# Identification and Applications of Key Elements in the Development of Pictorial Support for People With Aphasia After Stroke: A Co‐Design Approach

## TL;DR

This study identifies key design elements for pictorial support to help people with aphasia after stroke communicate better with healthcare providers.

## Contribution

The study co-designs pictorial support with stakeholders and identifies key elements for effective pictorial communication in healthcare.

## Key findings

- Pictures must be relatable and closely match written information to avoid becoming barriers.
- Communication partner skills are crucial for enhancing the use of pictorial support.
- Stakeholders emphasized the importance of aligning pictures with the text in pictorial support.

## Abstract

Access to health information is essential to ensure safe, person‐centred care and shared decision‐making. Following a stroke, communication difficulties, such as aphasia, often cause barriers to communication with healthcare staff and risk worsening the quality of care. Adaptations to make written information more accessible for persons with aphasia often include pictures. However, guidelines on creating pictorial support for persons with aphasia are limited. This study aimed to (1) identify key elements to consider when developing pictorial support to aid communicative accessibility and (2) co‐design an accessible pictorial support for the follow‐up tools, Post‐Stroke Checklist and the pre‐visit tool Stroke Health, together with stakeholders.

Six persons with aphasia, a patient‐partner with stroke, and eighteen stroke healthcare professionals were involved to co‐design a pictorial support. Stakeholders were engaged via interviews, e‐mail surveys and consensus workshops. Data were analysed using reflexive thematic analysis.

A reflexive thematic analysis resulted in two main themes and four sub‐themes. First, ‘Aspects to consider in the design of pictures in pictorial support’: The importance of being able to relate to pictures and Interpretation of pictorial support is complex and pictures risk becoming barriers if not carefully illustrated. Second, ‘The contextual use of pictorial support’: Pictures must correspond closely to the text, and Communication partner skills are important to enhance the use of pictorial support. The analysis also resulted in a list of key elements to consider when developing pictorial support.

Findings highlight the importance of pictures being relatable and closely matching the written information. Identified key elements can be used as principles in the future development of pictorial support in different settings.

Both persons with lived experience of stroke and aphasia and healthcare professionals within stroke rehabilitation contributed to the design process. This involvement included individual interviews, e‐mail surveys and one consulting group discussion. A patient‐partner with stroke was engaged in all workshops where feedback was discussed before deciding on revisions to proceed with. The final version of the pictorial support has been presented to stakeholders at a patient organisation, contributing to the recruitment of participants and facilitating rooms for interviews.