To develop a taxonomy of the environmental factors that influence communication between patients with communication disabilities and their health care providers in hospital stroke units.We conducted a metasynthesis of 3 qualitative studies conducted by our research team on the environmental factors that influence communication between patients and health care providers in hospital stroke units.These studies identified environmental factors which influence communication from the perspectives of 10 patients with communication disabilities, 10 health care providers, and by direct observation of 65 patients interacting with health care providers.The findings of each study formed the data for the metasynthesis.The findings of the qualitative studies were analyzed and then synthesized using reciprocal translation. The environmental factors were grouped into 11 higher order categories and 2 overall themes. The themes were (1) health care providers (knowledge, skills, attitude, experience, characteristics) and (2) stroke unit structure and processes (patient opportunities to communicate, family, use of communication aids and equipment, opportunities to learn, policies and procedures, physical environment).Acute stroke inpatients with communication disabilities need knowledgeable and skilled health care providers to communicate as effectively as possible. However, there are many environmental barriers and facilitators at the level of stroke unit structures and processes that also impact on the ability of health care providers to communicate with patients. Interventions to improve the communicative accessibility of stroke units need to focus on health care providers and on the processes that govern the unit.