Many people have communication-related impairments when they are patients in acute hospital stroke units. One way to improve a person's ability to communicate is by providing a supportive communicative environment.Using the World Health Organisation's (WHO) International Classification of Functioning, Disability and Health (ICF) framework, this research sought to identify the environmental factors that either create barriers to and/or facilitate communication between patients and their healthcare providers in acute hospital stroke units.A qualitative research methodology was used. Sixty-five patients were observed communicating with their healthcare providers in healthcare events. Interactions were transcribed and analysed to identify any environmental factors that may have influenced the interaction.In total, 126 environmental factors were identified, which were grouped into 89 subcategories, 28 categories, and seven overall themes. Four themes related to the healthcare provider's knowledge, communication skills, attitudes and individual characteristics. The other three themes included the presence of family, the physical environment, and hospital systems.There are many environmental factors that influence communication between patients and their healthcare providers in the acute stroke unit. Removing barriers and maintaining factors that facilitate communication may contribute towards the development of communicatively accessible stroke units.