Background:Little is known about what happens to people with severe aphasia in the years after stroke when rehabilitation comes to an end, or about day-to-day life for this group.Aims: This study aimed to track the day-to-day life and experiences of people with severe aphasia, and to document levels of social inclusion and exclusion as they occurred in mundane settings. Methods and Procedures: Ethnography was chosen as the qualitative methodology most suitable for studying the experience of people with profoundly compromised language. 20 people who were judged to have severe aphasia following stroke agreed to be visited and observed three times in different domestic and care settings. The observer documented environments, protagonists, events, and interactions. Field notes were elaborated with personal, methodological, and interpretative notes. Written material (for example information leaflets) was also documented and described. Data were subject to thematic analysis. Outcomes and Results: The study revealed how social exclusion is a common experience for this group, played out in a variety of ways in a range of domestic and care settings. Social exclusion occurs at infrastructural, interpersonal, and personal levels. Conclusions:The study suggests that the social exclusion of people who struggle to communicate could be addressed through training, for professional and lay carers, that promotes support for communication; opportunity and access; respect and acknowledgment; and attention to the environment.

This paper reviews some different meanings of the term ‘psychosocial’ and identifies the different ways in which the social and psychological sequelae of aphasia can be explored. These include qualitative methods, which seem well suited to addressing such complex issues. Having outlined some features of qualitative research, the paper describes a study in which fifty people talked about the consequences and significance of their long-term aphasia. Their ‘insider perspective’ on aphasia suggests its impacts are extensive, complex, direct and indirect, interconnected, systemic, dynamic and diversely experienced. The paper discusses the various implications of the study for clinicians and researchers concerned with the psychosocial aspects of aphasia and outlines how some of the issues raised in the interviews might be addressed.

Although cancer patients from social class V were less likely than others to die in the hospice, social inequality in access to or utilisation of healthcare in terminal illness was not prominent in carers' accounts. When it did arise, it was associated with passivity in seeking information and support on the part of some carers from social classes IV and V. Carers from social classes IIIM-V received more regular and reliable support from their families than those from social classes I-IIIN.

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Four women whose husbands had aphasia were asked to talk about their lives in several indepth interviews. Themes from their accounts were used to plan, deliver, and evaluate a support course. Themes from their initial interviews were used to create a course plan containing skill training, provision of information, and discussion topics. Themes emerging from their reports during course discussions provided a means for participants to explore and problem-solve their current issues. Evaluation of the course was based on themes drawn from two post-course interviews. Findings suggest that (1) aphasia affected these four participants differently, (2) themes from autobiographical reports were useful in planning content of a course to assure its relevance, (3) issues raised by participants during the course served to assure course relevance in its delivery, and (4) autobiographical descriptions offered a way of discovering whether and how the course experience had an ongoing impact on the lives of the participants. It is concluded that the collection and analysis of autobiographical reports provide an effective way to design, deliver and evaluate learning in a support course for partners of those with aphasia.