators and students have reported a lack of preparedness to cope with the basic communication and interaction requirements inherent in client contact . This interfered with students’ abilities to maximise learning during clinical education placements, and took the focus off student development in other domains such as goal-setting and clinical reasoning . Anxiety surrounding basic communication with clients may be even more critical for SLP students as they are interacting with individuals with a communication disability, so their interpersonal skills and clinical skills are closely interrelated. Indeed, qualitative research by Jagoe and Roseingrave  suggested that SLP students may experience considerable apprehension at the prospect of communicating with PWA. During the study by Jagoe and Roseingrave  the students wrote reflective letters to themselves at the start and completion of a service learning module, which involved pairs of students visiting a PWA. Data analysis involved thematic analysis of the letters. However, out of the cohort of 22 students who participated in the module, only eight students consented to their letters being used for the study, with only six of these students providing both pre and post letters . As a result, further research involving a larger student sample and a direct self-reported confidence rating is required to investigate the confidence of SLP students when communicating with PWA.
Although all SLP students are required to have achieved specific competencies for entry level practice prior to graduation, they may have substantially varying levels of confidence and experience interacting with PWA as aphasia-related clinical education placements frequently involve inequitable and arbitrary clinical experiences for students for a number of reasons, including variation in type and severity of clients’ communication disabilities and attendance rates . This is particularly pertinent given that repeated experience in clinical skills has been linked to improved knowledge and confidence with the skills [19, 20]. Effective communication with clients is featured as an underlying theme in many of the entry requirement areas ranging from assessment, treatment planning to treatment evaluation nationally in Speech Pathology Australia’s Competency-based Occupational Standards for Speech Pathologists Entry Level (CBOS)  and internationally in the American Speech-Language-Hearing Association’s Standards and Implementation Procedures for the Certificate of Clinical Competence in Speech-Language Pathology . Following graduation SLPs do not usually receive further formal training in practical techniques to communicate effectively with PWA and must rely on a “learning on the job” approach to gain skills. While confidence and skills in communicating with PWA may be achieved with time and experience, it would be preferential for graduating SLPs to already have confidence and knowledge of strategies that may be implemented to assist communication with people with PWA. This is particularly important given that other health professionals will likely look to them for guidance in the field of communication when working with clients with aphasia. It remains unknown whether entry level coursework on the nature and treatment of aphasia prepares SLP students sufficiently to communicate effectively with PWA prior to their first clinical education placements with PWA. It is likely that confidence and knowledge of a range of potential communication strategies to assist in basic communication with PWA might alleviate the students’ focus on developing foundation level interpersonal communication during clinical placements and allow the students to instead maximize their learning experiences in more specific clinical domains; such as clinical reasoning.
An important first step is to investigate students’ confidence levels and their knowledge of strategies to assist communication with PWA after these students have participated in routine academic coursework about aphasia. This information could then be used to justify (or refute the need for) subsequent development and evaluation of tailored practical skills programs that could be provided as an adjunct to existing theoretical based academic courses. Consequently, the present study aimed to investigate SLP students’ self-reported confidence levels in communicating with PWA and their knowledge of strategies that could be used to assist communication with PWA.