Reframing Communication Partner Training in Healthcare: A Critical Interpretive Synthesis to foreground culture, power and linguistic diversity
1
Continuing Education, University of Oxford, Oxford, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Communication disability can disrupt equitable participation in healthcare, particularly for people with acquired communication impairments such as aphasia, most commonly following stroke. Communication Partner Training (CPT) is a widely adopted approach applied across healthcare contexts to improve communication accessibility by targeting the knowledge, skills and practices of healthcare providers and caregivers (1). Most CPT models were developed in Global North contexts and operationalise success primarily through behavioural and interactional metrics. In doing so, culture, power and linguistic diversity are more often treated as contextual factors rather than core to communication and participation. This study critically examines how CPT is conceptualised and theorised in the literature, with particular attention to assumptions that researchers make regarding communication success, participation and change.
METHODS:
Critical Interpretive Synthesis methods were used to locate and synthesise literature from multiple international settings, including culturally and linguistically diverse contexts like South Africa (2). Our initial search yielded 326 papers, of which 25 were included as core to the review. Literature was analysed iteratively to identify underlying assumptions, theories of change, and conceptual frameworks.
RESULTS:
Three key patterns were identified. First, culture is rarely theorised explicitly and is typically positioned as contextual background rather than constitutive of communication. Second, despite acknowledging interactional complexity, CPT models privilege observable behavioural change, often marginalising relational, moral and epistemic dimensions of participation. Third, participation is frequently operationalised as interactional performance rather than social recognition, authority and inclusion. Evidence from culturally diverse settings challenges assumptions that participation can be enhanced primarily through standardised strategies and training models.
CONCLUSIONS:
This synthesis reframes CPT as a culturally situated, relational and power-influenced practice. A narrow focus on effectiveness risks obscuring public health concerns regarding appropriateness, equity and contextual fit, with implications for both research and clinical care.
Communication disability can disrupt equitable participation in healthcare, particularly for people with acquired communication impairments such as aphasia, most commonly following stroke. Communication Partner Training (CPT) is a widely adopted approach applied across healthcare contexts to improve communication accessibility by targeting the knowledge, skills and practices of healthcare providers and caregivers (1). Most CPT models were developed in Global North contexts and operationalise success primarily through behavioural and interactional metrics. In doing so, culture, power and linguistic diversity are more often treated as contextual factors rather than core to communication and participation. This study critically examines how CPT is conceptualised and theorised in the literature, with particular attention to assumptions that researchers make regarding communication success, participation and change.
METHODS:
Critical Interpretive Synthesis methods were used to locate and synthesise literature from multiple international settings, including culturally and linguistically diverse contexts like South Africa (2). Our initial search yielded 326 papers, of which 25 were included as core to the review. Literature was analysed iteratively to identify underlying assumptions, theories of change, and conceptual frameworks.
RESULTS:
Three key patterns were identified. First, culture is rarely theorised explicitly and is typically positioned as contextual background rather than constitutive of communication. Second, despite acknowledging interactional complexity, CPT models privilege observable behavioural change, often marginalising relational, moral and epistemic dimensions of participation. Third, participation is frequently operationalised as interactional performance rather than social recognition, authority and inclusion. Evidence from culturally diverse settings challenges assumptions that participation can be enhanced primarily through standardised strategies and training models.
CONCLUSIONS:
This synthesis reframes CPT as a culturally situated, relational and power-influenced practice. A narrow focus on effectiveness risks obscuring public health concerns regarding appropriateness, equity and contextual fit, with implications for both research and clinical care.
| eISSN: | 2654-1459 |
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