Towards Better Communication Accessibility for People Living with Aphasia: Identifying Barriers and Facilitators in Financial Institutions

Abstract

Approximately one-third of stroke survivors live with aphasia, an acquired communication disorder that significantly impacts their ability to understand, speak, read, or write. This condition often leads to social isolation and a reduced quality of life. Financial institutions, as essential community services, present numerous communication barriers for people living with aphasia. This study aims to identify the barriers and facilitators influencing the communicative accessibility of financial institutions for people living with aphasia and to discuss solutions to optimize accessibility. A qualitative descriptive research design was employed, involving semi-structured interviews with people living with aphasia and questionnaires filled by employees from financial institutions. Data were analyzed using thematic analysis to identify key themes related to barriers and facilitators. People living with aphasia identified thirteen types of barriers and forty facilitators, related to physical environmental factors, conversational attitudes and service systems and policies. Financial institution employees highlighted the need for better training and awareness regarding aphasia. The study underscores the significant barriers people living with aphasia face in financial institutions and the potential facilitators that could enhance communicative accessibility. Implementing targeted training programs and standardizing accessibility policies are crucial steps towards improving service access for people living with aphasia.

1. Introduction

About one-third of stroke survivors suffer from aphasia, an acquired communication disorder resulting from brain injury [1]. People living with aphasia may experience several deficits that can affect, to varying degrees, their ability to understand what is said to them, to speak, to read, or to write [2]. This acquired communication disability compromises the participation of people living with aphasia, fostering their isolation and significantly reducing their quality of life [3,4,5].

Visiting community local services is one of the most frequent activities carried out by people living with aphasia upon their return to the community after the rehabilitation center [6]. As these local services often present significant communication barriers (e.g., background noise, complex written information) [7], tasks such as ordering a coffee or opening a bank account can become major challenges. Thus, people living with aphasia experience limited access to community services and a decrease in attendance at public places [8], which contributes to increased isolation [9,10]. Most of the barriers faced by people living with aphasia in accessing local services appear environmental (physical, attitudinal and related to services, systems and policies) [10]. Even when some personal facilitators (e.g., motivation, personality) were identified by recent studies, they seem to be insufficient to counterbalance environmental barriers [10]. However, the teaching of effective communication strategies to employees of local services [11] and the presence of specific environmental elements [12] have been proposed as key facilitators in improving accessibility to local services for people living with aphasia.

Recent research has suggested that one of the most significant unmet needs and primary concerns of people living with acquired brain injury is related to their financial capability [13]. Indeed, being able to carry out routine financial activities (e.g., money transfer, bill payments, investments) is important and necessary during adulthood [14]. People living with aphasia frequently need to access financial institutions, which are local services that could present significant communication barriers. Thus, the general aim of this research was to identify the barriers and facilitators influencing the communicative accessibility of financial institutions for people living with aphasia, and, if necessary, to propose solutions aiming to optimize communicative accessibility. More specifically, this project intended to (1) describe the experience of people living with aphasia during their visits to local financial services, (2) identify the barriers perceived by people living with aphasia in financial institutions, (3) describe the strategies (facilitators) implemented by financial institutions to promote and facilitate communicative accessibility, and (4) propose solutions to optimize accessibility to financial institution’s services for people living with aphasia. This study was approved by the ethics committee from CIUSSS-CN (number: 2023-2730).

2. Materials and Methods

2.1. Design

A qualitative descriptive research design was used.

