A mHealth application for the training of caregivers of children with developmental disorders in South Africa: rationale and initial piloting.

Background: Evidence-based mobile health (mHealth) interventions have been successful for an array of physical and mental health conditions. Children with developmental disorders (DD) often have secondary speech and language disorders. The lack of high-quality medical and educational services in low- and middle-income countries limits the opportunities for children with DD to succeed in life. South Africa currently offers limited access to education, social, and health services. Methods: Twelve caregivers of twelve children with DD between the ages of 3 and 6 years who already received monthly early childhood therapy participated in this study. A mHealth app, called Nna'Le'wena, a Setswana phrase meaning "Me and You", was designed, developed, installed, and tested on tablets. The app provided a systematic framework and guidance to the caregivers in order to use evidence-based communication interaction strategies with the children over a twelve-week period. The app could be used offline and provided audio instructions in English and Setswana, two dominant languages in South Africa. The app automatically generated log files and collected answers to weekly surveys. At the end of the study, caregivers were asked to evaluate the app by using relevant portions of the Mobile App Rating Scale (MARS). Results: Caregivers were able to successfully interact and use the app. The app was well-received and liked by the caregivers. Caregivers listened to the instructional audios in English and Setswana during the 12-week period. They were able to provide communication opportunities to their children during daily living activities, especially during play- and mealtime activities. Conclusions: The Nna'Le'wena app was successfully deployed and used by caregivers of children with DD. mHealth solutions can be effective and are relatively affordable solutions that can enhance health care and educational delivery in different settings, including in low-and middle-income countries with limited Internet capabilities.

Leadership Development Strategies in Interprofessional Healthcare Collaboration: A Rapid Review.

Background: Contemporary healthcare practitioners require leadership skills for a variety of professional roles related to improved patient/client outcomes, heightened personal and professional development, as well as strengthened interprofessional collaboration and teamwork. Objective/Aim: The aim of this study is to systematically catalogue literature on leadership in healthcare practice and education to highlight the leadership characteristics and skills required by healthcare practitioners for collaborative interprofessional service delivery and the leadership development strategies found to be effective. Methods/Design: A rapid review was conducted. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) diagram shows that the 11 databases, yielded 465 records. A total of 147 records were removed during the initial screening phase. The remaining 318 records were uploaded onto Rayyan, an online collaborative review platform. Following abstract level screening, a further 236 records were removed with 82 records meeting the eligibility criteria at full text level, of which 42 were included in the data extraction. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal. Results: Results showed variability in methodologies used, representing various healthcare disciplines with a range in population size (n = 6 to n = 537). Almost half of the results reported on new programs, with interprofessional collaboration and teamwork being the most frequently mentioned strategies. The training content, strategies used as well as the length of training varied. There were five outcomes which showed positive change, namely skills, knowledge, confidence, attitudes, and satisfaction. Conclusion: This rapid review provided an evidence-base, highlighted by qualitative, quantitative, and mixed methods research, which presents distinct opportunities for curriculum development by focusing on both content and the methods needed for leadership programs. Anchoring this evidence-base within a systematic search of the extant literature provides increased precision for curriculum development.

Agreement between children with long-term health conditions and their primary caregivers on reports of perceived participation.

Background: There is limited knowledge regarding the perceived participation of children with long-term health conditions in everyday activities. Children may have perceptions that differ from those of their primary caregivers. It is unclear whether children and caregivers rate their participation in everyday situations in the same way. Objectives: We aimed to explore the level of agreement pertaining to perceived participation (attendance and involvement) and examine whether differences exist in the rank order of activities selected as the three most important between reports from children with long-term health conditions and their primary caregivers. Methods: The simplified Chinese version of the Picture My Participation (PMP-C; Simplified) was used in an interview with children with long-term health conditions; meanwhile, their primary caregivers finished the questionnaire independently. Data were analyzed using Wilcoxon tests, weighted kappa values, and Spearman's rank order correlation. Results: Children with long-term health conditions reported significantly lower attendance scores for six activity items (p < 0.05) and higher involvement scores for two activity items (p < 0.05) than their primary caregivers did. An overall slight to fair agreement in perceived participation was found at the child-caregiver dyad level, though differences in dyads were observed. A strong correlation was identified between the rank order of the most important activities for both groups (r = 0.81). Conclusions: Differences may exist between the perceived participation of children with long-term health conditions, as reported by primary caregivers and the children themselves. The findings highlight that children with long-term health conditions exhibit unique views with respect to their perceived participation and have to be asked regarding their perceptions themselves.

