Khetsiwe Phumelele Masuku

Background: Rehabilitation remains an unmet need and a neglected health service in South Africa. To address the country’s complex burden of disease, a skilled rehabilitation workforce is needed. Aim: This study aimed to identify prevalent medical conditions and disease trends among patients treated by rehabilitation therapists over a six-year period. It further examined whether these prevalent health conditions are represented in the rehabilitation health education curricula. Setting: The study was undertaken in public healthcare facilities within Gauteng province, South Africa. Methods: Secondary data on provincial rehabilitation data from April 2019 to March 2024 were analysed and categorised into non-communicable diseases (NCDs), children-specific conditions, injuries, and communicable diseases. Data were analysed descriptively. Lastly, the undergraduate rehabilitation health training curriculum (Occupational therapy, Physiotherapy, Speech therapy and Audiology) was reviewed to assess whether it covers the medical conditions treated by rehabilitation therapists. Results: The most treated conditions were NCDs (44.1%), injuries (36.4%) and children-specific conditions (15.6%). All health conditions decreased during the coronavirus disease 2019 pandemic, followed by an increase in NCDs and injuries between 2022 and 2024. The undergraduate rehabilitation health training curriculum covers the most prevalent conditions treated by public sector rehabilitation therapists. Conclusion: The burden of diseases treated in public healthcare rehabilitation departments aligns with the national burden of diseases. The impact of the COVID-19 pandemic on rehabilitation services is evident in the trend analysis over the years. Continual review of the curriculum is needed to ensure local health responsiveness. Contribution: This study highlights the burden of disease treated by the public health sector rehabilitation therapists, the trends over time and the importance of ensuring that the curriculum is locally responsive.

Background: Diagnostic language assessments are central to identifying developmental language disorder; however, many widely used tools were developed and normed within monolingual Western contexts. Their application in multilingual and multicultural settings raises concerns about linguistic, cultural and psychometric validity. Although adaptation of diagnostic tools is frequently reported, the scope and quality of published adaptation research has not been systematically mapped. Aims: This scoping review aimed to map the literature on the cultural and linguistic adaptation of diagnostic language assessment tools for multilingual and multicultural child populations, to describe the adaptation and validation approaches used, and to identify gaps relevant to future diagnostic tool development. Methods and Procedures: A scoping review was conducted following the Arksey and O'Malley framework and reported in line with PRISMA‐ScR guidelines. Searches were conducted across four electronic databases for peer‐reviewed studies published between 2014 and 2025. Studies ( n = 14) were included if they reported the translation, cultural adaptation, or contextual modification of diagnostic language assessments for children aged 3–12 years. Data were charted on study characteristics, assessment tools, adaptation frameworks, validation methods and reported challenges. Outcomes and Results: Fourteen studies met inclusion criteria, representing 10 countries. Adapted tools assessed a range of language domains. Most studies reported multi‐step adaptation processes and referenced established international frameworks; however, the depth of cultural adaptation and the rigour of psychometric validation varied substantially. Conclusions and Implications: Diagnostic language assessment adaptation research remains fragmented and methodologically inconsistent. The limited evidence base across diverse multilingual settings highlights an urgent need for contextually grounded, psychometrically robust diagnostic tools to support equitable assessment in multilingual settings. WHAT THIS PAPER ADDS: What is already known on this subject Diagnostic language assessments are often developed in monolingual Western contexts and may not be valid for multilingual children. Translation and cultural adaptation of assessments are increasingly reported, but practices vary widely. What this paper adds to existing knowledge This review provides a systematic mapping of diagnostic language assessment adaptations, highlighting substantial variation in adaptation depth and validation quality. Only 14 studies across 10 countries were identified, indicating that the evidence base for culturally and linguistically adapted diagnostic language assessments remains limited and geographically fragmented. What are the potential or actual clinical implications of this work? Clinicians should exercise caution when using translated diagnostic tools and adopt multi‐method, culturally responsive assessment practices. The findings provide a framework to guide future diagnostic tool adaptation and development in multilingual contexts.