2.2. Participants

Ten people living with aphasia (including eight women) and 14 employees working in five different financial institutions, (including five managers and nine customer service employees), participated in this study. The profiles of people living with aphasia were highly varied, in terms of age (ranging from 30 to 80 years old), years post brain injury (ranging from one to 20 years) and communicative profile (ranging from mild to moderate expressive or receptive difficulties). The inclusion criteria for people living with aphasia consisted of living with aphasia for at least one year, being users of in-person services offered by financial institutions, having a sufficient comprehension of French to understand the study instructions, and being able to give informed consent. People living with aphasia were recruited after responding to flyer advertisements, shared by the post-stroke community organization ARTERE [15] and subsequently contacting the research team to express their interest. All participants received written information about the study and signed a Participant Information and Consent Form prior to the interview. No people living with aphasia participant dropped out of the study. Financial institutions’ employees were recruited through intentional sampling and networks. Among the financial institutions’ employees, all except one customer service employee mentioned having occasional or frequent contact with individuals with communication difficulties.

2.3. Procedures

2.3.1. Semi-Structured Interviews

Semi-structured interviews were conducted with people living with aphasia by one of the researchers (S.B.L.), who is a speech-language therapist working with people living with aphasia and has significant experience in interviewing. She was previously trained by an expert in qualitative research. Prior to this study, the interviewer knew three of the ten participants from different contexts (research and groups activities for people living with aphasia). At the beginning of the interview, she introduced herself as a researcher and a speech-language therapist to the participants. Interviews (one per participant) lasted from 30 to 60 min and took place in spring 2023 in a quiet place, either at the participant’s house or at the research center (CIRRIS) [16], depending on the participants’ preferences. Four out of the ten people living with aphasia were accompanied by a relative to facilitate communication. The interviews were audio recorded, with the participants’ permission to allow subsequent transcriptions for analysis. Interviews were led using an interview script developed by the four speech-language therapists of the research team (S.B.L., L.M., A.L., M.L.). The general questions that guided the interviews were summarized into four themes: (1) General questions about people living with aphasia’s acquired communication disabilities (speaking/writing/reading/understanding/digital concepts); (2) Life situation and financials habits; (3) Communicative barriers encountered when using the various services of financial institutions, and (4) Communicative facilitators that could optimize communicative accessibility when using the various services from financial institutions.

2.3.2. Focus Group

Five months after the interviews, a focus group was held with three people living with aphasia, all of whom had previously participated in the interviews, accompanied by their respective relatives. The discussion was led by two of the project researchers (L.M. and S.B.L.), and a representative from the community organization (J.D.) [15]. The purpose of this meeting was to share the interview results, to validate their accuracy and to add any missing information. This 75 min meeting took place in a room at the research center CIRRIS [16]. A PowerPoint presentation and a visual aid presenting all the communicative barriers and facilitators, mentioned during the interviews, were used to facilitate discussions with the participants. Focus group notes were taken by one of the researchers (L.M.) and the community organization’s representant (J.D.) for ulterior analysis.

2.3.3. Online Questionnaire

The 14 financial institutions’ employees completed an online questionnaire on environmental facilitators, including closed-ended questions about (a) physical environment referring to the inanimate characteristics (visual, acoustic, physical) of the financial institution (i.e., presence of elements that support communication) and (b) services, systems, and policies environment, which refer to the operational procedures of financial institutions (i.e., presence of policies or training on disability, in general). One distinct questionnaire for customer service employees only also included questions on the attitudinal environment, referring to their behaviors and actions (i.e., the use of strategies to facilitate communication with individuals experiencing communicative accessibility challenges). Since one customer service employee reported never having had contact with people living with aphasia, only 8 out of 9 participants answered the questions regarding the use of strategies. No demographic data (age, gender, etc.) were collected for financial institutions’ employees.