Describing the Spoken Language Skills of Typically Developing Afrikaans-Speaking Children Using Language Sample Analysis: A Pilot Study.

PURPOSE: Language sample analysis is widely regarded as the gold standard of language assessment. However, the uncertainty regarding the optimal length of sample and the limited availability of developmental language data for nonmainstream languages such as Afrikaans complicate reliable use of the method. The study aimed to provide guidelines on representative length of sample and concurrently provide a preliminary description of the spoken language skills of Afrikaans-speaking children. METHOD: The study involved 30 typically developing Afrikaans-speaking children aged between 3;6 and 9;6 (years;months). A descriptive research design was used to transcribe and analyze 1-hr interactions collected in natural environments of participants who were recruited using referral sampling. Video and audio recordings of the samples were transcribed using adapted Sampling Utterances and Grammatical Analysis Revised analysis procedures. RESULTS: Results indicated that mean length of utterance in words per minute, number of different words per minute, and total number of words per minute stabilized at 30 min and no significant differences were found between 30 min and longer time segments. Morphology results concur with existing developmental findings in Afrikaans. Lexical diversity results correlated with the findings of the lexical specificity and accuracy in the Prutting and Kirchner Pragmatic Protocol (Prutting & Kirchner, 1987). The developmental trajectories for pragmatic and phonological development were consistent with existing guidelines. CONCLUSIONS: The study concluded that a 30-min interaction segment provides a representative language sample for Afrikaans-speaking children who are between 3;6 and 9;6. It provides promising preliminary developmental data and clinical guidelines, confirming the potential of language sample analysis (LSA) as a reliable component of language assessment in Afrikaans.

The Sustainable Development Goals: A framework for addressing participation of persons with complex communication needs in South Africa.

BACKGROUND: Participation in society is the cornerstone to living a meaningful, connected, and healthy life. Persons with complex communication needs, however, often have restricted opportunities to participate in everyday contexts and situations. Reasons for this include societal attitudinal barriers, as well as limited knowledge and skills about augmentative and alternative communication (AAC) to enhance participation. Enhancing participation of persons with complex communication needs requires a holistic and multi-faceted approach. The 17 Sustainable Development Goals (SDGs) with their disability-inclusive agenda provide an impetus for shaping the approach of the Centre for Augmentative and Alternative Communication (CAAC) in enhancing participation of persons with complex communication needs in South Africa. PURPOSE: This paper aims to provide a reflective description and application of the work conducted by the CAAC in addressing the SDGs in South Africa. RESULT: Research and training conducted by the CAAC is shown to be aligned to five SDGs, namely zero hunger (SDG 2), good health and well-being (SDG 3), quality education (SDG 4), decent work and economic growth (SDG 8) and peace, justice, and strong institutions (SDG 16), with a focus on reaching these goals in order to benefit persons with complex communication needs. CONCLUSION: The paper demonstrates that, despite some gains in addressing the SDGs, research and clinical practice still needs to be on these and the remaining SDGs. Furthermore, there is a need to also find ways to integrate the SDGs to ensure participation of persons with complex communication needs in major life activities and society.

Multimodal communication reported by familiar caregivers to build communication capacity in persons who are minimally conscious.

