Exploring facilitators and barriers for delivering person-centered care in a socio-economically diverse context: Perspectives of speech-language pathologists and audiologists.

OBJECTIVE: The study aimed to explore facilitators and barriers in delivering person-centered care from the perspective of speech-language pathologists and audiologists in a socio- economically diverse workplace across micro, meso, and macro levels. METHOD: A national cross-sectional e-survey was conducted among pooled speech-language pathologists and/or audiologists from South Africa. The e-survey included quantitative components to describe participant demographics which was analysed using descriptive and inferential statistics. The qualitative data was analyzed using metaphor and thematic analysis approaches to describe respondents' perspectives of barriers and facilitators in delivering person-centered care. RESULTS: The e-survey was completed by 63 clinicians (36.5% Audiologists; 36.5% Speech-Language Therapists; 27.0% dually qualified Speech-Language Therapists and Audiologists) mostly between the ages of 26 to 35 years old (33.3%). Respondents were working in various settings including the public sector (41.3%), private sector (44.4%) and in academia (14.3%). Facilitators and barriers were identified within all three systems (macro, meso and micro). The metaphor analysis resulted in six categories: uncertainty of Person centered care; its essential nature; associated challenges; relational aspect; analogies referring to animals; and food-related analogies. Thematic analysis of open-ended questions revealed five barriers, with three relating to micro systems; i) clinician factors, ii) client factors, iii) clinician and client interaction, and two related to factors within the meso system; iv) resources, and v) workplace. Only two themes were identified as facilitators towards PCC, clinician factors (mirco) and workplace factors (meso).' CONCLUSIONS: Insights gained from exploring Speech-Language Pathologists' and Audiologists' perceptions of implementing PCC in a socio-economically diverse setting highlight the need to address contextual (meso and macro systems) and personal (micro system) factors to promote and deliver PCC effectively. Notably, for the public sector, resources emerged as a major concern and barrier on the macro system level. Despite these challenges, the investigation revealed two noteworthy facilitators: clinician factors, at the micro level, and workplace factors, at the meso level. This nuanced understanding emphasizes the necessity of tailored interventions targeting both individual and systemic aspects to enhance the successful implementation of person-centered care. PRACTICAL IMPLICATIONS: Strategies should focus on enhancing clinicians' communication skills, collaboration, and teamwork, as well as addressing resource limitations through the adaptation of tools and implementation of PCC ISO standards.

Vocal Characteristics across English-Northern Sotho Bilingual Speakers: A Comparative Study.

INTRODUCTION: Bilinguals constitute a significant portion of speech-language pathologists' (SLPs) caseloads. Insight into the cross-linguistic effect on voice is needed to guide SLPs to make linguistically appropriate observations when working with heterogenous populations. METHOD: Nineteen female English-Northern Sotho bilinguals performed three speech tasks (reading, picture description, and monologue) in each language. Acoustic analysis of mean fundamental frequency (f0), intensity, and articulation rate was conducted with Praat. A panel of blinded listeners reached consensus after independently reviewing the recordings during perceptual analysis of voice quality, resonance, and glottal attack. RESULTS: The following statistically significant differences were found across and within the languages: The mean f0 was 204.61 Hz in the Northern Sotho picture description yet 196.50 Hz in the English picture description. The mean intensity of reading in Northern Sotho was 66.38 dB whereas the mean intensity of reading in English was 65.09 dB. Articulation rate was 3.78 syllables/s in English passage reading and 3.41 syllables/s in Northern Sotho passage reading. Within English, passage reading elicited a significantly quicker articulation rate than the picture description (3.34 syllables/s) and monologue (3.46 syllables/s). Within Northern Sotho, mean f0 was 203.83 Hz in passage reading yet 191.11 Hz in the monologue. Perceptual voice quality, glottal attack, and resonance were comparable across languages. CONCLUSION: Relationships between languages spoken, task performance, and vocal characteristics were observed in English-Northern Sotho bilingual females. SLPs must consider the interaction of language, task performance, and vocal characteristics when working with bilingual clients.

