Searching for active ingredients in rehabilitation: applying the taxonomy of behaviour change techniques to a conversation therapy for aphasia.

Abstract

A taxonomy of behaviour change techniques has been developed to help specify the active ingredients of behaviour change interventions. Its potential for rehabilitation research is significant, however, reliable use among allied health professionals has not yet been explored. This article describes the content of a conversation therapy for post-stroke aphasia using the taxonomy and investigates inter-rater reliability among Speech and Language Therapists. Two Speech and Language Therapists undertook the same half day, self-led training programme in the behaviour change technique taxonomy and independently coded all materials in the "Better Conversations with Aphasia" programme. Inter-rater reliability was evaluated using the kappa coefficient and percentage agreement. Reliably agreed techniques were categorised according to the speaker and type of behaviour they targeted. Sixteen behaviour change techniques were reliably agreed to be present. Inter-rater reliability was moderate (<i>K</i> = 0.465), and in line with satisfactory percentage agreement (79.8%). More techniques were used to target the adoption of new behaviours (15) than the termination of old ones (3). People with aphasia received fewer behaviour change techniques (10) than their communication partners (16). Describing the content of conversation therapy with the taxonomy of behaviour change techniques offers clinically useful insights with potential to enhance both research and practice. The intervention is shown to target different types of behaviour in different ways, and offer different speaker groups different content. Non-psychologist users of the taxonomy may encounter challenges working with unfamiliar concepts and terminology, which may impact on reliable use.IMPLICATIONS FOR REHABILITATIONIn order to change communicative behaviours within conversation, feedback should focus not only on performance but also on the immediate social and emotional consequences of a behaviour.This study adds to the evidence that unhelpful conversational behaviours can be reduced by providing speakers with information about any unwanted consequences, and then agreeing on a supportive behaviour to use instead.People with aphasia should be offered the same range of behaviour change techniques as their communication partners.