ANCHOR: Communication Partner Training for Maintaining Friendships After Aphasia

Aphasia significantly disrupts social relationships, with friendship loss occurring early after stroke and continuing into chronic stages. Despite friendships being prioritised by people with aphasia and families, they rarely receive explicit focus in rehabilitation. Communication partner training is an intervention with potential to keep friendship bonds strong after aphasia.

This paper describes the development of ANCHOR (Aphasia: Nurturing Connection, Honoring Ongoing Relationships), a communication partner training intervention protoype designed specifically for people with aphasia and their pre-existing friends-and the foundational elements of ANCHOR and how they informed its design and components, and then situates ANCHOR within the broader communication partner training literature with attention to partner type, candidacy and real-world delivery in service settings.

ANCHOR represents the first communication partner training intervention explicitly targeting friendship maintenance after aphasia. Development was grounded in a systematic research progression including lived experience research, relational competence theory and the behaviour change wheel, and a planned cycle of refinement across a two-year development period. Key distinguishing features include a hybrid delivery model that combines self-paced digital modules with in-person coaching sessions, universal 'talking tools' accessible to friends with minimal aphasia knowledge, first-year post-stroke timing to prevent relationship deterioration, and explicit attention to implementation barriers.

By grounding communication partner training design in lived experience, relationship theory and implementation science, ANCHOR is designed as a comprehensive, implementable approach to sustaining friendships after aphasia, thereby addressing a critical gap in post-stroke rehabilitation with potential to reduce social isolation and support mental health. ANCHOR is an intervention prototype and its core functions, forms and implementation supports will be refined as feasibility and trial data accrue.

What is already known on this subject Aphasia greatly impacts the ability for people to maintain a strong social network. People with aphasia often lose most of their pre-stroke friends early in the recovery journey. Friends of people with aphasia need access to interventions that can help them understand aphasia and its impact on communication. What this study adds to the existing knowledge We developed a communication partner training program called ANCHOR based upon lived experience research involving people with aphasia and their friends and theories and relationship maintenance and behaviour change. ANCHOR is different than other communication partner training programs which target family members or healthcare providers in that it is limited to three face-to-face sessions, includes a self-guided digital component, and focuses on a standard package of communication strategies. What are the potential clinical implications of the study? ANCHOR continues to be refined and evaluated. It is our hope that ANCHOR will be a clinically feasible and person-centered communication partner training program that is effective in improving communication and relationships for people with aphasia and their friends.