The hearing aid effect across diverse African populations and various hearing device modalities.

INTRODUCTION: The stigma associated with wearing hearing aids, known as the "hearing aid effect," remains a significant issue in hearing healthcare. Despite notable changes in the look and feel of hearing aids over the last decade, little is known about the influence of socioeconomic factors on the perception of different hearing devices in a socioeconomically diverse setting. OBJECTIVE: To determine the hearing aid effect across a range of hearing devices and its association with socioeconomic factors, namely area of residence and level of education across African communities. METHOD: The study used a cross-sectional design with 322 participants (161 rural, 161 urban); mean age 31.9 years (14.7 SD). Participants rated photographs of seven different styles of devices [standard behind-the-ear hearing aid (BTE HA) with an earmould, mini BTE HA with a slim tube (ST), in-the-canal (ITC) HA, Airpod, receiver-in-canal (RIC), completely-in-canal (CIC) HA, and Personal Sound Amplification Product (PSAP)] worn by a peer model using a validated scale of eight attributes (attractiveness , age, success, hardworking, trustworthiness, intelligence, friendliness, education). The ratings of the BTE HA with earmould were used as a benchmark for comparison. RESULTS: No hearing aid effect was observed across all participants (n=322) with device ratings ranging between neutral and positive. Significant differences between device ratings were evident for attractiveness for ST and PSAP and trustworthiness for ITC. In terms of residence, urban participants provided more favorable ratings compared to rural participants, with significant differences across three attribute ratings: hardworking for ST; attractiveness, hardworking for ITC; age for RIC and Airpod and hardworking for PSAP. For level of education, significant differences were found for attributes of attractiveness (H = 13.5; p = 0.001) for ITC; attractiveness (H = 14.7, p = 0.001) for PSAP; age (H = 9.5; p = 0.009) for RIC; age (H = 14.3; p<0.001) and intelligence (H = 15.1; p< 0.001) for Airpod and; hardworking (H =11.9, p = 0.003) for ST. CONCLUSION: Overall, participants had a neutral to positive view of hearing devices with preferences for less visible, conventionally styled devices. Socioeconomic variables such as educational attainment and geographical location influence perceptions of hearing devices emphasizing the importance of taking these aspects into account when prescribing hearing devices.

Evolution of Feeding and Developmental Outcomes in Infants With Moderate Hypoxic-Ischemic Encephalopathy: A Pilot Study.

The purpose of the study was to describe the evolution of outcomes among full-term infants with moderate hypoxic-ischemic encephalopathy (HIE); from their early swallowing and feeding abilities during hospitalization, to their later developmental outcomes at 6 and 12 months. Four participants with moderate HIE were recruited. Early feeding and swallowing were assessed using the Neonatal Feeding Assessment Scale and video fluoroscopic swallow studies. Developmental assessments were conducted at 6 and 12 months using the Rossetti Infant-Toddler Language Scale and Vineland-3 Scale. All participants displayed atypical outcomes throughout the study, including oropharyngeal dysphagia initially during hospitalization. All participants were discharged on oral feeds but some breastfeeding difficulties persisted. Variable but pervasive developmental delays were found among all participants at 6 and 12 months. This study emphasizes the need for consistent early intervention from the neonatal period onward, for all infants with moderate HIE. Future studies should use larger cohorts, longer follow-up, and correlational designs.

Person-centered care: preferences and predictors in speech-language pathology and audiology practitioners.