2.4. Analyses

The pre-analyses steps involved (1) Transcription of the interviews into Word documents; (2) Importing the transcripts into NVivo software (version 14). Thematic analysis was conducted on the interviews transcripts to identify key themes, following the steps framework outlined by Braun and Clarke [17]. A deductive approach, following the same procedure as Howe and colleagues [3] was adopted. First, the data were classified according to barriers and facilitators for the seven major themes identified by Howe and colleagues [3]: (a) Awareness of Aphasia (involving other people’s general awareness of aphasia and communication difficulties); (b) Opportunity for Participation (referring to whether society create the conditions for allow participation for people living with aphasia); (c) Familiarity (related to the degree of constancy of the environment); (d) Availability of Extra Support for Communication (referring to the presence of additional assistance that enable people living with aphasia to participate); (e) Communication Complexity (related to the degree of complexity of verbal and written tasks; (f) Message Clarity (referring to the clarity of the verbal or written messages); and finally (g) the Time Available for Communication (involving the time the people living with aphasia is allowed to complete communication tasks). For each theme, examples were then classified according to three main domains: Physical environment factors, attitudes, and finally, services, systems, and policies. Our methods are reported in accordance with the consolidated criteria for reporting qualitative research [18]. Two of the researchers (S.B.L, L.M.) met to discuss the codification of the various barriers and facilitators raised by the interviewed participants. Participant quotes were extracted from the data to illustrate each theme and domain. The data collected during the focus group discussion were analyzed by two of the researchers (S.B.L., L.M.) to validate the accuracy of the thematic analysis and to add any missing information, if necessary. As suggested in a previous study [19], the questionnaire responses from financial institution employees were also categorized into the same three broad environmental factors than the responses from people living with aphasia: (1) attitudinal, or people related, environmental factors, (2) physical environmental factors, and (3) services, systems, and policies environmental factors. Descriptives statistics were used to analyze the questions of the questionnaire.

3. Results

Results revealed that people living with aphasia identified, in the specific environment of financial institutions, all seven major themes suggested in the literature as barriers and facilitators to communication accessibility: (a) Awareness of Aphasia; (b) Opportunity for Participation (c) Familiarity; (d) Availability of Extra Support for Communication; (e) Communication Complexity; (f) Message Clarity; and (g) the Time Available for Communication. Thirteen types of barriers and forty types of facilitators emerged from the interviews for these themes and were subsequently validated during the focus group. No new information emerged from the focus group discussion.

3.1. Barriers Encountered by People Living with Aphasia in Financial Institutions

As shown in

Table 1. Themes in environmental barriers reported by people living with aphasia and their relatives.

Domains	Barriers	Examples from Interviews
(a) Awareness of Aphasia
Attitudes	Inadequate attitude due to a lack of understanding of the issue	Relative 1: “Often, she’d say, ‘When I speak, they’ll think I’m dumb, you know? Because of the aphasia, she speaks slowly. So, she often holds back from speaking in some places.”
(b) Opportunity for Participation
Attitudes	Talking to the relative instead of the people living with aphasia	Relative 5: “They look at me more than they look at her, and it bothers her a lot. Sometimes, she raises her hand and says, ‘Hey!’”
(c) Familiarity
Services, systems and policies	Changes in the automated teller machines (ATMs), different configurations	Person Living with Aphasia 6: “They recently changed the ATM, and there are things that (…) it was easy when you went often, but for me, after a long time of not going (…) when I went back (…) they changed the machine and all the options.”
(d) Availability of Extra Support for Communication
Physical environment factors	No paper or pen available at the counter	Person Living with Aphasia 4: “There was no paper to write with at the bank.”
Attitudes	Does not confirm if they have understood	Relative 3: “Instead of validating what she wanted, he assumed she wanted to open a bank account… too quickly because she didn’t respond to say “that’s not what I want”.
Services, systems and policies	Appointment scheduling process (e.g., by phone rather than at the front desk)	Person Living with Aphasia 9: “But the girl at the counter, she’s right in front of you. She could have taken 5 min to give me an appointment immediately instead of starting everything over by phone.”
	Need to speak directly to the client over the phone	Relative 3: “I think we tried to do things over the phone, but by phone, it’s difficult. They often ask, ‘Madam, do you authorize her to speak for you?’ But sometimes, no.”
(e) Communication Complexity
Physical environment factors	Presence of distractors or ambient noise	Person Living with Aphasia 5: “Sometimes there’s someone moving next to me, I look, and I lose track. The concentration just isn’t there.”
Attitudes	Provides too much information/Changes the subject without warning/Speaks too quickly	Person Living with Aphasia 2: “You know, when they say xxxx, they lose me after 3–4 sentences.”
Services, systems and policies	Voicemail (e.g., information given too quickly, several options.	Researcher: “Does it happen that when you call the bank, there are several options?” Person living with aphasia 9: “Oh, that annoys me, I press zero!”
	Direct phone number of the institution is not easily accessible	Person Living with Aphasia 1: “The number is never written on the back of the card.” Relative 1: “Well, there is one, but it’s the general number, not direct; it’s printed among the other numbers and isn’t very readable.”
(f) Message Clarity
Physical environment factors	Unclear written information	Person Living with Aphasia 8: “When it’s written (…) this long (…) I pressed OK, but I didn’t know if I was right.”
(g) Time Available for Communication
Attitudes	Lack of hospitality, or doesn’t take the time	Person Living with Aphasia 6: “Yes, because when you feel like a number, you get extra stress and then you understand less, and it’s worse.”

