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.

Breastfeeding Outcomes and Associated Risks in HIV-Infected and HIV-Exposed Infants: A Systematic Review.

Purpose: To critically appraise recent literature regarding breastfeeding outcomes and associated risks in HIV-infected (HI) and HIV-exposed (HE) infants, using the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement guidelines. Materials and Methods: Five electronic databases were systematically searched to obtain English publications from the last 10 years (2010-2020), pertaining to breastfeeding outcomes and associated risks of HI and HE infants and children. Gray literature sources were also included. Data were extracted according to various data items and were synthesized using thematic synthesis. Results: Of the initial 7,151 sources identified, 42 articles were eligible for final inclusion. The final selection included 19 cohort studies and 2 expert committee reports, classified as gray literature. The remaining 21 studies comprised case-control, cross-sectional, and randomized controlled trial studies. The following themes were identified: breastfeeding outcomes in HI and HE infants, risks for suboptimal breastfeeding, HI and HE infant growth and developmental outcomes, and barriers and facilitators to feeding decisions. Most studies highlighted HE infants' growth and developmental outcomes and did not directly interrogate breastfeeding outcomes. The most prevalent risks for suboptimal breastfeeding were maternal factors affecting decision making for breastfeeding. Conclusions: This systematic review adds to the evidence of breastfeeding in HIV-affected mother-infant dyads. Findings reiterated that exclusive breastfeeding has a positive outcome on growth and development of all infants irrespective of HIV status. The review highlighted a dearth of research on breastfeeding outcomes of HI and HE infants. Large-scale prospective comparative studies should profile breastfeeding and developmental outcomes of infants with HIV infection or exposure and antiretroviral treatment exposure to enable early identification and intervention for this vulnerable population in low-income settings.

Is Phonological Awareness Related to Pitch, Rhythm, and Speech-in-Noise Discrimination in Young Children?

Purpose Phonological awareness (PA) requires the complex integration of language, speech, and auditory processing abilities. Enhanced pitch and rhythm discrimination have been shown to improve PA and speech-in-noise (SiN) discrimination. The screening of pitch and rhythm discrimination, if nonlinguistic correlates of these abilities, could contribute to screening procedures prior to diagnostic assessment. This research aimed to determine the association of PA abilities with pitch, rhythm, and SiN discrimination in children aged 5-7 years old. Method Forty-one participants' pitch, rhythm, and SiN discrimination and PA abilities were evaluated. To control for confounding factors, including biological and environmental risk exposure and gender differences, typically developing male children from high socioeconomic statuses were selected. Pearson correlation was used to identify associations between variables, and stepwise regression analysis was used to identify possible predictors of PA. Results Correlations of medium strength were identified between PA and pitch, rhythm, and SiN discrimination. Pitch and diotic digit-in-noise discrimination formed the strongest regression model (adjusted R 2 = .4213, r = .649) for phoneme-grapheme correspondence. Conclusions The current study demonstrates predictive relationships between the complex auditory discrimination skills of pitch, rhythm, and diotic digit-in-noise recognition and foundational phonemic awareness and phonic skills in young males from high socioeconomic statuses. Pitch, rhythm, and digit-in-noise discrimination measures hold potential as screening measures for delays in phonemic awareness and phonic difficulties and as components of stimulation programs.

Perspectives of working-age adults with aphasia regarding social participation.

BACKGROUND: Working-age adults with aphasia experience difficulties in social participation, specifically fulfilling social roles and reintegrating into communities. Literature regarding social participation of people with aphasia (PWA) is predominantly based on studies conducted in high-income countries (HIC), limiting generalisability of findings. Perspectives of social participation are influenced by person, place and cultural background warranting investigation in heterogeneous low- and middle-income countries (LMICs), like South Africa. OBJECTIVES: Describe perspectives of working-age adults with aphasia regarding social participation within the first 2 years post-incident. METHOD: Semi-structured interviews gained perspectives of 10 working-age adults (with mild to moderate aphasia) using principles of supported conversation for adults with aphasia. Data were thematically analysed to describe participants' perspectives of social participation. RESULTS: Seven themes were identified pertaining to participants' perspectives of social participation. Participants considered rehabilitation services, faith-related activities and returning to work as valued areas of social participation. Previous interests, presence of support and characteristics of communication partners determined their preference and willingness to participate with others. Finally, personal attitudes and feelings continued to influence their perspectives of social participation, as well as their motivation to participate. CONCLUSION: Successful social participation was dependent on the PWA's perceived value of social activities and presence of support from significant others. Speech-language therapists are in the ideal position to facilitate PWA's communication abilities and their experience of successful participation through the implementation of person-centered care and community-led intervention. This study provided a preliminary investigation of social participation in South Africa and further investigation is warranted.

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.

The Contribution of Individual Differences in Memory Span and Language Ability to Spatial Release From Masking in Young Children.

Purpose Working memory capacity and language ability modulate speech reception; however, the respective roles of peripheral and cognitive processing are unclear. The contribution of individual differences in these abilities to utilization of spatial cues when separating speech from informational and energetic masking backgrounds in children has not yet been determined. Therefore, this study explored whether speech reception in children is modulated by environmental factors, such as the type of background noise and spatial configuration of target and noise sources, and individual differences in the cognitive and linguistic abilities of listeners. Method Speech reception thresholds were assessed in 39 children aged 5-7 years in simulated school listening environments. Speech reception thresholds of target sentences spoken by an adult male consisting of number and color combinations were measured using an adaptive procedure, with speech-shaped white noise and single-talker backgrounds that were either collocated (target and back-ground at 0°) or spatially separated (target at 0°, background noise at 90° to the right). Spatial release from masking was assessed alongside memory span and expressive language. Results and Conclusion Significant main effect results showed that speech reception thresholds were highest for informational maskers and collocated conditions. Significant interactions indicated that individual differences in memory span and language ability were related to spatial release from masking advantages. Specifically, individual differences in memory span and language were related to the utilization of spatial cues in separated conditions. Language differences were related to auditory stream segregation abilities in collocated conditions that lack helpful spatial cues, pointing to the utilization of language processes to make up for losses in spatial information.

Investigating the Effect of One Year of Learning to Play a Musical Instrument on Speech-in-Noise Perception and Phonological Short-Term Memory in 5-to-7-Year-Old Children.

The benefits in speech-in-noise perception, language and cognition brought about by extensive musical training in adults and children have been demonstrated in a number of cross-sectional studies. Therefore, this study aimed to investigate whether one year of school-delivered musical training, consisting of individual and group instrumental classes, was capable of producing advantages for speech-in-noise perception and phonological short-term memory in children tested in a simulated classroom environment. Forty-one children aged 5-7 years at the first measurement point participated in the study and either went to a music-focused or a sport-focused private school with an otherwise equivalent school curriculum. The children's ability to detect number and color words in noise was measured under a number of conditions including different masker types (speech-shaped noise, single-talker background) and under varying spatial combinations of target and masker (spatially collocated, spatially separated). Additionally, a cognitive factor essential to speech perception, namely phonological short-term memory, was assessed. Findings were unable to confirm that musical training of the frequency and duration administered was associated with a musicians' advantage for either speech in noise, under any of the masker or spatial conditions tested, or phonological short-term memory.