Introduction: Increasingly person-centered care (PCC) is being recognized as an important aspect of speech-language pathology and audiology (SLP/A) service delivery. This study aimed to (i) identify preferences toward PCC; (ii) determine predictors of these preferences; and (iii) describe the understanding and views of PCC among SLP/A in South Africa. Methods: A mixed-method design was followed utilizing an online survey and four focus group discussions. The survey included demographic questions, the modified Patient-Practitioner Orientation Scale (mPPOS), the Ten-Item-Personality-Inventory (TIPI) and an open-ended question. The focus group discussions included prompting questions which facilitated an open-ended discussion. Results: A total of 91 practitioners (39.6% speech-language pathologists) completed the online survey, with nine (44.4% audiologists) participating in the focus group discussions. A high preference toward PCC was noted, with a total mean mPPOS score of 4.6 (0.6 SD). Quantile regression analysis revealed four predictors (age, home language, sector, and personality trait openness) associated with PCC preferences. Three main categories emerged from the open-ended question and focus group discussions: (i) Positive experiences with PCC; (ii) restrictions toward PCC, and (iii) PCC exposure. Discussion: Positive (age and personality trait openness) and negative (home language and sector of employment) predictors toward PCC exist among speech-language pathologists and audiologists, with an overall general preference toward PCC. Practitioners experience facilitators and barriers toward implementing PCC including the extent of personal experiences, available resources and tools as well as workplace culture. These aspects require further investigation.

Developmental characteristics of young children in a low-income South African community.

Adequate early childhood development is critical for later-life success. Developmental profiles of specific populations are required to support implementation of early intervention services. Three hundred fifty-three caregivers of children with mean age 17.9 months (SD = 10.5) were selected from a primary healthcare clinic. Overall positive identification of signs of a developmental delay, with the Bayley Scales of Infant and Toddler Development III, was 51.8% (n = 183). Logistic regression analysis determined the effect of age and gender on results. Prevalence of developmental delay increased with age from 33.1% for children under 12 months to 61.7% and 66.3% for children between 13-24 months and 25-36 months, respectively. Females were 1.82 times (95% CI [1.16, 2.85]) more likely to have had no signs of developmental delay; 2.30 times (95% CI [1.14, 4.65]) in motor and 2.06 times (95% CI [1.23, 3.45]) in adaptive behaviour domains. One-third of children presented with low levels of adaptive behaviour functioning. One hundred and one (28.6%) participants across age groups displayed superior social-emotional ability, possibly due to familial structures and relationships. One-third of children presented with poor adaptive behaviour function, attributed to cultural differences. This study contributes to information on developmental characteristics of children in South Africa.

Comparing Hearing Aid Outcomes in Adults Using Over-the-Counter and Hearing Care Professional Service Delivery Models.

PURPOSE: More affordable hearing aids are now available due to over-the-counter (OTC) hearing aid regulations. Although laboratory studies have validated many OTC hearing technologies, there are limited real-world benefit studies. This study compared hearing aid outcomes reported by clients from OTC and conventional hearing care professional (HCP) service delivery models. METHOD: An ecological, cross-sectional survey design was employed. An online survey was sent to the Hearing Tracker user and OTC Lexie hearing aid user databases. Moreover, 656 hearing aid users completed the survey-406 through conventional HCP services (M age = 66.7 ± 13.0 years) and 250 through the OTC model (M age = 63.7 ± 12.2 years). Self-reported hearing aid benefit and satisfaction were measured with the International Outcome Inventory for Hearing Aids outcome tool. RESULTS: No significant difference for overall hearing aid outcomes between HCP and OTC users was evident using regression analyses, controlling for age, gender, duration of hearing loss, duration before hearing aid purchase, self-reported hearing difficulty, and unilateral versus bilateral fitting. For the "daily use" domain, HCP clients reported significantly longer hours of daily use. For the "residual activity limitations" domain, OTC hearing aid users reported significantly less difficulty hearing in situations where they most wanted to hear better. CONCLUSIONS: OTC hearing aid outcomes could complement and provide similar satisfaction and benefit to HCP models for adults. Service delivery aspects such as self-fitting, acclimatization programs, remote support, behavioral incentivization, and payment options should be investigated for their potential role in OTC hearing aid outcomes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22134788.

Self-reported Vocal Demands, Perceptions, and Knowledge of Occupational Voice Users in South Africa.