, all the main themes proposed by Howe and colleagues [3] were identified as barriers within financial institutions (See Table 1). The barriers currently hindering the accessibility of financial institution services for people living with aphasia are related to physical environmental factors (3 out of 13), conversational attitudes (5 out of 13), and supported services and policies (5 out of 13).

3.2. Facilitators That Could Optimize Communicative Accessibility in Financial Institutions

As shown in

Table 2. Physical facilitators, attitude-related facilitators and services, systems, and policies-related facilitators reported by people with aphasia and their relatives.

Domains	Facilitators	Examples from Interviews
(a) Awareness of Aphasia
Attitudes	Understands the issue	Relative 4: “He had dealt with the illness with his grandfather, so he was more sensitive to the difficulties that people might have.”
Services, systems and policies	Option to note on file people living with aphasia and that the signature may vary	Person Living with Aphasia 2: “Like the signature, I said I don’t always sign the same (…) she said we can put a note. Researcher: A note on the file saying the signature may vary? Person Living with Aphasia 2: Yes, and that I am aphasic too.”
	Appointments available at a time of day when the person is less tired	Researcher: “So, if you had an important appointment at the bank, you’d prefer it to be in the morning. Person Living with Aphasia 6: Yes, I’d prefer in the morning, it would help me a lot.”
(b) Opportunity for Participation
Attitudes	Asks how they can help	Researcher 3: “They could ask how they could help (…) because she knows (…)”
	Addresses the people living with aphasia directly	Researcher 2: “Sometimes she’d turn her eyes to look at me, but it’s to her that he’d give the information, not me.”
	Kind, welcoming	Person Living with Aphasia 6: “She was smiling and took the time to talk to me.”
(c) Familiarity
Services, systems and policies	Flexibility to keep the same person on the case (stability)	Person Living with Aphasia 4: “When they changed, someone called me (…) I will be your advisor. (…) I said I can’t, I’d just had a stroke, and I can’t change things like that (…) So they agreed to let X continue with me. I was very happy.”
(d) Availability of Extra Support for Communication
Physical environment factors	Quiet place away from distractions	Person Living with Aphasia 10: “I said at the beginning I’m aphasic, and she said let’s sit down, and she closed the door. There was no noise, it was perfect.”
	Paper and pen available	Person Living with Aphasia 8: “Paper and pen at the counter (…) that’s really good.”
	Option to sit down in front of the clerk	Person Living with Aphasia 5: “Yes, it was perfect, plus there was a chair, so it’s easier for me if I want to take things out to ask questions.”
Attitudes	Takes the people living with aphasia to a quieter area	Person Living with Aphasia 10: “She said no problem, she took me to an office (…) I sat down and all that, and she answered my questions.”
	Shows the screen	Person Living with Aphasia 2: “He turned his screen around and said, I’ll try to do something.”
	Writes down the information	Person Living with Aphasia 8: “I ask them to write it down for me, and sometimes she makes a small summary.”
	Repeats or rephrases	Person Living with Aphasia 7: “To repeat until the information gets to the right place. Also, rephrasing differently is important.”
	Demonstrates the procedure	Person Living with Aphasia 6: “She said: no problem, I’ll explain how it works, and you’ll be able to do it. S: She went to the ATM with you? people living with aphasia 6: Yes, with me, and she showed me everything.”
	Validates the understanding	Person Living with Aphasia 9: “She asks me: ‘Is that okay, sir? Do you understand?’”
	Offers paper and pencil	Person Living with Aphasia 9: “give me a sheet and a pencil.”
	Offers relevant information without waiting for it to be asked	Person Living with Aphasia 7: “Complete (…) with the information he has. Researcher: You mean to give you the information that he knows you need? Person Living with Aphasia 7: Yes, yes!”
	Asks questions, offers choices	Person Living with Aphasia 7: “She can ask me questions: about what subject? Who do you want to talk to? They ask me questions.”
