Transactional Success in the Texting Exchanges of People with Aphasia

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Abstract Individuals with aphasia experience reduced social networks, a contributor to poor health-related quality of life. Increased reliance on electronic communication in today’s digital world may exacerbate the challenges individuals with aphasia have in connecting with others and accomplishing their participation goals. Indeed, preliminary research shows that people with chronic aphasia have fewer contacts with whom they text and fewer text exchanges than neurologically healthy adults. The long-term goal of the proposed research is to develop an intervention to support electronic messaging in individuals with aphasia to provide access to a mode of communication that is critical for maintaining and strengthening relationships. The overall objectives of this proposal are to: 1) validate a novel measure of transactional success (information exchange) in texting and 2) identify texting behaviors that persons with aphasia and their partners engage in that enable and detract from texting success. The rationale for this proposal is two-fold. First, it is critical to have a psychometrically strong measure to assess texting performance in persons with aphasia. Second, it is imperative to identify factors associated with successful transaction to develop an intervention that facilitates texting. To attain the overall objective, the following specific aims will be pursued via a mixed methods approach. Aim 1 uses a set of statistical analyses to evaluate the validity and reliability of a measure of texting transactional success (TTS). The psychometric properties of a TTS rating scale will be evaluated using performance data from 60 participants with chronic aphasia on a three-turn texting script collected under a previous clinical trial. Aim 2 applies the TTS scale to authentic texting data collected from a prospective sample of 24 individuals with aphasia. External validity of the standard texting script will be assessed by examining the agreement between participants’ scores on this measure and scores yielded from participants’ authentic text exchanges. Aim 3 identifies texting behaviors used by people with aphasia and their partners that enable and disrupt transactional success. Conversation analysis will be employed to text exchanges from the same sample of participants from Aim 2 to reveal repair strategies and various multimedia and paralinguistic tools (e.g. emojis, images, CAPS, punctuation) that may enhance transactional success. These repair behaviors and multimedia/paralinguistic tools are strategies that could be trained to increase texting success. The proposed research is innovative because it addresses texting, an increasingly pervasive mode of communication that is understudied in aphasia rehabilitation. This research applies conversation analysis to study text messaging in aphasia, a novel application of this methodology. The proposed research is significant because the contribution of a validated measure of TTS will offer a means of assessing texting performance and evaluating treatment outcomes. Findings will inform future development of an intervention to support texting in people with aphasia and potentially reduce social isolation and improve quality of life.