Service encounter interactions of people living with moderate-to-severe post-stroke aphasia in their community

Background: Access to the community is recognised as a need as well as a right for people living with a disability, including people living with aphasia (PLWA). Although studies have shown factors that hinder or support participation of PLWA, few examined naturally occurring interactions outside the home. Aims: This qualitative study aimed to describe the structure of natural interactions occurring between people with aphasia and individuals at the checkout in service encounters. Methods and Procedure: Six participants with moderate-to-severe expressive post-stroke aphasia were video-recorded during commercial interactions within their community environment. Data collection took place in grocery stores, supermarkets, restaurants, drug stores, coffee shops, specialised shops, and a movie theatre. A total of 20 commercial interactions were analysed using conversation analysis. Outcomes and Results: The interactions between PLWA and checkout assistants during payment were characterised by a sequence of four communication stages based on mutual agreement of (1) their availability for the commercial transaction, (2) the item(s) that would be purchased, (3) the price, and (4) the fact that the interaction was over. The second and third parts of the sequence were more challenging in terms of physical access to the desired item(s) or its representation in stage two and access to a visual display of the price in stage three influenced the communication accessibility of the stores. Conclusions: The present findings suggest that PLWA can successfully participate in interactions involving the purchase of goods, even if aphasia is severe, as these interactions are structured by communication and four stages of mutual agreement. During rehabilitation, speech-language pathologists could help prepare PLWA to carry out commercial transactions in self-selected shops to support active community participation post-rehabilitation.