	Mentions if he does not understand	Person Living with Aphasia 10: “If there are things they don’t understand, tell me.”
	Validates his own understanding	Researcher 3: “Not necessarily assuming or putting words in her mouth, you know? Because sometimes for her, if they say something, she’ll say yes, yes, but…”
	Reads or writes	Person Living with Aphasia 5: “It will take me a very long time, I will also (…) misread certain words (…) so yes, I would need the person to be able to read it to me.”
	Explains written information	Person Living with Aphasia 2: “To explain it to me too.”
	Fills out forms on behalf of the person	Person Living with Aphasia 8: “That she writes it for me or checks to see if what I wrote is correct.”
Services, systems and policies	Presence of a person at the front desk	Person Living with Aphasia 6: “And she comes up to me and says ‘Can I help you?’”
	In-person services offered	Researcher: “Do you find they adjust better when they see you, when you’re with them? people living with aphasia 2: Yes, sometimes.”
	Possibility of a power of attorney to speak on behalf of the people living with aphasia	Relative 3: “He said you know, you can fill out a form that authorizes someone to speak on her behalf.”
	Possibility of automatic withdrawal for certain payments	Person Living with Aphasia 8: “They withdraw it automatically. Researcher: Does that make life a bit easier for you? Person Living with Aphasia 8: Yes, because I’m not, it’s too much for me.”
	Option to receive appointment confirmations by email	Researcher: “And at the bank, I imagine you have the option to receive the appointment by email? people living with aphasia 2: Yeah, I’ve already received one. Researcher: Does that help you too? people living with aphasia 2: Yes.”
	Help line for using online services	Researcher: “With your financial institution, do you use the Internet?” people living with aphasia 9: “Yes, I pay my bills.” Researcher: “Okay, is that clear for you, or was it an adjustment?” Person Living with Aphasia 9: “Yes, but otherwise, I call, I dial the 1-800-help number, and the lady answers all my questions, she guides me, do this, do that. (…) She says, ‘I’ll stay on the line while you do it.’”
	Speaking with a person over the phone	Person Living with Aphasia 7: “If it’s a person talking, it’s much more personal than if you’re talking to a computer.”
	Voice authentication over the phone	Researcher: “Did you need to authenticate over the phone to access your account?” Person Living with Aphasia 10: “No, I had voice authentication already set up. He was able to tell me (…) you’re authenticated by your voice (…) I had done that before.” S: “Just with your voice, that was enough?” people living with aphasia 10: “Yes.” Person Living with Aphasia 2: “(…) much more convenient.”
	Possibility of typing numbers on the keyboard instead of saying them over the phone	Researcher: “To be able to write them?” people living with aphasia 2: “Yes, exactly.”
	Transactions possible at the ATM instead of in person	Relative 3: “The ATMs have made transactions easier for her. I manage the accounts, but for managing her money, ATMs are helpful for her.”
(e) Communication Complexity
Attitudes	Does not give too much information at once	Relative 5: “You have to give her time to soak in.”
	Does not speak too fast	Person Living with Aphasia 2: “Yes, it’s when the person in front of me talks a little slower.”
(f) Message Clarity
Physical environment factors	Clear or visual written document	Person Living with Aphasia 8: “Yes, a document (…) something clear with the main information, then if I have questions, I can ask them.”
(g) Time Available for Communication
Physical environment factors	No waiting in line	Person Living with Aphasia 2: “It’s not stressful because since you took a number, there aren’t like 15 people behind you.”
Attitudes	Takes the time; does not rush	Person Living with Aphasia 7: “I told him directly I had a speech problem, which was still quite present (…) he was very reassuring, he said, there’s no problem, we’ll take as long as it takes, and we’ll go through this together. It went very well.”
	Gives time to make a decision	Relative 4: “Think about it, and when you’re ready, you come back to see us.”

