Frontiers in Psychology (Apr 2014)
How does biographic-narrative intervention influence identity negotiation and quality of life in aphasia? - The participants' perspective
Abstract
Problem Many persons with aphasia experience a loss of Quality of Life (QoL). Although life story work supports processes of sense-making and by this QoL improvement, only a few studies made use of the “talk-based” approach in aphasic patients because of the language deficit (e.g. Shadden, 2005). We developed an adapted interdisciplinary biographic-narrative intervention, which was already shown to be effective in terms of gains in quantitative measures of QoL (Corsten, Konradi, Schimpf, Hardering, & Keilmann, 2013). For a deeper understanding we will now analyze the participants’ perspective obtained in interviews. Procedure and Analysis Five face-to-face in-depth interviews and seven group sessions were conducted over ten weeks in a mixed-method-design with pre- and post-tests and a follow-up assessment three months after the intervention. The multidimensional construct of QoL was measured with a battery of instruments: – the pictorial version of the Aachen Life Quality Inventory (ALQI, Engell, Hütter, Willmes, & Huber, 2003) – the Satisfaction with Life Scale (SWLS, Diener, Emmons, Larsen, & Griffin, 1985) – a German version of the Visual Analogue Mood Scales (VAMS, Stern, 1997) Semi-structured interviews, conducted post-treatment, included questions concerning the participants‘ experiences with the intervention, identity change and future perspectives e.g. Analysis was based on interpretative principles from grounded theory (Corbin & Strauss, 2008). Results For our entire sample of 27 participants with chronic but different types of aphasia we found a significant and stable growth in health-related QoL (ALQI, Wilcoxon signed-ranks test, two-tailed, p < .05). Self-reported states of mood also improved significantly (VAMS, t-test, two-tailed, p < .05). As expected, overall life satisfaction (SWLS) did not change. The interviews revealed three main themes “effectiveness of the intervention”, “QoL” and “self-concept”. The following associations with improvements in QoL were identified: enhanced coping regarding chronic illness, improved self-efficacy and control, and a more differentiated picture of self. The impacts of the different kinds of intervention are discussed. Discussion The quantitative and the qualitative results were complementary in demonstrating the effectiveness of the biographic-narrative intervention. As predicted, there was a specific treatment effect with a significant and stable improvement in QoL. Analysis of the semi-structured interviews indicated that through the approach the participants’ sense of self changed. The findings provide foundations for future work into intervention.
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