A shared reading intervention: Changing perceptions of caregivers in a semi-rural township.

BACKGROUND:  Many caregivers from low-middle income (LMI) households consider that preschool children are too young for shared book reading. Thus, many caregivers are unaware of their potentially powerful role in their children's emergent literacy and communication. OBJECTIVES:  To describe (1) caregivers' perceptions of shared reading, (2) caregivers' perceptions of barriers to shared reading and (3) changes in these perceptions following a short intervention. METHOD:  A qualitative methodology was used to understand the perceptions of 40 caregivers from a semi-rural South African township. Two semi-structured interviews were conducted before and after intervention. The intervention was a short training video about shared reading. RESULTS:  Caregivers described the unfamiliar reading culture and viewed reading as an educational activity that they knew little about. Barriers to shared reading included lack of time, few reading materials and low levels of literacy or lack of exposure to this type of activity. Following the intervention, they acknowledged the importance of shared reading, described growing confidence in their shared reading abilities and closer relationships with their children. CONCLUSION:  Speech-language therapists (SLTs) have a pivotal role to play in caregiver training of emergent literacy skills and can make a marked impact in guiding caregivers' shared reading. A short video-based intervention can alter caregiver perceptions and practices, which may be the first step in changing behaviours.Contribution: The study provides an example of a simple and cost-effective intervention that changed caregiver perception and caregivers' reported shared reading practice.

In pursuit of best practice through contextually relevant, accountable and responsive research.

No abstract available.

The impact of COVID-19 on speech-language and hearing professions in low- and middle-income countries: Challenges and opportunities explored.

BACKGROUND:  Since the advent of the coronavirus disease 2019 (COVID-19), the speech-language and hearing (SLH) professions globally have been confronted with novel and unexpected challenges. OBJECTIVE:  The aim of this article was to explore the impact of COVID-19 on SLH professions in low- and middle-income countries (LMICs) as presented in the Special Issue of the South African Journal of Communication Disorders in the year 2022. METHOD:  Divergent from the standard editorial writing style, this editorial adopted a research approach where a qualitative, descriptive scoping review design was conducted to meet the objectives of the study. Three specific objectives were targeted: (1) exploring the challenges to SLH research, teaching and practice; (2) establishing evidence-based solutions available for these challenges that can be used to improve the professions' response in the post-pandemic era; and (3) determining the areas that require further investigation, alternative solutions and innovation for improved readiness for future pandemics. A total of 21 manuscripts were reviewed that covered three predetermined themes - research, teaching and practice - that were constructed through a deductive approach as part of the call for papers for the special issue. These manuscripts were from academics, researchers and clinicians from various institutions in LMICs. The review is presented using thematic analysis. RESULTS:  The review raised important challenges, presented under various subthemes, to the three key themes. These challenges reflect on the impact of COVID-19 on the SLH professions in terms of research, teaching, service provision and ethical challenges, as well as its impact on speech language, hearing, swallowing and balance functions. The review also advanced solutions and future directions during and beyond COVID-19. CONCLUSION:  These findings raise global implications for research, teaching and practice that are not only relevant to the SLH professions.

Feeding practices in public hospitals' neonatal intensive care units: An exploration into the ways in which COVID-19 affected the best practice in Gauteng.

BACKGROUND:  South Africa's healthcare system has a multitude of pre-existing challenges prior to the onset of the coronavirus disease 2019 (COVID-19) pandemic, ranging from reduced number of staff, lack of resources and units being at overcapacity both in the adult and paediatric populations. The neonatal intensive care units (NICUs) require a team approach to ensure best practice with vulnerable infants, but little is known about how the onset of the COVID-19 pandemic and the resultant lockdown restrictions impacted the feeding practices within the NICU. OBJECTIVES:  This study aimed to explore the impact that COVID-19 had on the feeding practices within the NICU settings in public hospitals in Gauteng. METHODS:  A qualitative design was employed with data collected in two NICUs in Gauteng. Data were collected in the form of observations and semi-structured interviews with healthcare workers (HCWs) in the NICU. Data were analysed using inductive thematic analysis. RESULTS:  Although the sample size of participants was limited, social distancing proved to be a challenge resulting in mothers and healthcare workers being given restricted access. This had effects on the ability to provide adequate feeding practices and resulted in anxiety for the mothers and mental health challenges for the HCWs when feeding these at-risk infants. A limitation of this study was the use of only two sites. CONCLUSION:  COVID-19 amplified the existing challenges in the NICU. A multidisciplinary and family-centred approach to address feeding challenges is required to offset the challenges resulting from the pandemic and subsequent lockdown.

