Abstract
In a linguistically and culturally diverse country like South Africa, cross-linguistic and cross-cultural (CLACC) early communication intervention (ECI) is a complex issue considering the heterogeneity of speech-language therapy clients. In contrast, the workforce of speech-language therapists (SLTs) is less heterogeneous. Trained SLTs are still mostly English- or Afrikaans-speaking white women and therefore do not represent the country’s general demographics. As a result, many clients are unlikely to receive intervention in their home language, even though research shows that ECI delivery in the child’s home language is ideal. SLTs need to make specific adjustments during assessment, in therapy planning and delivery, during interaction with the child and caregiver, and in the design of home programmes. However, they lack relevant and practical strategies and solutions to make these adjustments and provide accessible, family-centred, applicable ECI in a cross-linguistic and -cultural context. To address this need, we, as a guideline development group, developed a document with guidelines for cross-linguistic and -cultural (CLACC) early communication intervention (ECI) after extensive research and consulting with SLTs and caregivers. The guideline developers were three SLTs with clinical and research expertise of CLACC ECI and one nursing practitioner and researcher with specific expertise in the selected research methodology. The guideline document was developed by integrating three data sets, namely the findings of an international scoping review and an investigation into the experiences of South African SLTs and caregivers during CLACC ECI, respectively. In line with the recommendations of the National Institute for Health and Care Excellence (NICE) and the World Health Organization, the guideline document was based on existing frameworks. NICE’s principles of guideline development were applied and adapted to provide structure to the planning and documentation of the guidelines and recommendations, whilst the AGREE II instrument (a tool for assessing guidelines for research and evaluation) guided the methodological strategy. Some examples of the guidelines include prioritising dignity and respecting language preferences, different cultures, convictions, and value systems; making innovative and situation-appropriate adaptations in communication; facilitating caregiver participation; and monitoring caregiver understanding. Each of the 14 guidelines includes between one and seven practical recommendations which SLTs can utilise to bring each of the guidelines into existence.
The research formed part of a larger multi-phase project to investigate and interpret the experiences of South African SLTs (as the providers) and caregivers (as the recipients) of CLACC ECI. This article reports on the main objective of the final phase of the multi-phase project, namely the assessment of the proposed guideline document by 41 stakeholders (SLTs) whose quantitative and qualitative feedback was obtained through an 18-point online questionnaire. A cross-sectional questionnaire design was used, which included closed questions answered on a five-point Likert scale, and open-ended questions that prompted participants to comment on and suggest changes to the proposed guideline document. Some examples of closed-ended questions included: Rate whether the overall purpose of the guidelines is specifically described; Rate whether the method for formulating the guidelines is clearly described; Rate the overall quality and feasibility of the guidelines. Some examples of open-ended questions included: Would you recommend the guidelines for use? If yes, what modifications, if any, would you suggest; Please provide any comments or feedback regarding the quality and feasibility of the guidelines – indicate the number of the guideline and/or recommendation you are commenting on.
The results were integrated by presenting the quantitative findings first, followed by the qualitative findings in the form of participant quotes and themes developed from the qualitative data set. The quotes confirmed and explained the quantitative findings as set out by a narrative description. A list of the participants’ comments and suggestions for possible adjustments to the guideline document was compiled, and the guideline development group decided whether or not the adjustments should be made.
We believe the participants viewed the document earnestly and made valuable contributions. Over 90% of participants consistently responded positively to the guideline document. Most participants either agreed or strongly agreed that the guidelines’ overall objectives, population, target users and formulation method were clearly and specifically described. In addition, participants agreed that the group that developed the guideline document included individuals from relevant healthcare professions, that the guidelines were specific and unambiguous, applied to the South African context, and that there were no conflicts of interest in developing the guidelines.
Due to the relatively small sample size (N = 41), conclusions could not be made with certainty based on the quantitative responses, but they can nevertheless be considered indicative. The results of a Likert-type questionnaire, such as the AGREE-II, are also viewed cautiously because the responses are subjective and merely indicative of the participants’ feelings, opinions or assessments. Qualitative data was also collected to support the quantitative findings. Ultimately, the data indicated that the guideline document can provisionally be considered a relevant, feasible document of high quality, which practising SLTs can utilise when providing CLACC ECI services. The participants also made valuable suggestions that can further increase the quality and implementation of the guidelines, many of which have already been included in the final version of the guideline document. These suggestions included using examples to illustrate specific guidelines better, expanding the target user group to include other complementary healthcare professions, such as occupational and physiotherapists and educators; and editing language that may confuse readers.
We recommend that experts in the field of guideline development, ECI research, and clinical CLACC ECI be invited to further assess the methodology of the guideline document as part of future research studies. A group of CLACC ECI experts may also be appointed to formally evaluate the content of the guidelines after they have been implemented in practice for a while. For example, the new AGREE-REX instrument could be used in addition to AGREE II to refine the implementation of the guideline document and make a valuable contribution to the implementation sciences in speech-language therapy. Future research could investigate the validity and reliability of the adapted version of the AGREE II instrument, as used in this study. Lastly, educators working with young children and their caregivers, as well as members of other complementary healthcare professions (other than SLTs) may be asked to review the guideline document to determine which of the guidelines may apply to those professions working in an early development context.
Keywords: assessment; cross-linguistic and cross-cultural; early communication intervention; practicability; practical guidelines; relevance; speech-language therapy
- This article’s featured image was created by Yuliya Pauliukevich and obtained from Vecteezy.