Pilot study of a culturally sensitive intervention to promote genetic counseling for breast cancer risk.

BACKGROUND: Despite the benefits of genetic counseling and testing, uptake of cancer genetic services is generally low and Black/African American (Black) women are substantially less likely to receive genetic services than non-Hispanic White women. Our team developed a culturally sensitive, narrative decision aid video to promote uptake of genetic counseling among Black women at risk for a hereditary breast cancer syndrome that can be incorporated in conjunction with population-based cancer risk assessment in a clinical setting. We report here a pilot study to demonstrate changes in intention to access genetic counseling and intervention satisfaction. METHODS: Black women who were personally unaffected by breast cancer and were recommended for genetic counseling based on family history screening in a mammography center were recruited at the time of the mammogram. A prospective, pre-post survey study design, guided by theoretical constructs, was used to evaluate baseline and immediate post-intervention psychosocial factors, including intention to participate in genetic counseling and intervention satisfaction. RESULTS: Pilot recruitment goals were met (n = 30). Pre-intervention, 50% of participants indicated that they were extremely likely to make a genetic counseling appointment, compared with 70% post-intervention (p = 0.05). After watching the intervention, 50% of participants indicated that the video changed their mind regarding genetic counseling. CONCLUSIONS: This study demonstrated cultural satisfaction with a decision aid intervention designed to motivate Black women with hereditary breast cancer risk to attend a genetic counseling appointment. Our study showed that intention may be a specific and key construct to target in interventions designed to support decision-making about genetic services. Study results informed the design of a subsequent large scale, randomized implementation study. TRIAL REGISTRATION: Trial registration: Clinicaltrials.gov NCT04082117 . Registered September 9, 2019. Retrospectively registered.

Development of a culturally sensitive narrative intervention to promote genetic counseling among African American women at risk for hereditary breast cancer.

BACKGROUND: African American women with hereditary breast cancer risk are less likely to undergo genetic counseling and testing compared with non-Hispanic White women. Inequities in the use of precision cancer care are likely to exacerbate racial disparities in cancer outcomes. A culturally sensitive multimedia narrative intervention was developed to motivate African American women at risk for hereditary breast cancer to engage in genetic counseling. METHODS: Development of the intervention was grounded in the Integrative Model of Behavioral Prediction using a phenomenological, deductive approach and employed multiple qualitative methods for data collection, including 1-on-1 interviews and story circles with members of the target audience to identify salient themes and lived experiences. Focus group testing was then conducted with members of the group of focus, primary care providers, and community stakeholders. RESULTS: Six themes that mapped to the theoretical model were identified. Lived experiences were abstracted from story circle data to create a narrative storyline. Educational content and motivational messaging derived from the 6 themes were embedded into the script. Focus group testing with stakeholder groups was used to refine the intervention. Testing of the final multimedia narrative with focus groups indicated that the intervention was culturally sensitive and authentic, and the messaging was effective. CONCLUSIONS: Multiple qualitative data collection methods and a robust theoretical framework of health behavior were key elements for this study to develop a culturally sensitive, narrative intervention that reflects lived experiences and motivates underserved African American women with hereditary breast cancer risk to engage in genetic counseling. This strategy can be applied to mitigate racial inequities in the use of other genomic approaches for personalizing cancer care.

Sentences Are Key: Helping School-Age Children and Adolescents Build Sentence Skills Needed for Real Language.

PURPOSE: In this article, we present key concepts pointing to the importance of targeting complex sentences for school-age children and adolescents with developmental language disorders (DLD). Drawing on current treatment research, we argue that the sentence is a crucial but often neglected piece of the puzzle when it comes to understanding relationships between DLD and academic outcomes. We provide detailed suggestions for how clinicians can focus on complex sentence structures in natural academic contexts to bridge this gap. METHOD: Background information on sentence complexity is presented, along with a rationale for targeting complex sentences with school-age children and adolescents with DLD. Intervention methods from a variety of studies targeting multiclausal sentences are discussed in relation to current accounts of language learning and language processing models. We provide a robust catalog of suggested strategies for targeting sentence complexity in a manner that is aligned with research findings to date and integrated into real academic contexts. CONCLUSIONS: Complex sentence structures are a key challenge for students with DLD as they tackle discipline-specific language and academic tasks. Sentence complexity treatment programs employ one or more treatment methods including priming, modeling, recasting, contextualization, metalinguistic instruction, and sentence combining. While studies have consistently shown a measurable improvement in complex sentence production on proximal outcomes regardless of treatment approach, evidence of durable, functional changes for students with DLD remains sparse. We encourage new treatments that target comprehension and production of complex sentences in real-life academic contexts in clinical practice and research. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23969103.