OBJECTIVES: The study aimed to describe daily vocal demands, perceptions and knowledge as reported by occupational voice users. STUDY DESIGN: A descriptive, cross-sectional research design was employed. METHODS: A survey on vocal demands, perceptions and knowledge was distributed to 102 occupational voice users via a snowball sampling technique. RESULTS: Slightly more than half of the participants (55%) reported using their voice for work 36.5 hours a week on average (SD = 15.5, range: 33-40). Participants reported that, on average, their daily voice use is 6.3 hours (SD = 2.7) for work and the majority (81%) reported a decrease in voice quality after work; Three-quarters (75%) also reported vocal fatigue at the end of day. Approximately one-third (33%) reported being exposed to environments where they are expected to shout, scream or cheer loudly. More than half of the participants (61%) reported that they have previously received vocal health education but 40% reported that they felt this training was insufficient. High vocal demands are significantly correlated to an increase in perceived vocal handicap rs = 0.242; (P = 0.018), tiredness of voice rs = 0.270; (P = 0.008), physical discomfort rs = 0.217; (P = 0.038) as well as how occupational voice users experience improvement of symptoms with rest rs = -0.356 (P < 0.001). Other risk factors highlighted by occupational voice users are the ingestion of liquid caffeine, alcohol, and carbonated drinks, smoking or the presence of chronic cough, chronic laryngitis, and gastroesophageal reflux disease. CONCLUSIONS: Occupational voice users are subjected to high daily vocal demands that can be seen to be linked to vocal fatigue, changes in voice quality and vocal symptoms experienced. It is essential that occupational voice users as well as treating clinicians are aware of certain significant predictors of both vocal handicap and vocal fatigue. These findings provide insights for developing strategies for training and cultivating vocal health consciousness and preventive voice care initiatives that focus on occupational voice users in South Africa.

Extended High-Frequency Audiometry for Ototoxicity Monitoring: A Longitudinal Evaluation of Drug-Resistant Tuberculosis Treatment.

PURPOSE: The aim of this study was to describe extended high-frequency (EHF) pure-tone audiometry monitoring of ototoxicity in a longitudinal treatment program for drug-resistant tuberculosis (DRTB). METHOD: This was a retrospective record review of longitudinal conventional (0.25-8 kHz) and EHF (9-16 kHz) audiometry for ototoxicity monitoring of DRTB patients undergoing treatment at community-based clinics between 2013 and 2017. Data from 69 patients with an average age of 37.9 years (SD = 11.2, range: 16.0-63.8 years) were included. Patients were assessed by primary health care audiologists (87%) or community health workers (13%) using portable audiological equipment. The average length of time between initial and exit assessments was 84.6 days (SD = 74.2, range: 2-335 days). RESULTS: EHF ototoxicity of a mild or greater degree of hearing loss (> 25 dB HL in one or both ears across frequencies) was evident in 85.5% of patients' posttreatment, compared with 47.8% of patients across conventional frequencies. EHF audiometry demonstrated an ototoxic shift (American Speech-Language-Hearing Association criteria) in 56.5% of cases compared with 31.9% when only conventional audiometry was considered. Mean hearing deterioration for patients was significant across EHFs (9-16 kHz) bilaterally (p < .05). Absent EHF thresholds at the initial assessment, owing to maximum output limits, was a limitation that occurred most frequently at 16 kHz (17.4%, 24/138). CONCLUSIONS: EHF audiometry is most sensitive for the early detection of ototoxicity and should be included in monitoring programs. Clinical ototoxicity monitoring protocols should consider shortened assessment approaches that target frequencies most sensitive to ototoxicity, including EHFs. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21651242.

Satisfaction with hearing assessment feedback using the My Hearing Explained tool: client and audiologist perceptions.