The application of qualitative approaches in a post-colonial context in speech-language pathology: A call for transformation.

Purpose: Legacies of colonialism continue to influence the profession of speech-language pathology (SLP) around the world. While there is some literature on ways in which we can decolonise the profession, there is little written on these issues in relation to research and practice in the field. In this paper, we discuss how qualitative approaches can be useful particularly in post-colonial contexts to transform research and practice in the profession.Method: Using a reflective framework, we draw on examples from several of our own research and teaching experiences that have embraced a variety of qualitative approaches, conducted across various contexts in the post-colonial South African context.Result: Qualitative approaches can play a central role in achieving transformation goals because they offer opportunities for highlighting the voices of marginalised communities and they are flexible and adaptable to the needs of particular contexts. We reflect on how qualitative approaches can be linked to SLP curricula, practice and research, and consider innovative ways in which such approaches can be embraced within the profession. Specifically focussing on research, we explore issues of access, representation and inclusion, the use of contextually relevant methods, and ethical considerations when working in post-colonial contexts.Conclusion: Many of the points raised in this article are important for all contexts. Embracing qualitative approaches offers opportunities for the SLP profession to transform and meet our mandate of providing culturally safe, appropriate, effective care.

Life under lockdown for children with autism spectrum disorder: Insights from families in South Africa.

BACKGROUND: Children with Autism Spectrum Disorder (ASD) remain vulnerable during the Covid-19 outbreak due to significant changes to their daily routines, social interactions and diets. In addition, these challenges may be exacerbated for children living in low- and middle-income countries (LMIC) such as South Africa where there are already barriers such as poverty, access to resources and availability of support. Understanding the impact of the Covid-19 outbreak on children with ASD is imperative in order to create awareness as well as provide equitable services and support to both children with ASD and their families. PURPOSE: The study aimed to explore family-reported changes for children with ASD and their reactions and responses to the Covid-19 restrictions in South Africa. METHOD: A qualitative research design was employed. Twelve families consisting of different family compositions with a total of 21 family members (mothers, fathers and grandmothers) participated in the current study using semistructured interviews. Data were transcribed and analysed using a framework method for thematic analysis. RESULTS: Findings indicated that children with ASD present with unique challenges related to Covid-19. Negative themes such as children's obstructive reactions due to the immediate changes to their routines, increases in emotional dysregulation as well as loss of previously acquired skills as a result of lack of access to services during lockdown were reported. However, families also reported on positive changes such as improved social interactions as children became more accustomed to their new lockdown routines. IMPLICATIONS: The Covid-19 response has had a negative impact on children with disabilities, specifically around access to services and support for both children with ASD and their families. While the future of the virus and impending lockdown measures is unknown, clinicians, providers and educators need to ensure that provisions are made for children's current adjustments as well as further adjustments to their current routines both during and after the pandemic.

Speech-Language Pathology and Audiology in South Africa: Clinical Training and Service in the Era of COVID-19.

INTRODUCTION AND PURPOSE: The novel coronavirus (COVID-19) presented new and unanticipated challenges to the provision of clinical services, from student training to the care of patients with speech-language and hearing (SLH) disorders. Prompt changes in information and communication technologies (ICT), were required to ensure that clinical training continued to meet the Health Professions Council of South Africa's regulations and patients received effective clinical care. The purpose of this study was to investigate online clinical training and supervision to inform current and future training and clinical care provision in SLH professions. METHODOLOGY: A scoping review was conducted using the Arksey and O'Malley (2005) framework. The electronic bibliographic databases Science Direct, PubMed, Scopus, MEDLINE, and ProQuest were searched to identify publications about online clinical training and supervision and their impact on clinical service during COVID-19. Selection and analysis were performed by three independent reviewers using pretested forms. RESULTS AND CONCLUSIONS: The findings revealed important benefits of teletraining and telepractice with potential application to South African clinical training and service provision. Five themes emerged: (1) practice produces favorable outcomes, (2) appreciation for hybrid models of training and service delivery, (3) cost effectiveness is a "big win" (4) internationalization of remote clinical training and service provision, and (5) comparable modality outcomes. These findings may have significant implications for teletraining and telepractice in low-and-middle income countries (LMICs) in the COVID-19 era and beyond, wherein demand versus capacity challenges (e.g., in human resources) persist. Current findings highlight the need for SLH training programmes to foster a hybrid clinical training model. Few studies were conducted in LMICs, indicating a gap in such research.