, forty facilitators were reported by people living with aphasia as either encountered or perceived as optimal solutions. The availability of extra support for communication was the most frequently identified theme, with 27 out of 40 different facilitators reported by people living with aphasia relating to this category. Additionally, at least one facilitator from each of the other themes was mentioned (see Table 2). Of these, 5 were related to physical environmental factors, 22 to conversational attitudes, and 13 to supported services and policies that currently enhance the accessibility of financial institution services for people living with aphasia (see Table 2).

3.3. Facilitators Implemented by Financial Institutions to Promote Communicative Accessibility

Regarding facilitators related to the physical environment, employees reported having access to useful tools to support individuals with communicative accessibility challenges such as explanatory diagrams/charts or illustrated informational brochures on products/services (7/14), calm individual meeting rooms (9/14), as well as having paper and pencils available at the counter (11/14). Concerning existing facilitators related to services, systems, and policies, most of the participants (8/14) reported the existence of general policies in their financial organizations that aimed at facilitating service use for customers living with disabilities. These policies are related to motor accessibility, telephone services, a senior-dedicated phone line, internet services, braille keyboards, audio descriptions, ATMs equipped with buttons for the visually impaired people, service access for deaf individuals, etc. The existence of specific training for financial institution employees was reported by only 4/14 of participants, including a communicative accessibility training that was reported by 3/14 of participants. Additionally, 5/14 of participants mentioned that strategies to facilitate communication are taught during general training sessions (i.e., the use of interpreters, the use of specific documents, and other communication channels available to customers according to their needs). According to what was most frequently reported by the financial institutions’ employees, the most implemented environmental facilitators were those related to the physical environment, and those associated with services, systems, and policies. Attitudinal facilitators were less commonly reported.

Questions about attitudinal, or people related, environmental factors, were asked only to employees who work directly with customers. Since one customer service employee reported never having had contact with people living with aphasia, only eight out of nine participants answered these questions. The responses showed that, among financial institution employees, four out of eight felt very comfortable responding to and supporting someone who has difficulty expressing themselves or understanding what is being said, while the other half (four out of eight) reported feeling either not very comfortable or not comfortable at all in these situations. Only one out of fourteen respondents mentioned knowing what communicative accessibility is, but eight out of fourteen participants believed they understood what an acquired communication disorder in adults entails. Employees reported using various strategies to facilitate communication with individuals experiencing communication difficulties. The most used strategies—reported by three out of eight participants—included using simple language, allowing time to express oneself, and providing pencil and paper. See

Table 3. Strategies used by financial institution staff to promote communicative accessibility.

Type of Communication Difficulties	Strategies Used	Number of Employees Using It/8 *
Difficulty understanding	Use simpler language	3
	Use explanatory diagrams	2
	Use gestures	2
	Refer the person to another employee	2
	Raise the voice level	1
	Rephrase	1
	Summarize	1
	Use drawings	1
	Confirm understanding with the client	1
	Offer paper and pencil	1
	Use the Internet	1
	None	1
Difficulty expressing themselves	Give them time to express themselves	3
	Offer them paper and pencil	3
	Doing nothing specific	2
	Take the time to listen carefully	1
	Clarify if needed	1

* Only 8/9 participants answered these questions.

for examples of strategies used.

