Barriers in cross-linguistic and cross-cultural paediatric speech-language therapy and strategies for promoting culturally safe practices: a scoping review

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Abstract

Culturally and linguistically diverse countries such as South Africa require speech-language therapy services that are accessible and culturally safe. Cultural safety refers to a client’s experience during cross-linguistic and cross-cultural intervention when speech-language therapists (SLTs) act in a culturally sensitive, culturally competent manner and with cultural humility (Phiri, Dietsch and Bonner 2010). The practice of cultural safety is a more equal division of power between the therapist and the client, and leads to the client’s feeling understood and respected with regard to his/her language and cultural background.

The speech-language therapy profession in South Africa still comprises mostly white Afrikaans- or English-speaking women (Mdlalo, Flack and Joubert 2016; Khoza-Shangase and Mophosho 2017) and the trend is similar in some other countries, for example the United Kingdom (Ferguson and Armstrong 2004). These professionals serve a diverse population with different indigenous and foreign languages and cultural backgrounds that often differ from the SLT’s own language and culture. Although there is a marked increase in the number of South African SLTs that can serve clients in an African language, research findings suggest that children who are native speakers of African languages are still likely to receive assessment and treatment in a language other than their first language (Southwood and Van Dulm 2015).

SLTs worldwide have a responsibility to develop cultural competence in order to promote cultural safety during cross-linguistic and cross-cultural engagements. Cultural competence develops over time and is addressed in formal guidelines such as those proposed by The South African Speech, Language and Hearing Association (SASLHA), American Speech, Language and Hearing Association (ASHA) and the Health Professions Council of South Africa (HPCSA). In its official document “Guidelines for speech-language therapists regarding early communication intervention” SASLHA refers to the development of cultural competence (The South African Speech-Language-Hearing Association 2017). SASLHA members are also referred to ASHA’s online resources for more information on cultural considerations, cross-cultural assessment, and a “mark list for personal reflection”. In October 2019 the HPCSA released a document with guidelines for practice in the linguistically and culturally diverse local context. These guidelines are valuable, structured, and based on research literature. Several international studies have investigated practical strategies/recommendations listed by SLTs which are utilised in their everyday engagements with culturally and linguistically diverse paediatric populations, as well as the barriers they have experienced.

A comprehensive list of such strategies/recommendations and the barriers that SLTs may expect during cross-linguistic and cross-cultural intervention can assist them to prepare more effectively for such engagements and to develop a deeper understanding, respect and empathy for their clients. Such comprehensive information would benefit not only SLTs but also any other professionals, such as teachers, psychologists and medical practitioners who work in cross-linguistic and cross-cultural domains. However, no such list has yet been developed.

The aim of this scoping review was to develop two comprehensive lists as well as to propose a framework for culturally safe paediatric speech-language therapy practices. We searched international and local literature to determine the barriers that can be expected as well as effective strategies that SLTs have developed while engaged in cross-linguistic and cross-cultural practice. The nature and extent of research that has been conducted over the past 20 years in the field of cross-linguistic and cross-cultural paediatric speech-language therapy was also established.

The Joanna Briggs Institute’s manual for scoping reviews was used to direct the research (The Joanna Briggs Institute 2015). The research report is structured as indicated in the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Scoping Reviews” (PRISMA-ScR) (Tricco, Garritty, Moher, Aldcroft, Levac, Hartling, Moriarty, McGowan, Straus, Colquhoun, Godfrey, Peters, Langlois, Lewin, Chang, Hempel, Soares-Weiser, O’Brien, Clifford, Wilson, Macdonald, Akl, Stewart, Weeks, Horsley, Zarin, Tunçalp and Lillie 2018), with transparency and thorough reporting in mind. A search strategy was developed to identify relevant articles from electronic databases. Twelve articles that fitted the selection criteria were included in the scoping review.

The findings suggest a list of ten primary barriers regarding cross-linguistic and cross- cultural paediatric speech-language therapy that SLTs have identified, including language and communication barriers, lack of appropriate assessment and therapy materials, and lack of appropriate training. Eleven proposed practical strategies for effective cross-linguistic and cross-cultural speech-language therapy included establishing good relationships with caregivers and ways of involving them, ways of making adjustments in communication with caregivers, and advocating for a more diverse workforce in the profession.

Contribution and originality: To the best of our knowledge, this scoping review provides the first summary of strategies for cross-linguistic and cross-cultural paediatric speech-language therapy used by SLTs across the world as well as possible barriers that can be expected. The value of this contribution is increased by relating it to the South African context. The findings regarding the nature and extent of the literature on this subject serve as a baseline for planning further research. A cultural framework is also proposed based on the resources that have been available over the past 20 years.

Keywords: caregivers; children; cross-linguistic and cross-cultural; cultural competence; culturally and linguistically diverse; cultural security; speech-language therapy

 

Lees die volledige artikel in Afrikaans

Struikelblokke in kruislinguistiese en -kulturele pediatriese spraak-taalterapie en strategieë vir die bevordering van kultuurveilige praktyke: ’n omvangsbepaling

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