PURPOSE: Limited clinical and research evidence is available to support healthcare practitioners in the communication assessment and intervention of persons who are minimally conscious. This study placed a specific focus on the multimodal communication strategies familiar caregivers of persons who are minimally conscious observed, as well as the verbal and the nonverbal communication strategies they employed to build communication capacity. This may inform clinical practice as it provides valuable autobiographical information as well as familiar stimuli that may elicit responses from persons in a minimally conscious state. METHOD: A descriptive qualitative design employing in-depth semi-structured interviews with familiar caregivers was utilised to address the purpose of the study. RESULT: Familiar caregivers reported that they used both nonverbal and verbal communication strategies to obtain a response from persons who are minimally conscious. These caregivers also reported that these persons appeared to rely on nonverbal communication strategies to express 36 different communication functions. CONCLUSION: Based on the findings of this study, it is clear that caregivers can be beneficial to persons who are minimally conscious, if they are able to observe and capitalise on naturally occurring multimodal communication strategies and functions. This study emphasises that familiar caregivers respect and value the dignity of persons who are minimally conscious and want to improve their communication capacity, but often lack confidence in their own communication skills.

Participation of children with long-term health conditions compared to that of healthy peers: A cross-sectional comparative study.

BACKGROUND: Knowledge is limited on attendance and involvement of perceived participation of children with long-term health conditions. AIMS: To evaluate the perceived participation of children with long-term health conditions and to compare their participation with that of healthy peers. MATERIAL AND METHODS: A cross-sectional comparative study was designed using self-reported data from 65 children with long-term health conditions and from 65 healthy peers, utilising the simplified Chinese version of Picture My Participation (PMP-C; Simplified). RESULTS: The frequency scores of children with long-term health conditions were significantly lower than those of healthy peers in terms of attendance for the total domain and for 13 activity items. The involvement scores of children with long-term health conditions were significantly lower than those of healthy children in 3 items. There was a strong correlation between rank orders of the most important activities for the two groups (r = 0.83). CONCLUSIONS: Children with long-term health conditions participated less in activities compared to healthy children. Further studies are required to investigate factors of the participation of children. SIGNIFICANCE: The PMP-C (Simplified) offered an opportunity for children to express their own perspectives of participation based on their individual experience of the activity.

Multidisciplinary Perspectives on Automatic Analysis of Children's Language Samples: Where Do We Go from Here?

BACKGROUND: Language sample analysis (LSA) is invaluable to describe and understand child language use and development for clinical purposes and research. Digital tools supporting LSA are available, but many of the LSA steps have not been automated. Nevertheless, programs that include automatic speech recognition (ASR), the first step of LSA, have already reached mainstream applicability. SUMMARY: To better understand the complexity, challenges, and future needs of automatic LSA from a technological perspective, including the tasks of transcribing, annotating, and analysing natural child language samples, this article takes on a multidisciplinary view. Requirements of a fully automated LSA process are characterized, features of existing LSA software tools compared, and prior work from the disciplines of information science and computational linguistics reviewed. KEY MESSAGES: Existing tools vary in their extent of automation provided across the process of LSA. Advances in machine learning for speech recognition and processing have potential to facilitate LSA, but the specifics of child speech and language as well as the lack of child data complicate software design. A transdisciplinary approach is recommended as feasible to support future software development for LSA.

Development and Utility of an International Classification of Functioning, Disability and Health Code Set for Younger-Old Adults With Fall Risk: Implications for Audiologists.

PURPOSE: Falling is a multifactorial condition that can cause severe injury and even death in older adults. Early identification of fall risk factors, as the first step of preventive health care, can assist in reducing the negative and often debilitating effects of falls in older adults. By using the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to develop an ICF code set to identify fall risk factors in older adults, health care practitioners could obtain health information in a multidimensional way. METHOD: This study describes the final phase of a comprehensive, three-phase, mixed-methods sequential study. For this third phase, a pre-post group design that focused on the audiologist's perceptions of the clinical utility of a newly developed ICF code set was employed. The questionnaire that was used for this purpose consisted of two distinct sections: clinical application and clinical utility (viz., appropriateness, accessibility, practicability, acceptability, and professional utility). Thirty practicing audiologists participated in the study. Data were analyzed for each of the two sections of the questionnaire. RESULTS: Results related to clinical application indicated that regardless of the audiologists' experience in routine fall risk assessment or fall risk factor identification, the use of the developed ICF code set increased their ability to correctly identify relevant clinical aspects. Results related to clinical utility showed high scores across all five measure components, with the highest clinical utility component being acceptability, closely followed by appropriateness and professional utility, and the lowest being accessibility. CONCLUSION: Several clinical implications have emerged from this study, including the usefulness of the ICF code set to identify and document fall risk factors in older adults, the code set's ability to guide audiologists to determine individualized assessment needs either by themselves or by other health care disciplines, and that the code set could be used by audiologists regardless of their experience in vestibular assessments.

