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    Unspoken Voices: How can augmentative and alternative communication (AAC) support people with communication disability towards greater participation in activities of daily life?

    Broomfield, Katherine (2024) Unspoken Voices: How can augmentative and alternative communication (AAC) support people with communication disability towards greater participation in activities of daily life? Doctoral thesis (PhD), Manchester Metropolitan University.

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    File will be available on: 16 January 2026.
    Available under License Creative Commons Attribution Non-commercial No Derivatives.

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    Abstract

    Background: People who experience communication disability may benefit from using augmentative and alternative communication (AAC) strategies. The NHS funds services that assess, make devices available to, and support people who may benefit from AAC devices. Current NHS strategy is promoting person-centred care and shared decision-making. People who access NHS AAC services are frequently not included in decision-making about AAC devices or the support the receive with their AAC, and it is not clear what outcomes are important to them. Aims: This project aimed to understand more about the factors that influence people’s engagement with AAC devices and services, and what outcomes are important following receipt of AAC devices. The objective was to inform the development of a patient-reported outcome measure (PROM) that can be used to re-orient AAC services towards individual’s priorities and therefore facilitate person-centred care. Method: A public involvement (PI) group informed all aspects of this project. Two systematic reviews and two phases of qualitative data collection were carried out. A theoretical perspective was developed during the project which was informed by John Shotter’s theory of dialogue. This theoretical perspective informed the development of a novel method for qualitative data analysis that added depth and authenticity to the results. Results: A conceptual framework was generated to inform the further development of a PROM for AAC. Constructs that represent areas of significance and 33 items that reflect important outcomes to people who use AAC were identified. A theoretical framework was established that can extend practice and will support the implementation of a PROM. Impact: The results can be used to inform the further co-design of a PROM to evaluate the impact of AAC devices and shape greater person-centredness in service provision. The theoretical learning, which was inspired by collaborative work with the PI group, and which evolved through the qualitative phases of the project, will enrich discussions about the conceptual tools that practitioners employ in research and clinical practice with people who have communication disability.

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