Self-help and help-seeking for communication disability in Ghana: implications for the development of communication disability rehabilitation services

Building the speech-language pathology workforce in Cambodia through the lens of the Sustainable Development Goals

PURPOSE

Current speech-language pathology (SLP) services in Cambodia are limited in scope, service accessibility and integration into government systems. However, momentum is growing to develop an internationally recognised profession. This paper examines the depth and breadth of SLP support available to people with communication and/or swallowing difficulties in relation the Sustainable Development Goals (SDGs).

METHOD AND RESULT

Qualitative interview data collected from service facilities (n = 13) and speech therapy practitioners (n = 27) were mapped and analysed for accessibility and scope of SLP services. Data revealed a workforce density of 0.16:100 000. Disparity in service accessibility was identified between provincial and urban locations, adult and paediatric populations and range of practice areas.

DISCUSSION AND CONCLUSION

The findings demonstrate the importance of partnerships (SDG 17) among government departments, non-government organisations and private sector entities to establish a sustainable and culturally responsive SLP profession in Cambodia. Although there is no Cambodian university training program, there is a growing momentum and local commitment to establishing a workforce to support Cambodians with communication and/or swallowing difficulties. This commentary paper focuses on good health and well-being (SDG 3), decent work and economic growth (SDG 8), reduced inequalities (SDG 10), and also addresses no poverty (SDG 1), quality education (SDG 4) and partnerships for the goals (SDG 17).

Successes and challenges of speech language therapy service provision in Western Kenya: Three case studies

Background

The need for communication-related services in sub-Saharan Africa to support individuals experiencing communication disability is a longstanding and well-documented situation. We posit the inequities highlighted by coronavirus disease 2019 (COVID-19) make this a relevant time for speech language therapists and the professional bodies that govern us to broadly consider our roles and practices in education, health and disability in local, national and global contexts.

Objective

To illustrate what services developed with local knowledge can look like in Kenya in order to promote dialogue around alternative speech language therapy models, particularly in contexts where there are insufficient services, few trained speech language therapists and limited structures to support the emerging profession.

Method

This article examines three clinical case studies from Western Kenya, using a conceptual framework for responsive global engagement.

Results

Service needs in Western Kenya well exceed a direct one-on-one model of care that is common in the minority world. The service delivery models described here emphasise training, skills sharing and engaging the myriad of communication partners available to individuals with communication disabilities.

Conclusion

We offer up these case studies of collaborative practice as contextual realities that may be present in any speech language therapy programming in under-resourced communities. We dispel the idea that success in this work has been linear, progressed on planned time frames or come to fruition with targeted goal attainment. The fact that our relationships have endured in these communities since 2007 is our primary success.

Optimising existing speech-language therapy resources in an underserved community: A study of the Maldives

BACKGROUND

People living in Majority world countries face complex challenges regarding speech-language therapy services. As traditional individualised service delivery approaches may not suit the needs of the population, customised solutions are needed.

AIM

This study explored speech-language therapy and related resources available in the Maldives, a Majority world country, as seen by local government representatives and service providers. The goal was to identify service delivery approaches for children with communication difficulties that could yield the most out of existing resources.

METHOD

Semi-structured interviews were conducted with six service providers (three speech-language therapists (SLTs), three representatives from Non-Governmental Organisations (NGOs) related to disabilities) and six local government representatives (atoll councillors) of the Maldives. Interview questions related to services available for children with communication difficulties. The data were analysed via deductive content analysis.

RESULTS

SLTs predominantly delivered traditional individualised and rehabilitative therapy. Services were unevenly distributed across the Maldives with some atolls receiving no services. Support was available from community groups and atoll councillors in some atolls, for instance to access aids provided by the government. Some NGOs were trialling alternative service delivery approaches by conducting programs for parents and teachers in atolls. Participants suggested several possible measures including increasing awareness of speech-language therapy and communication difficulties amongst communities, engaging active community groups to support interventions and allowing less qualified professionals to provide services. The costs related to access and provide services were noted as a challenge.

CONCLUSION

While this study discovered limitations, the existing resources that were identified can be better directed to reach more children who require services in the Maldives. The following potential alternative service delivery approaches were derived from the results: focusing on prevention, using public health approaches to train families and teachers, creating awareness, building capacity within the community, and adopting cost-effective approaches to provide services.

A Qualitative Analysis of Factors Impacting Comprehensive Cleft Lip and Palate Care in Ghana

OBJECTIVE

The objective of this study was to examine practices regarding cleft lip and palate (CLP) among medical professionals and caregivers of children with CLP and to identify barriers and facilitators to comprehensive CLP care at a hospital in West Africa.

DESIGN

Qualitative methods used consisted of individual semistructured interviews with caregivers of children with CLP and one focus group with CLP team members.

SETTING

A majority of the interviews took place in the hospital, with some occurring during home visits. The focus group was conducted in the same hospital.