OBJECTIVE: To determine the perceived satisfaction and understanding of hearing assessment feedback, using the Ida My Hearing Explained Tool (IMHET), compared to the standard audiogram reported by adult clients and audiologists. DESIGN: This study is a mixed-method design comparing clients and audiologists' perceptions through a single-blinded, randomised control trial and focus group discussions. After using either the audiogram or IMHET for feedback, clients and audiologists completed the adapted Patient Satisfaction Questionnaire (PSQ). STUDY SAMPLE: During client's initial audiological consultations, audiologists provided hearing assessment feedback (Total = 51) using the IMHET or audiogram. Twenty-seven clients and seven audiologists participated in focus groups, and/or open-ended questions. RESULTS: Satisfaction was not significantly different (p > 0.05) between the IMHET (76.18; SD: 2.66) or audiogram (75.63; SD: 4.73) for the overall PSQ scores reported by clients and audiologists. Two shared main themes, understanding and satisfaction, were identified for both tools from the focus groups and open-ended questions. A third main theme, recommendations, was identified only for the IMHET. CONCLUSIONS: The IMHET is a valuable resource for clients during hearing assessment feedback. Audiologists recommend that the audiogram be used as a supplement when using the IMHET to provide feedback.

An Assessment of the Reliability and Validity of the PERMA Well-Being Scale for Adult Undergraduate Students in an Open and Distance Learning Context.

BACKGROUND: The PERMA well-being scale measures the multidimensionality of well-being in human populations. It highlights positive emotions, engagement, relationships, meaning, and accomplishment. Despite the empirical advancement and evolution of the PERMA scale in different settings, its applicability to open and distance learning (ODL) has not been adequately established among undergraduate students in sub-Saharan Africa. METHODOLOGY: Our study examines the theoretical reliability, validity, and five-factor structure of the shortened 35-item version of the PERMA well-being scale as it was adapted in an ODL tertiary institution in Botswana. The PERMA model of well-being and self-determination theory (SDT) served as theoretical frameworks. We evaluated the adapted PERMA scale's reliability, construct validity, confirmatory factor analysis, and measures of invariance to assess if the data of undergraduate students in an ODL context study fitted the PERMA model of a well-being five-factor structure. We used a multi-stage sampling scheme incorporating a convenience sampling approach where the respondents were invited to voluntarily participate in the study through a WhatsApp group, followed by snowball sampling where we asked the participants to add others to the WhatsApp group during the timeline of the survey; the sample comprised 215 respondents (age: mean = 38.17, standard deviation = 6.472). We collected data from former and active undergraduate B.Ed. (Bachelor of Education) degree students from five regional campuses of the open university through an online survey built into the Qualtrics platform. The Cronbach's alpha indicated that one item should be removed from the engagement domain. RESULTS: The overall adapted scale retained a 34-item PERMA well-being scale in the particular ODL context. The goodness of fit indices confirmed the five-domain structure with the 34 items. CONCLUSIONS: The psychometric properties of the 34-item adapted PERMA well-being scale suggest that it can be a valuable and feasible instrument in ODL in sub-Saharan Africa. Furthermore, the adapted scale can be applied in educational settings moving towards open and distance e-learning forms of delivery.

Audiologists' Perceptions of Hearing Healthcare Resources and Services in South Africa's Public Healthcare System.

Background: Hearing loss poses a significant burden globally. Its prevalence is exceptionally high in countries across the African region, where healthcare resources and services remain inaccessible. This study aimed to describe audiologists' perceptions regarding hearing healthcare resources and services within South Africa's public healthcare system. Methods: A national self-developed telephonic survey was conducted with audiologists in public healthcare system hospitals across South Africa, with the final sample comprising 100 audiologists. Results: Most (82%) audiologists indicated that their hospitals did not have adequate hearing healthcare resources to render efficient audiology services to patients. Binaural amplification devices (invasive and non-invasive) for adults with bilateral hearing loss who adhered to the criteria for these devices were perceived to be unavailable in most hospitals. Audiologists also perceived that universal newborn hearing screening services, adult aural rehabilitation services, and follow-up care for all hearing devices post-warranty expiration were limited. Conclusion: Efforts should be made to upsurge hearing healthcare resources, including increasing the financial budgets allocated to audiology resources so that increased diagnostic and screening audiology equipment and hearing devices can be procured where required, and additional audiologists can be employed within the South African public sector hospitals where needed.

mHealth-Supported Hearing Health Training for Early Childhood Development Practitioners: An Intervention Study.