A Systematic Review of Ethics Knowledge in Audiology Literature: A Follow-Up Study (2011-2020).

PURPOSE: This systematic review aimed to update and explore the extant literature (2011-2020) regarding ethics knowledge in audiology and to compare the findings to an earlier study (2001-2010). METHOD: This systematic review employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS: MEDLINE, CINAHL, ERIC, MasterFILE Premier, E-Journals, Africa-Wide information and Academic Search Premier electronic databases, and non-peer-reviewed papers in Seminars in Hearing yielded a total of 63 papers. Following systematic screening using inclusion and exclusion criteria, a total of 12 full-text papers were included in this review. Pertinent data and findings from the review were tabulated and analyzed using a qualitative, deductive approach. Results showed that the 12 papers were published in nine peer-reviewed journals with a predominantly social scientific approach. This differs from the earlier review that reported only five papers with a predominantly philosophical approach. However, both the current and earlier studies focused on the rehabilitation/management role of the audiologist. In the earlier study, the focus was on moral judgment (as one of the components of moral behavior), whereas this was the focus of only half of the papers identified in this study, with the remaining papers focusing on moral sensitivity and moral motivation. CONCLUSIONS: The focus of papers had evolved and continued to include more elements related to the multiple perspectives used to analyze and describe ethics research. The body of knowledge of ethics in audiology specifically expanded in the area of social scientific research, focusing on beneficence and nonmaleficence, including moral motivation and basing research on moral judgment with the emphasis on the rehabilitation/management and education/research/administration role of audiologists.

Using key-word signing to support learners in South African schools: a study of teachers' perceptions.

Key-word-signing (KWS), an unaided augmentative and alternative communication (AAC) strategy, has an important role to play in the education system. To date, limited research exists regarding the use of unaided AAC strategies in the school environment, especially in low- and middle-income countries. To address this research gap, the current study aimed to explore the perceptions of South African teachers toward the use of KWS strategies in the educational context. The study used a descriptive paper-based survey comprised of both closed and open-ended questions that was completed by 101 special education teachers. The sample was drawn from 10 public and independent schools for learners with special education needs in five urban school districts within South Africa's Gauteng province. These schools accommodate students with a broad spectrum of disabilities and are likely to include learners with complex communication needs. The participants identified various factors and challenges that influenced the use of KWS within the education system (e.g., school culture, parents and other team members, community awareness, learner-related considerations, and training needs). These factors and challenges are assessed and discussed in relation to both local and international norms. Recommendations are made regarding expanding both an understanding and acceptance of unaided AAC strategies as a further means to support learning in the educational context.

Policy gaps and opportunities: A systematic review of autism spectrum disorder and criminal justice intersections.

LAY ABSTRACT: The number of people with autism spectrum disorder has increased, and as this population ages, research is showing high rates of contact with the criminal justice system among this group. Social and communication differences that autistic individuals experience can act as a risk factor during these interactions, as shown by public reports of negative and violent encounters between autistic individuals and the law enforcement. There is a clear need for evidence-based strategies to reduce high rates of contact and to improve outcomes when an interaction occurs. This article provides a systematic review of research on autism spectrum disorder and criminal justice system to compile this evidence base. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis structure was used to identify 89 articles after searching six databases. The Sequential Intercept Model describes the criminal justice system as different stages, or intercepts, that are connected, and the Sequential Intercept Model serves as an overall framework to organize the included articles. Articles were analyzed to identify research themes at each intercept, which offer guidance for policy and program changes that support equitable justice for autistic individuals.