4. Discussion

The general goal of this research was to identify the barriers and facilitators influencing the communicative accessibility of financial institutions for people living with aphasia and to propose solutions to facilitate communicative accessibility in those institutions.

4.1. Barriers Affecting Communicative Accessibility in Financial Institutions

This study identified several environmental barriers that hinder the participation of people living with aphasia in financial institutions. These barriers were grouped into three main categories: (1) lack of physical environmental adaptations, (2) inadequate communicative attitudes of interlocutors, and (3) absence of supportive services and policies. Notably, barriers within these categories have also been reported in previous studies involving people living with aphasia in other contexts (e.g., supermarkets, transportation) [3,10,20,21], as well as by industry professionals [19]. Furthermore, all seven key themes identified in earlier research [3] emerged from the interviews conducted in this study.

The results of the present study on financial institutions appear to differ slightly from those of previous research. Specifically, in this study, the three identified environmental categories—physical, societal, and attitudinal—seem to equally hinder the accessibility of financial services for people living with aphasia. In contrast, earlier studies conducted in other contexts have primarily highlighted societal and attitudinal barriers, with physical environmental barriers being less prominent [10]. In the actual context of financial institutions, however, physical barriers—such as the lack of pen and paper or unclear written information—were frequently mentioned by people living with aphasia during interviews. Although such barriers have also been reported in the literature as obstacles to communication in commercial settings [3,22,23], they have generally been considered less impactful than attitudinal and societal factors.

Regarding the themes that emerged from the interviews, inadequate conversational attitudes—mainly stemming from a lack of awareness about aphasia and communication accessibility—were identified by people living with aphasia as a significant barrier. While this theme has been emphasized in a recent literature review as the primary obstacle to communication in local services, appearing in nearly every study [10], the present findings suggest a more nuanced picture. In financial institutions, other factors—such as limited opportunities for participation, insufficient communication support, time constraints, and the complexity of both written and oral communication—also appear to play an equally important role in hindering communication with people living with aphasia. More specifically, two of these themes emerged as cross-cutting barriers across all three environmental categories. First, the lack of additional communication support was identified as a barrier in relation to the physical environment (e.g., absence of pen and paper at the counter), conversational attitudes (e.g., lack of validation of understanding), and services and policies (e.g., challenges in the appointment scheduling process). Similarly, communication complexity was mentioned in connection with the physical environment (e.g., presence of distractors or ambient noise), conversational attitudes (e.g., providing excessive or unclear information), and services and policies (e.g., complexity of voicemail systems). These findings highlight the multifaceted nature of communication barriers in financial settings and the need for comprehensive, multi-level strategies to improve accessibility for people living with aphasia.

Finally, this study also uncovered specific barriers within financial institutions that, to our knowledge, have not been previously reported in the literature—such as challenges related to the appointment scheduling process and the structure of voicemail menu options. These findings may reflect the particular complexity of financial institutions, which is shaped by factors such as rigid physical environments, intricate procedures, and heightened security concerns.

4.2. Facilitators Influencing Communicative Accessibility in Financial Institutions

People living with aphasia reported several facilitators that could optimize their communicative exchanges when using financial institution services. The most salient facilitators were those related to the attitude of the conversational partner (i.e., repeat or rephrase). In previous studies reporting on other services (public transport, local stores), people living with aphasia also mentioned how beneficial it was when people slowed down their speech [3,20,21,23,24], provided choices when asking a question or gave clear instructions [3,20,24]. For their part, employees of financial institutions reported that, while some strategies to facilitate communication with people living with aphasia were occasionally used, their type and frequency varied greatly among staff members. This variability appeared to depend on the person’s knowledge of aphasia and in their personality and not on general policies or training. Better general awareness of this issue and the strategies to use with people living with aphasia would be relevant to address this gap and enable employees to adopt the right attitudes more systematically. This finding has already been reported in the literature in different contexts [10] but this is the first time, to our knowledge, that these results have been obtained in the context of the financial institution.