(1) Hearing health training and promotion is a priority for early childhood development (ECD) practitioners, but training opportunities are limited, especially in low- and middle-income countries (LMIC). mHealth (mobile health) has the potential to deliver scalable ear and hearing training to ECD practitioners. (2) This study investigated the effect of an mHealth training intervention program for ECD practitioners to improve knowledge and perceptions of hearing health in young children. An experimental one-group, pre-post-test study included ECD practitioners working with children between birth and 6 years old across 31 neighbouring communities in the Western Cape Province, South Africa. Hearing health training was provided using WhatsApp messages that encompassed infographics and voice notes. Knowledge and perceptions regarding hearing and hearing-related problems in children were surveyed pre-training, directly post training, and 6 months post training. (3) ECD practitioners (N = 1012) between 17 and 71 years of age received the mHealth training program and completed both the pre-and post-training surveys. Overall, knowledge scores indicated a significant improvement from pre- to post training (Z = -22.49; p < 0.001). Six-month post-training knowledge scores were sustained. Content analysis of ECD practitioners' application of the training information 6 months post training indicated improved awareness, practical application, better assistance for hearing problems, and widespread advocacy. (4) The mHealth training program supports improved knowledge and perceptions of ECD practitioners regarding hearing health for young children. With improved knowledge scores maintained 6 months post training, mHealth hearing health training is an effective intervention. An mHealth training program for ECD practitioners provides a scalable, low-cost intervention for primary and secondary prevention in childhood hearing loss, especially in LMICs.

Perceptions of Telehealth Services for Hearing Loss in South Africa's Public Healthcare System.

Telehealth promises increased access to hearing healthcare services, primarily in areas where hearing healthcare resources are limited, such as within the South African public healthcare system. Telehealth for hearing healthcare is especially important during the COVID-19 pandemic, where physical distancing has been essential. This study aimed to describe audiologists' perceptions regarding telehealth services for hearing loss within South Africa's public healthcare system. This study was divided into two phases. During Phase 1, 97 audiologists completed an electronic survey regarding their perceptions of telehealth for hearing loss within South African public sector hospitals. Synchronous virtual focus-group discussions were conducted during Phase 2. Results indicated that audiologists recognized telehealth services' potential to improve hearing healthcare efficiency within the public sector, and most (84.1%) were willing to use it. However, telehealth's actual uptake was low despite almost doubling during the COVID-19 pandemic. Prominent perceived barriers to telehealth were primarily related to hospital resources, including the unavailability of equipment for the remote hearing/specialized assessments, internet-related barriers, and limited IT infrastructure. An increased understanding of telehealth in South Africa's public healthcare system will assist in identifying and in improving potential barriers to telehealth, including hospital resources and infrastructure.

Comparing Mental Health, Wellbeing and Flourishing in Undergraduate Students Pre- and during the COVID-19 Pandemic.

There has been a preponderance of studies on student mental health, wellbeing and flourishing during the COVID-19 pandemic. Few studies have compared data on student mental health and wellbeing before and during the pandemic. The purpose of the current study was to compare mental health and wellbeing in undergraduate students before and during the COVID-19 pandemic. Survey research was conducted with three groups of undergraduate students (n = 905) from diverse scientific fields at a large, urban university in South Africa. Data was collected by means of electronic surveys, combining full-scale items from three instruments, the Mental Health Continuum Short Form, the Flourishing Scale and the Fragility of Happiness Scale. Data was analysed by the Statistical Package for the Social Sciences (SPSS), the Analysis of Moment Structures (AMOS) and R software. The results indicate that while the mental health and wellbeing of students declined during the pandemic concerning their perceived ability to contribute to society, having supportive and rewarding social relationships and them being engaged and interested in their daily activities, it also improved in terms of their perceived ability to manage their daily lives (environmental mastery), being challenged to grow (personal growth) and in terms of their views that society was becoming better (social growth/actualisation).

Effects of language experience on selective auditory attention and speech-in-noise perception among English second language learners: Preliminary findings.

