City Research Online

Abstract

BACKGROUND: Cognitive-communication disorders (CCD) are common after acquired brain injury (ABI) and can have a negative impact on a person’s life. Training a communication partner can improve the communication skills of the person with ABI, however, families are dissatisfied with existing communication partner training (CPT) and support. There is emerging evidence for the effectiveness of training for communication partners, though there is variability in the content, dosage and delivery of training; and published programmes are rarely used by speech and language therapists in practice. The strongest evidence is for a single programme, TBI Express, which has three different versions. Therefore, the aim of this study is to identify and describe the active components of existing training programmes for people with CCD.

METHOD: The treatment manuals from each of the training programmes (i.e., TBI Express, TBI Express-Adapted, and TBIconneCT) were coded using the BCTTv1. Mechanisms of action (MoAs) and each behaviour change technique (BCT) was identified and linked using the Theory and Techniques Tool. Prior to coding, pilot coding was completed on two modules from TBI Express with reliability of coding established (kappa and % agreement) for two modules of the remaining two programmes representing ~20-33% of treatment content. Coding disagreements were recorded and described and subsequently resolved.

RESULTS: Across the three programmes, between 20-25 BCTs were identified and comprised 27 unique BCTs across all manuals. These BCTs were linked to between 15-16 identified MoAs and comprised 16 unique MoAs. The most common BCTs were providing information about social and environmental consequences; instruction on how to perform the behaviour; behavioural practice/rehearsal; and feedback on the behaviour. The most common mechanisms targeted were beliefs about capabilities; skills; and behavioural regulation. Reliability of coding BCTs and MOAs was moderate-to-almost-perfect (kappa=0.69-0.88, 73-85% agreement). Disagreements in coding were discussed and resolved through consensus agreement.

CONCLUSIONS: Applying behaviour change theory to TBI Express has revealed unique insight into the active ingredients of training. Communication partners are anticipated to improve their communication behaviours via capabilities, skills and regulation, through SLT-delivered CPT which focuses most commonly on information provision, instruction, rehearsal, and feedback. Such insights are gathered to further refine and adapt existing interventions. Further work is needed to identify the most important active ingredients to expert clinicians, to design and test the feasibility of an adapted CPT programme for implementation in public healthcare services.

Publication Type:	Article
Additional Information:	© 2026 The Author(s). International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords:	Cognitive-communication; social communication; training; rehabilitation; brain injury; behaviour change; techniques
Subjects:	R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Allied Health
SWORD Depositor:	Symplectic Administrator

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