Being heard - Supporting person-centred communication in paediatric care using augmentative and alternative communication as universal design: A position paper.

Person-centred care, with its central focus on the patient in partnership with healthcare practitioners, is considered to be the contemporary gold standard of care. This type of care implies effective communication from and by both the patient and the healthcare practitioner. This is often problematic in the case of the paediatric population, because of the many communicative challenges that may arise due to the child's developmental level, illness and distress, linguistic competency and disabilities. The principle of universal design put forth in conventions and legislation means that the design of products and services should be usable by all people, to the greatest extent possible. Augmentative and alternative communication encompasses strategies, for example pictures and apps, that are typically used with people with communication disability. In this position paper, we argue for the universal use of augmentative and alternative communication to support person-centred communication and care for children, regardless of age or potential disability. Clinical examples are shared from three different paediatric care settings where pictorial supports were applied universally. Interviews were conducted with children and adolescents (with and without disabilities), parents and healthcare practitioners, and the principles of universal design were used as a framework to demonstrate how person-centred communication is supported in paediatric care.

Unaided communication behaviours displayed by adults with severe cerebrovascular accidents and little or no functional speech: A scoping review.

BACKGROUND: Unaided communication behaviours may provide communication support for persons with severe cerebrovascular accidents (CVA), as these individuals often experience severe communication difficulties, regardless of the aetiology. Though often subtle, these behaviours are present during all stages of recovery, and therefore communication partners need to know not only which unaided strategies are used as communication attempts, but also what their function is (i.e., what the person aims to achieve with the communication). AIM: To identify the unaided communication behaviours that adults with severe CVA and little or no functional speech use to communicate, and to determine the communication functions addressed by these behaviours. METHODS & PROCEDURES: The study used a scoping review methodology and included articles on communication partners of persons with CVA published between 1986 and 2020. Initially the searches yielded 732 studies from which 211 duplicates were identified. The remaining studies (n = 531) were then screened on title, abstract and full-text level resulting in a final inclusion of 18 studies. Of the 18 studies, five were qualitative and 13 consisted of quantitative methodologies. MAIN CONTRIBUTION: The subtle communication behaviours used by persons with CVA (and resultant severe communication difficulties) are often misinterpreted or overlooked by their partners. If partners are trained to recognise such subtle or unaided communication behaviours, they can provide adequate support to access a range of communication functions. The unaided communication behaviours, which include 13 primary behaviours ranging from non-linguistic to linguistic, were utilised to convey 31 communication functions classified into four main communication categories. CONCLUSIONS & IMPLICATIONS: Although unaided communication behaviours often appear as limiting, they can be utilised to communicate various communication functions. The findings of this review support the training of partners to identify these behaviours and improve person-partner communication. WHAT IS KNOWN?: Unaided communication has been widely researched. However, a summary is needed of the various unaided communication behaviours and of the different communication functions addressed by these behaviours. What the paper adds… This paper emphasises that unaided communication behaviours range from non-linguistic to linguistic, and they can support unintentional, pre-intentional and intentional communication functions. Clinical implications Even though aided communication is preferred, unaided communication behaviours are generally used in contexts with limited resources, as well as among culturally and linguistically diverse populations. This study advocates the identification of unaided communication behaviours by partners as well as the support and provision of access to communication strategies for persons with severe CVA. Future research should include more untrained communication partners.

Academic Well-Being in Higher Education: A Cross-Country Analysis of the Relationship Between Perceptions of Instruction and Academic Well-Being.

The purpose of this research was to explore the relationship between university students' perceptions of the overall quality of instruction (PQI) they experienced since COVID-19 and their academic well-being. This relationship was examined in the context of a moderated moderation with students' household income and the cultural value of power distance (PD), which measures the extent to which less powerful members of an organization expect and accept that power is unequally distributed. Two countries with societally moderate levels of PD (South Africa and the United States) were assessed. Moderated moderations between PQI, income, and PD were found for the academic well-being of students from both the United States and South Africa. The patterns of interactions were in some ways similar and other ways different, highlighting the complexity of how students may react to potential stressors in their academic environment. Potential explanations and implications of these results are discussed.