OBJECTIVE: The purpose of the study was to examine the effects of language experience on selective auditory attention and speech-in-noise perception in English Second Language (ESL) learners aged seven to eight years. METHOD: A quantitative, descriptive, comparative cross-sectional research design was used to determine the effect of age of exposure to English on the selective auditory attention abilities and speech-in-noise perception skills of 40 children with normal hearing in first or second grade (aged seven to eight years). The control group comprised of 20 English first language (EFL) learners (mean age = 7.35 years ±0.49) and the research group included 20 s language learners (mean age = 7.70 years ±0.47). In order to compare the control and research groups with respect to the age of exposure to English through various sources, the Mann Whitney test was used. Information regarding the age of exposure was gathered by a case history questionnaire, completed by the parents/guardians of the participants. The Selective Auditory Attention Test (SAAT) and Digits-in-Noise (DIN) test were performed in one sitting. RESULTS: No statistically significant differences between the EFL and ESL groups were found for the SAAT and DIN. However, a statistically significant difference was obtained between the SAAT lists 1 and 3 & the DIN: diotic listening condition for the ESL group only (rs = -0.623; p = 0.003). The difference between the EFL and ESL groups in the mean age of exposure to English was statistically significant (p = 0,019), with mean age of exposure to English in the ESL group (mean age = 2.82 ± 0.53) being higher than the mean age of exposure in the EFL group (mean age = 1.81 ± 1.53). However, this difference did not influence the results of the SAAT and DIN significantly. CONCLUSION: The main finding was that selective auditory attention and speech-in-noise perception were not significantly affected in the ESL learners who participated in the study - learners who were recruited from private schools located in an urban area and thus from higher socio-economic status (SES) households. There is a need for additional research with a larger sample size to determine the selective auditory attention abilities and speech-in-noise perception skills of ESL learners in government-funded schools located in rural areas and from various socio-economic backgrounds.

Psychosocial care of people with aphasia: Practices of speech-language pathologists in South Africa.

Purpose: The study aimed to explore the practices of a sample of South African speech-language pathologists (SLPs) in providing psychosocial care to people with aphasia. People with aphasia are at risk of adverse psychosocial disruptions and access to appropriate support may be particularly challenging for individuals with compromised communication abilities. The study considered the multilingual and multicultural context of South Africa. By understanding current practices, direction for improved psychosocial care to clients as well as support to SLPs is highlighted.Method: A 20-item previously published online survey was completed by 56 South African SLPs. Purposive and snowball sampling were used to recruit participants. Descriptive and inferential statistics, and qualitative content analysis, were used.Result: Respondents recognised addressing psychosocial wellbeing to be very important. A variety of psychosocial approaches were used in practice. However, 67.9% of the sample felt ill-equipped to provide psychosocial care to people with aphasia. Further barriers included: time/caseload pressures (60.7%) and feeling out of their depth (48.2%). Enablers were: access to more training opportunities (89.3%), adequate time (62.5%), and ongoing support from skilled professionals (55.4%). The majority of respondents also perceived mental health professionals to have limited expertise in working with people with aphasia, making onward referral challenging.Conclusion: Respondents support people with aphasia's psychosocial wellbeing by employing counselling strategies, including family, and person-centred goal-setting. However, many challenges to the provision of psychosocial care to people with aphasia were identified. To improve services, more training opportunities, improved role definition and interprofessional collaboration, are required.

Community-Based Ototoxicity Monitoring for Drug-Resistant Tuberculosis in South Africa: An Evaluation Study.

In response to the drug-resistant tuberculosis (DRTB) ototoxicity burden in South Africa, ototoxicity monitoring has been decentralised, with community health workers (CHWs) acting as facilitators. This study describes a community-based ototoxicity monitoring programme (OMP) for patients with DRTB. Findings are compared to the recommended guidelines for ototoxicity monitoring, the OMP protocol and published studies. This was a retrospective study of longitudinal ototoxicity monitoring of 831 patients with DRTB, using data collected at community-based clinics in the City of Cape Town between 2013 and 2017. Approximately half (46.8%) of the patients had an initial assessment conducted in accordance with the OMP protocol recommendations, and follow-up rates (79.5%) were higher than those of a similar DRTB programme. However, patients in this study were not monitored within the timeframes or with the regularity recommended by the guidelines or the OMP protocol. Extended high-frequency pure-tone audiometry (27.5%) was underutilised by testers and data recording was inconsistent (e.g., 37.7% of patient gender was not recorded by testers). Community-based OMP using CHWs to facilitate monitoring showed improvement over previous hospital-based reports, with more accessible services and higher follow-up rates. However, to improve OMP outcomes, OMP managers should reassess current protocols and data recording practices.