Explicit Grammatical Intervention for Developmental Language Disorder: Three Approaches.

Purpose This article summarizes the shared principles and evidence underpinning methods employed in the three sentence-level (syntactic) grammatical intervention approaches developed by the authors. We discuss associated clinical resources and map a way forward for clinically useful research in this area. Method We provide an overview of the principles and perspectives that are common across our three syntactic intervention approaches: MetaTaal (Zwitserlood, 2015; Zwitserlood, Wijnen, et al., 2015), the SHAPE CODING system (Ebbels, 2007; Ebbels et al., 2014, 2007), and Complex Sentence Intervention (Balthazar & Scott, 2017, 2018). A description of each approach provides examples and summarizes current evidence supporting effectiveness for children with developmental language disorder ranging in age from 5 to 16 years. We suggest promising directions for future research that will advance our understanding of effective practices and support more widespread adoption of syntactic interventions with school-age children. Conclusion In each approach to syntactic intervention, careful and detailed analysis of grammatical knowledge is used to support target selection. Intervention targets are explicitly described and presented systematically using multimodal representations within engaging and functional activities. Treatment stimuli are varied within a target pattern in order to maximize learning. Similar intervention intervals and intensities have been studied and proven clinically feasible and have produced measurable effects. We identify a need for more research evidence to maximize the effectiveness of our grammatical interventions, encompassing languages other than English, as well as practical clinical tools to guide target selection, measurement of outcomes, and decisions about how to tailor interventions to individual needs.

Targeting Complex Sentences in Older School Children With Specific Language Impairment: Results From an Early-Phase Treatment Study.

Purpose: This study investigated the effects of a complex sentence treatment at 2 dosage levels on language performance of 30 school-age children ages 10-14 years with specific language impairment. Method: Three types of complex sentences (adverbial, object complement, relative) were taught in sequence in once or twice weekly dosage conditions. Outcome measures included sentence probes administered at baseline, treatment, and posttreatment phases and comparisons of pre-post performance on oral and written language tests and tasks. Relationships between pretest variables and treatment outcomes were also explored. Results: Treatment was effective at improving performance on the sentence probes for the majority of participants; however, results differed by sentence type, with the largest effect sizes for adverbial and relative clauses. Significant and clinically meaningful pre-post treatment gains were found on a comprehensive oral language test, but not on reading and writing measures. There was no treatment advantage for the higher dosage group. Several significant correlations indicated a relationship between lower pretest scores and higher outcome measures. Conclusions: Results suggest that a focused intervention can produce improvements in complex sentence productions of older school children with language impairment. Future research should explore ways to maximize gains and extend impact to natural language contexts. Supplemental Material: https://doi.org/10.23641/asha.5923318.

The word length effect in children with language impairment.

UNLABELLED: Two types of serial word recall tasks (full verbal recall and probed recall) were administered to 11 children with language impairment and 22 language-normal children matched for productive language or chronological age. The methods were designed to take into account age-related differences in the use of subvocal rehearsal, as measured by the word length effect. The word length effect was significant for all three groups in full recall, but not in probed recall, supporting the hypothesis that children with language impairment demonstrate limited capacity for processing verbal output. Discussion focuses on the importance of considering developmental factors in measuring short-term memory effects in children with language impairment. LEARNING OUTCOMES: As a result of this activity, the participant will be able to describe the phonological loop hypothesis and discuss the interactions between working memory and language performance in children with language disorders.

The Grammar of Information: Challenges for Older Students With Language Impairments.

PURPOSE: The purpose of this article is to describe the nature of informational (expository) language in terms of unique grammatical characteristics and discuss applications for assessment and intervention for older school-age children and adolescents with language impairments. METHODS: Information presented is based on a selected literature review of topics including the nature of academic texts, expository text processing of older children and adolescents with language impairments and/or learning disabilities, and language intervention studies that target higher level language in the same populations. RESULTS: We summarize key grammatical strategies found in informational text: (1) complex nominal (noun phrase) groups, (2) clausal subordination, and (3) theme and information mechanisms. Although facility with these structures is not routinely or systematically tested by language clinicians, we highlight assessment procedures useful this purpose. Promising intervention evidence suggests that grammatical features characteristic of informational text can be targeted with positive results for students who struggle with this aspect of higher level language. CONCLUSIONS: Success comprehending and producing informational text requires unique grammatical knowledge. A qualitative literature review is used to derive best practices in assessment and intervention with school-age children who are particularly challenged by these types of texts.