Barriers to and facilitators of employment of persons with disabilities in low- and middle-income countries: A scoping review.

BACKGROUND: Unemployment rates for persons with disabilities in low- and middle-income countries (LMICs) are high. This is despite the call to action by the United Nations Convention on the Rights of Persons with Disabilities and Sustainable Development Goals aimed at improving the economic well-being of the marginalised. To improve the employment outcomes of persons with disabilities in these countries, factors that facilitate and hinder employment should be explored. OBJECTIVES: This study explored barriers to and facilitators of employment for persons with disabilities in LMICs through a scoping review. METHODS: A search strategy included a systematic search of nine databases using specific keywords. The International Classification of Functioning, Disability and Health (ICF) framework was used as a conceptual framework and barriers and facilitators were reported according to the domains of the ICF. Articles published between 2008 and 2020 were reviewed using a predefined criteria. RESULTS: Thirty-two studies were identified in the review. Factors were identified in all domains of the ICF: (1) body function and body structure (12; 39%); (2) activities and participation (13; 42%); (3) personal factors (23; 74%); (4) environmental factors (27; 84%). CONCLUSION: Factors that hinder and facilitate the participation of persons with disabilities in LMICs were mainly found in the environment, with personal factors also influencing participation. The presence of negative attitudes and lack of services mainly in health and transport were major factors within the environment whilst personals factors included the lack of educational qualifications and skills. These results indicate the importance of consideration of contextual factors when developing intervention strategies aimed at facilitating the employment of persons with disabilities in LMICs.

Text messaging "Helps Me to Chat": exploring the interactional aspects of text messaging using mobile phones for youth with complex communication needs.

This study explored the interactional aspects of text messaging on mobile phones for youth with complex communication needs. A qualitative case study design was used to investigate aspects such as reasons, place, timing of communication, content and communication partners. Data were gathered from seven youth with complex communication needs (primary participants) and one communication partner for each youth (secondary participants). In addition to using a questionnaire and tests to obtain participant background information, four data collection methods were used: (a) face-to-face interviews with the primary participants via text messaging, (b) researcher observations of these participants interacting via text messaging, (c) an asynchronous text-messaging focus group involving all seven primary participants, and (d) asynchronous interviews with the secondary participants via text messaging. The thematic data analysis highlighted numerous interactional benefits, most notably that text messaging offered the youth with complex communication needs a means of expressing themselves that was easier than face-to-face interactions. It also emphasizes interaction symmetry with a wide range of communication partners including groups, the privacy to interact with others beyond their often-restricted environments (absent presence), and a measure of anonymity and control over interactions. The study concluded that text messaging provides youth with complex communication needs with new communication possibilities.

A model for cross-cultural translation and adaptation of speech-language pathology assessment measures: Application to the Focus on the Outcomes of Communication Under Six (FOCUS©).

PURPOSE: In the absence of a gold standard, this study illustrates the process involved in the cross-cultural translation and adaptation of the FOCUS© and its shortened version, FOCUS-34© (the Parent Form and Instruction Sheet, as well as the Clinician Form and Instruction Sheet), while also determining the social validity and clinical applicability of the translated measure. The target language used as example was Afrikaans, one of the 11 official languages of South Africa. METHOD: A two-phase cross-cultural translation model was employed in which Phase 1 (comprising a six-step blind back-translation procedure) was sequentially followed by Phase 2 (social validation and clinical applicability of the measure, using focus groups with stakeholders). RESULT: The extensive process followed in Phase 1 resulted in a clear and appropriate translation acceptable to both stakeholder groups (parents and speech-language pathologists). Both groups questioned the meaning of certain concepts, explored cultural differences and requested the extension of some items. Parents also shared their emotional reactions towards assessment, while therapists focussed on editorial changes to the measures. CONCLUSION: A framework is proposed for cross-cultural translation and adaptation of assessment measures with suitability in the speech-language pathology discipline.