"I was always struggling": Caregivers' experiences of transitioning a child from oral to long-term non-oral feeding at an out-patient hospital clinic in South Africa.

BACKGROUND: As the prevalence of paediatric dysphagia increases, the need for long-term non-oral feeding has also increased. Despite these developments, little is known about caregiver experiences of transitioning a child onto long-term non-oral feeds, and the factors which influence the process of decision-making and the provision of consent to do so. This paper aims to explore these factors. METHODS: Semi-structured interviews were conducted with nine participants recruited from the multidisciplinary out-patient non-oral feeding clinic at a hospital. Interviews explored caregiver experiences of decision-making and the process of providing consent when transitioning their child to non-oral feeds, as well as the support structures available to the caregivers. Interviews were audio recorded and transcribed, then analyzed using thematic analysis (Braun & Clarke, 2013) and content analysis (Neuendorf, 2016). RESULTS: Challenges to care and quality of life, access to information and culturally relevant counselling, and the involvement of family members and significant others emerged as prominent themes. Findings suggest that quality of life was the most common motivating factor for transitioning a child to non-oral feeding methods. Several participants suggested that support and information sharing via digital platforms were both useful and effective. IMPLICATIONS: The findings highlight caregivers' needs for improved access to information and social support. The findings hold implications for training of healthcare providers working in similar contexts and for models of service delivery which ensure that family-centred intervention can be delivered in culturally and contextually relevant ways. With widespread access to smartphones, counselling should include digital messaging as a way of providing support and information sharing. Future research should focus on the complexities of counselling and the process of informed consent in settings impacted by diverse cultural, contextual and linguistic barriers, as well as the potential value of mobile health (mhealth) in ensuring improved health outcomes.

A qualitative inquiry into the ways in which space and place influence the lived experiences of adults with disabilities in rural South Africa.

INTRODUCTION: The field of disability studies is a contested area of research that has transformed significantly over the past three decades. The move away from the medical model of disability in the early 1980s created opportunities for the voices of people with disabilities to be heard. However, research into the lived experiences of this population has historically relied on proxy accounts and, where first-person accounts have been included, people with disabilities have often been excluded on the basis of cognitive-communicative (dis)ability and language proficiency. This article explores the ways in which space and place influence the lived experience of disability in a rural South African context. METHODS: A qualitative approach underpinned by the principles of narrative inquiry was adopted. Thirty participants with a variety of impairments were interviewed over a period of 3 months. Data were analysed using inductive thematic analysis. RESULTS: Findings reveal a complex web of physical and socioemotional aspects that influence the spaces and places in which stories are lived and told. Overriding themes include exclusion on the basis of physical mobility; exclusion from healthcare, education and social services; exclusion from the employment sector; exclusion from participation in sociocultural activities; and the creation of 'safe places', which provide insight into the physical and psychosocial dimensions of inclusion. CONCLUSION: A case is made for social activism and for communities to confront the anxieties, silences, prejudices and injustices that exist in policy documents, healthcare consultations and community engagements.

An Exploration into Mothers' Experiences of Feeding Children with Autism Spectrum Disorder in South Africa.

OBJECTIVES: To explore the experiences of mothers feeding their children with autism spectrum disorder (ASD) in South Africa as well as to better understand the impact of context and culture on feeding disorders. PARTICIPANTS AND METHODS: A qualitative research design was employed. Seven mothers of 8 children (1 mother had twins), aged 4-9 years, who were diagnosed with ASD and who had associated feeding difficulties participated in the study. Semi-structured interviews were conducted, and data were transcribed and analysed using inductive thematic analysis. RESULTS: Findings indicated that children with ASD and feeding difficulties increase parental stress and anxiety. Novel findings pertaining to context and culture showed the negative impact feeding difficulties have on the siblings, the role taken on by the mother as the caregiver and the provider, and an additional financial burden associated with feeding a child with ASD. CONCLUSIONS: Findings add to the field of speech therapy by providing awareness of the challenges experienced by these mothers as well as those that are unique to the South African context. In addition, the current study provides insight into the experiences of mothers from different contexts and cultural backgrounds to those reported in previous literature.

The Interface Between Violence, Disability, and Poverty: Stories From a Developing Country.

