The feasibility of delivering motivational interviewing to those with communication difficulties following a stroke

Mood problems are common in stroke survivors, as are communication difficulties, which are experienced in around a third of patients. Patients with communication difficulties have a greater risk of depression. Despite this they are often excluded from trials that either treat or prevent depression using talking-therapies, such as Motivational Interviewing (MI). Through a series of studies this thesis aims to explore the feasibility of widening access to MI for patients with moderate to severe communication difficulties. In the first study, a secondary analysis of data from an earlier MI trial with stroke patients explored the communication characteristics of participants. Patients receiving MI were shown to benefit in mood compared to those receiving usual care, and this was more prominent in those with communication difficulties. The analysis found that no individual component of communication could account for changes in mood outcome. This highlighted the need for suitable tools to assess communication and mood in patients with communication difficulties post-stroke. Through a series of integrative reviews, tools suitable for the screening and assessment of communication and mood in patients with communication difficulties were explored. A number of tools were available, however few had been adequately validated in this patient group. Of the tools considered in the review, a small number were identified as suitable. Using the tools identified, a feasibility study explored delivering MI to patients with communication difficulties after stroke. The study found that with the implementation of aids and adaptations for communication difficulties, it is possible to deliver MI to patients with moderate to severe communication problems. The final study explored the implementation of the intervention from the perspective of staff involved in the trial. Firstly, views of screening and recruitment were explored through interviews and analysis of the trial screening log. Further interviews were held with MI therapists before and after the trial. Perceived barriers to their roles within the study included holding dual roles, and facilitators included feedback from supervisors. This thesis has contributed to knowledge, showing that through the use of aids and adaptations for communication difficulties, it is feasible to widen access to MI for patients with moderate to severe communication problems. The thesis has further added to knowledge through exploring staff views of implementing the intervention