Many facilitators related to services, systems, and policies also emerged during interviews with people living with aphasia—for example, improvements in telephone processes. Some of these facilitators were already in place, as reported by certain participants, while others were mentioned as desired strategies to improve communication. This suggests the importance of standardizing accessibility policies across financial institutions to ensure more consistent implementation of these facilitators. Among all facilitators, the availability of extra support for communication was the most frequently identified by people living with aphasia, with 27 different examples reported across the three main categories. This finding underscores that, while a variety of facilitators can enhance accessibility, additional communication support may have a particularly significant impact on improving communication experiences for people living with aphasia. Implementing such support and ensuring that users are informed about them could greatly contribute to communicative accessibility in financial institutions.

The previous literature has shown that certain elements in the physical environment of local businesses—such as visual aids or quiet spaces—can improve communication for people living with aphasia [12]. In line with this, some employees in financial institutions reported having access to tools like explanatory diagrams or quieter meeting rooms to facilitate interactions. However, these facilitators are not standardized across institutions.

Attitudinal facilitators were less commonly implemented than those related to the physical environment or institutional policies, according to employees. Yet, this gap could be addressed through targeted training focused on communication accessibility. As found in a previous study [19], and echoed in the present one, all employees expressed a strong willingness to better understand and accommodate individuals with acquired communication disorders, including people living with aphasia. With appropriate education and training, financial institution staff may be well-positioned to remove barriers and implement effective communication strategies tailored to the needs of people living with aphasia.

5. Conclusions

This study provides concrete insights into the specific barriers and facilitators that affect the communicative accessibility of financial institutions for people living with aphasia. It highlights the urgent need for targeted adaptations that go beyond general accessibility measures. Improving access requires a multi-level approach that addresses physical (e.g., availability of pen and paper, reduction in ambient noise), societal (e.g., implementation of accessible help lines), and attitudinal factors (e.g., staff training in communication strategies). The findings suggest that some of the most impactful facilitators—such as the provision of communication aids and simplified procedures—are relatively easy to implement but remain inconsistently applied across institutions. Standardizing these practices through institutional policies and regulations could significantly reduce communication barriers for people living with aphasia.

Moreover, while individual characteristics such as motivation and communication style influence access, the responsibility for accessibility should not fall solely on people living with aphasia. Self-advocacy can play a role, but it must be supported by systemic changes and increased awareness among service providers. Financial institutions have both the opportunity and the responsibility to lead by example in creating inclusive environments that support the full participation of people with communication disabilities.

Strengths, Limitations, and Future Perspectives

This study is, to our knowledge, the first to have studied communicative accessibility in the specific context of financial institutions. One of the strengths of this study lies in the integration of information from different methods and different sources. Indeed, the focus group, conducted a few months after the interviews with some participants, validates the results obtained during the interviews and increases the reliability of the answers. Additionally, the convergence of information from people living with aphasia with the experiences of employees working in financial institutions also constitutes a strength of this research. Indeed, addressing research questions from different perspectives enables the emergence of adapted and coherent solutions. Not integrating personal factors is a limit of the present research. Future studies could aim to raise awareness about aphasia, across all financial institutions, through the implementation of mandatory training programs relating to communication strategies. This type of training already exists in other types of local services. For example, in recent years, the ARTERE organization launched ACCES [15], a training program focused on communication strategies for employees in different local services such as catering business with counter service. It would also be interesting to study communication accessibility challenges in other populations (e.g., individuals with traumatic brain injuries or neurodegenerative diseases). Investigating accessibility issues across different societal contexts could provide a broader picture.