PARTICIPANTS

Forty-five caregivers of children with CLP and 1 adult with CLP completed an interview. Additionally, 2 of the caregivers had CLP and completed an interview from their perspective. The focus group consisted of 13 CLP team members from a comprehensive CLP team in Ghana.

INTERVENTIONS

Interviews consisted of semistructured, open-ended questions, and the focus group relied on a discussion guide. Line-by-line coding was used to identify common themes regarding barriers and facilitators to CLP care.

RESULTS

Barriers to CLP care that were consistent across caregiver interviews and the focus group were lack of knowledge regarding CLP, stigma and cultural beliefs surrounding CLP, transportation, financial, and feeding/nutrition issues. Barriers to care identified in the interviews and focus group were similar; however, facilitators to care varied greatly between the 2.

CONCLUSIONS

Two different qualitative methods provided unique perspectives on barriers and facilitators to CLP care. However, patients and caregivers continue to face substantial barriers to obtaining care.

Community service providers' roles in supporting communication disability rehabilitation in Majority World contexts: An example from Ghana

Purpose: In Majority World countries, where speech-language pathology services are extremely limited, people with communication disabilities (PWCD) may seek help from a range of service providers. This qualitative research aimed to explore the nature of community services offered to people with communication disabilities who seek help in Accra, Ghana.Method: Semi-structured interviews were conducted with nine individuals from three professions: pastors (3), doctors (3), and herbalists (3) exploring services that they may offer to PWCD seeking help. Interviews were analysed using Thematic Network Analysis.Result: Six global themes described beliefs about communication disability, types of intervention, explanations provided to people with communication disabilities, promoting communication, processes for selecting treatments, and links between service providers. Interventions encompassed physical, spiritual, psychosocial and environmental approaches, with the notion of plural beliefs interwoven through a number of themes.Conclusion: In Ghana, and other Majority World contexts, service providers in sectors not commonly associated with communication disability rehabilitation may have important roles to play in supporting people with communication disabilities. Understanding the contributions of other service providers may assist the growing profession of speech-language pathology to collaborate across sectors, to develop specific, culturally responsive approaches to service development.

Street-connected children with communication disabilities and their caregivers in Western Kenya: experiences, beliefs and needs

PURPOSE

Although street-connected children with communication disability have been identified in Western Kenya, little is currently known about the impact of communication disability on this group. In order to inform future service development, this qualitative study sought to understand the experiences, views and needs of street-connected children with communication disability, and of their caregivers at home and at school.

MATERIALS AND METHODS

13 children, 12 caregivers and 12 school-based Learning Support Assistants participated in interactive sessions, semi-structured interviews and focus groups respectively. Interviews were translated, transcribed and analysed thematically, using framework analysis.

RESULTS

Six main themes, with sub-themes, were identified: understanding and awareness of communication disability; the role of others; needs of the children and what might help; impact on those supporting the children; caregiver and Learning Support Assistant needs: support to better help the child; thoughts about the future. Participants' responses highlighted the importance of improving others' attitudes, awareness and willingness to adapt their communication, as well as a need for trusted relationships and some specialist help.

CONCLUSION

Organisations working with street-connected children should take communication disability into account in their services and interventions. Input based on a social model of disability is likely to be acceptable.Implications for rehabilitationThe attitudes and behaviour of others affect how communication disability is experienced by street-connected children and their families.Intervention based on a social model of disability and aimed at improving the communication environment around the child is likely to be acceptable to children, caregivers and education support workers.Caregivers and education support workers want more training and support alongside specialist intervention.Communication at the level of the child is central to building trusted relationships, which are important to the success of street-connected children's rehabilitation and re-integration.

Communication disability in Fiji: Community self-help and help-seeking support

PURPOSE

To understand how a Fijian community supports people with communication disability (PWCD) and whether their support is associated with participant demographics.

METHOD

Thematic analysis of 144 questionnaires that asked about participants' actions to support a fictional child and adult with communication disability.

RESULT

Participant responses fell into two categories: what they would do directly (self-help) and people and places where they would seek assistance (help-seeking). Self-help behaviours included: making a change to their own communication style or mode; trying to change their own and others' behaviour; teaching new skills; praying; changing the physical environment; seeking information independently; assessing or observing; and, using traditional medicine, western medicine, or traditional belief practices. Help-seeking behaviours included seeking help from: other community members; education professionals; a professional in another country; spiritual leaders; traditional belief practitioners; traditional medicine practitioners; western health care practitioners; or, an alternative provider (e.g. home, orphanage, nursing home). Younger participants and those of iTaukei Fijian ethnicity were more likely to seek help from other community members.

CONCLUSION

This Fijian community actively supports people with communication disability within available networks. Development of speech-language pathology services for people with communication disability living in similar communities should harness the informal knowledge within these networks.