The Effect of Superficial Hydration, With or Without Systemic Hydration, on Voice Quality in Future Female Professional Singers.

OBJECTIVE: The aim of this study was to describe the effect of superficial hydration, with or without systemic hydration, on voice quality in future female professional singers by assessing acoustic and perceptual parameters of voice production as well as symptoms of vocal fatigue. STUDY DESIGN: This is an experimental design study. METHODS: A study was performed on a sample of 24 female voice majors to ascertain the effect of superficial hydration, with or without systemic hydration, on acoustic parameters and perception of vocal fatigue. The study replicated a prior study by van Wyk et al (2016) with some modifications; we looked at the effect of both systemic and superficial hydration independently and together on voice quality and vocal fatigue. Acoustic measurements including GRBASI, jitter, shimmer, F0 MPT, frequency min and max, intensity min and max, and dysphonia severity index were measured along with perceived vocal fatigue using the Vocal Fatigue Index. RESULTS: A statistically significant increase in MPT values were obtained when comparing pre- and post-test results of the hypo hydrated (P = 0.015) and superficial hydration condition (P = 0.004). A significant increase in frequency min (Hz) within the hypo hydrated condition was also observed (P = 0.019). A significant increase was observed in the intensity min (dB) (P = 0.010) and F0 min (Hz) (P = 0.002) within the combined hydration condition. Also, when superficial hydration was applied, mean shimmer % (P = 0.016), MPT (sec) (P = 0.003) and dysphonia severity index (P = 0.020) scores increased significantly in a between-group, post-test comparison. A significant reduction in mean intensity max (dB) (P = 0.049) and intensity min (dB) (P = 0.018) was also observed. CONCLUSIONS: This study demonstrates that the use of superficial hydration results in positive outcomes of perceptual parameters of voice quality and symptoms of vocal fatigue in future female professional singers. However, mixed results were observed regarding the acoustic parameters of voice. The superficial hydration data is compelling enough to warrant implementing in a vocal hygiene protocol for singers.

Developmental outcomes of HIV-exposed infants in a low-income South African context.

BACKGROUND: Effective HIV transmission prevention strategies have led to a growing population of vulnerable HIV- and antiretroviral-exposed infants in sub-Saharan Africa, however uncertainty exists regarding their development. OBJECTIVE: To determine the developmental outcomes of HIV-exposed (HE) infants in a low-income South African context, when compared to HIV-unexposed (HU) counterparts. METHODS: In this prospective cross-sectional, group comparison study, the development of 41 HE and 40 HU infants (mean age=8.4 months, SD=2.1 months) from a low-income context was assessed. Caregivers were interviewed using the Vineland Adaptive Behavior Scales, Third Edition (Vineland-3) to evaluate infants' development. RESULTS: Most HE participants had age-appropriate overall development (90.2%;n=37). Some HE participants, however, presented with delays in domains of communication (9.8%;n=4), daily living skills (2.4%;n=1), socialisation (19.5%;n=8), and motor development (7.3%;n=3). HU participants also demonstrated some domain-specific delays, thus delays were present in both groups. No statistically significant between-group differences regarding development were found. CONCLUSION: Findings were reassuring and suggested that HE and HU participants had similar development. Developmental differences may, however, only emerge with age, therefore large-scale longitudinal research is recommended. It is suggested that the entire sample was vulnerable, highlighting the importance of developmental surveillance in low-income contexts, irrespective of HIV and antiretroviral exposure status.