People with disabilities are vulnerable to multiple forms of violence in their everyday lives, including structural violence, deprivation, and physical, emotional, and sexual exploitation. Despite increasing reports of violence against people with disabilities, little is known about this phenomenon, especially in the context of poverty. Furthermore, the various types of violence have traditionally been studied in isolation, which has led to a limited understanding of the nature and persistence of violence in society, and has affected our understanding of the relationship between different forms of violence. In this article, we explore the relationship between violence, disability, and poverty among people living in a rural area of South Africa. Thirty adults with a variety of disabilities living in 12 rural villages in the Mpumalanga Province of South Africa participated in the study. Each of the participants was provided with an opportunity to tell their life story. Narrative inquiry and participant observation were used to explore the ways in which violence pervades the participants' everyday experiences. Results were analyzed using thematic analysis and suggest that in the context of poverty, it is impossible to separate the experience of disability from the experience of violence. Structural violence was shown to underpin all other forms of interpersonal violence, making persons with disabilities vulnerable to additional forms of exploitation, and serve to further isolate people with disabilities from society, compromising both health and human rights. The findings suggest that an understanding of contextual factors is fundamental to understanding the relationship between violence and disability.

Beyond physical access: a qualitative analysis into the barriers to policy implementation and service provision experienced by persons with disabilities living in a rural context.

INTRODUCTION: Persons with disabilities make up approximately 15% of the world's population, with vulnerable communities disproportionately affected by the incidence of disability. Research reflects that persons with disabilities are vulnerable to stigma and discrimination, social isolation, and have physical barriers to accessing support services, all of which serve to perpetuate a sense of uncertainty and vulnerability within their lives. Recently a number of policies and models of intervention have been introduced intended to protect the rights of those affected by disability, yet limited research has been conducted into the lived experiences of persons with disabilities, particularly in rural contexts. This implies that little is known about the impact of the rural context on the lived experience of disability and the ways in which context impacts on the implementation of policies and practices. METHODS: The current study employed a qualitative design underpinned by the principles of narrative inquiry and participant observation. Thirty adults with a variety of congenital and acquired disabilities (15 men and 15 women, ranging in age from 19 to 83 years) living in 12 rural communities in the Mpumalanga Province of South Africa were recruited through snowball sampling. Data collection comprised a combination of narrative inquiry and participant observation. Narratives were collected in SiSwati with the assistance of a SiSwati-speaking research mediator and were transcribed and translated into English. Data were analysed inductively according to the principles of thematic analysis. RESULTS: Findings confirmed that the experience of living with a disability in a rural area is associated with discrimination, social exclusion, and isolation and barriers to accessing services, underpinned by numerous context-specific experiences, including mortality rates, exposure to numerous and repeated forms of violence across the lifespan, and corruption and lack of transparency in the implementation of government policies and practices. These experiences are not currently reflected in the literature or in guidelines on the implementations of policies and service provision, and thus have the potential to offer novel insights into the barriers faced by persons with disabilities living in rural areas. CONCLUSIONS: The results of this study suggest that barriers to service provision extend beyond physical obstacles, and include a variety of sociocultural and sociopolitical barriers. By failing to take these into account, policies and current models of service provision are only able to provide limited support to persons with disabilities living in rural areas. The findings reveal narrative inquiry to be a powerful and culturally safe tool for exploring lived experience among vulnerable populations and hold significant implications for both practitioners and policy developers. Furthermore, it emerges that one-size-fits-all policies are unable to meet the needs of persons with disabilities living in rural areas. However, the implementation of site-specific needs analyses with the use of flexible and culturally appropriate tools has the potential to redress the discrepancies in policy implementation and can be used to strengthen institutional ties and referral pathways.

A study Investigating Sound Sources and Noise Levels in Neonatal Intensive Care Units

Background. Exposure to noise in the neonatal intensive care unit (NICU) has the potential to affect neonatal auditory development; sleep patterns and physiological stability; thus impacting on developmental progress.Objectives. This study aimed to identify noise sources in three NICUs in Johannesburg; South Africa; and to determine the sound levels to which neonates in incubators are exposed at various positions in the NICU. These findings were then compared with the standards recommended by the American Academy of Pediatrics (AAP).Methods. A prospective; repeated designs measure was adopted. Sound levels were recorded in 5 different areas of the NICUs at four different times of the day over the course of 3 days. Data were analysed using descriptive statistics.Results. Sound levels recorded in all the NICUs were considerably higher than those recommended by the AAP; placing vulnerable neonates at risk for developmental disorders. Significantly; most of the noise was human-generated; highlighting the need to develop awareness of the negative effects of noise in the NICU and to implement programmes to reduce noise.Conclusion. The findings have important implications for neonatal care; and highlight the importance of noise reduction and monitoring strategies in the NICU