Background: Persons with communication disorders are susceptible to mental health difficulties and often require the help of mental healthcare professionals. Mental healthcare interventions require a significant amount of communication between the mental healthcare professional and the person with communication disorders, yet not much is known about how mental healthcare professionals provide mental healthcare services to persons with communication disorders. The study, therefore, aims to explore the experiences of mental healthcare professionals in providing mental healthcare services to persons with communication disorders. Methods: A qualitative phenomenological research approach was employed, where 11 semi‐structured interviews were conducted with mental healthcare professionals practising in the Gauteng Province of South Africa ( n = 7 social workers; n = 3 psychologists; n = 1 counsellor). Participants were purposively selected for the study. Data were analysed using inductive reflexive thematic analysis. Results: The following four themes emerged from the data that were analysed: (i) lack of preparedness to provide care to persons with communication disorders, (ii) communication barriers, (iii) emotional effects and (iv) accommodations. Conclusions: Findings suggest that communication barriers are a source of frustration, and they hinder persons with communication disorders from accessing quality mental healthcare services. There is therefore a need to include in the curriculum of mental healthcare professionals, training on communication disorders and on strategies to foster communication with this population during intervention. Conversational partner training and collaborations between mental healthcare professionals and speech language therapists could potentially be used to address the communication barriers in mental healthcare provision for persons with communication disorders. WHAT THIS PAPER ADDS: What is already known on this subject Persons with communication disorders are susceptible to mental health difficulties because the communication impairment reduces their societal and economic inclusivity, thus placing them at a higher risk of developing mental health challenges. Unfortunately access to quality mental healthcare services is a challenge for this population for many reasons, with the most pronounced one being the fact that they do not depend on verbal language to communicate their needs (are voiceless) and require reasonable accommodation to facilitate communication, yet the techniques and methods used in mental healthcare intervention whether formal or informal are predominantly based on verbal communication. What this paper adds to existing knowledge The study advocates for the implementation of educational opportunities for mental healthcare providers through communication/conversational partner training programmes. These programmes can potentially improve their knowledge and skills on how to effectively support communication with persons with communication disorders, to mitigate communication challenges. Research has demonstrated positive effects of communication partner training. Speech language therapists, as communication brokers due to their expertise in facilitating communication, should be at the centre of developing such training programmes. Speech language therapists should also foster collaborations with mental healthcare professionals in clinical spaces when treating persons with communication disorders. What are the potential or actual clinical implications of this work? The lack of knowledge on communication disorders and the subsequent lack of knowledge and skills on appropriate communication strategies to implement when conducting mental healthcare interventions with persons with communication disorders compromises patient care and subjects persons with communication disorders to continuous substandard patient care, which is essentially an infringement on their right to healthcare. It is common knowledge that communication forms the cornerstone of all healthcare interventions, and where there are communication barriers between healthcare providers and their patients, healthcare provision becomes unsuccessful, resulting in negative patient outcomes. The study offers a potential solution to these communication challenges.

Caregivers of children diagnosed with cerebral palsy (CP) frequently engage with healthcare professionals (HCPs) when seeking help on behalf of their children. However, little is known about their health-seeking experiences, particularly in low-resourced townships. A qualitative descriptive case study research design, underpinned by a phenomenological approach. A series of semi-structured interviews were conducted with fifteen caregivers who live in a township in South Africa and were selected using purposive and snowball sampling. Data were analysed using interpretative phenomenological analysis. The results revealed three main themes which include: (i) A primary focus in healthcare systems on child-centred care which neglects the needs of caregivers, (ii) Brief disease-focused consultations with HCPs that have a negative impact on caregiver health-seeking experiences, and (iii) Dismissal of caregivers' expert knowledge. The findings indicate that caregivers have needs that are separate from those of their children. To ensure that caregivers receive helpful help during their health-seeking attempts, there must be a shift from the traditional paternalistic roles of healthcare providers. Instead, HCPs should view themselves as collaborators with caregivers to ensure that they provide family-centred services. Additionally, the voice of the lifeworld needs to become a central feature of the care provided to caregivers and their children.

Hospitalisation can induce anxiety and trauma in children, complicating their medical experience. Exploring the role of visual schedules as a supportive strategy reveals that these schedules can significantly reduce stress during medical procedures. By providing clear and structured guidance, visual schedules improve communication, foster patient engagement and create a sense of predictability, thereby enhancing the overall patient experience. When tailored to individual needs, they help children navigate healthcare settings with greater confidence. Effective staff training is crucial for successful implementation, ensuring that paediatric patients receive the maximum benefits.

The case of Hellen Keller presents a great example of what a learner who is deafblind can achieve if provided with the appropriate educational accommodation in terms of content, environment, learning approach, instructional strategies, and teaching methodologies. However, access to education is not the reality for most learners who are deafblind due to their unique educational needs, owing to their dual sensory impairment. There has been an assertion that learners who are deafblind may not thrive in inclusive educational spaces, but there is a paucity of research to support or dispute this assertion. This scoping review explored what is documented in the literature on the barriers and facilitators to inclusive education for learners who are deafblind. A scoping review methodology using Arksey and O’Malley’s framework was employed. A search was conducted using six databases, including Science Direct, PubMed, Scopus Medline, ProQuest and gray literature, to identify publications focusing on the barriers and facilitators to inclusive education for learners who are deafblind. The findings from the scoping review suggest that the factors that influence the inclusion of learners who are deafblind in inclusive educational settings include the availability of educational settings; accessibility to the physical and social environment, and assistive devices; acceptability by peers and educators and the preparedness of educators; and the adaptability of classroom strategies. For learners who are deafblind to thrive in inclusive educational settings, transformational attitudes and intentional and specific strategies from multiple stakeholders are necessary. Therefore, the educational system, schools, peers and communities should be deliberate in putting in place specialized support and resources to accommodate the diverse needs of learners who are deafblind in all phases of their schooling life.

Providing children with complex communication needs (CCNs) with the right accommodations in a supportive schooling environment from the early childhood development (ECD) stage can significantly improve their developmental and educational outcomes. Inclusive education has been proposed as a possible framework that can promote positive educational outcomes; however, in South Africa, there has not been enough attention paid to inclusive education in ECD especially focusing on children with CCNs. The study therefore explored the perceptions of parents of children with CCNs and early childhood development teachers on inclusive education. Semi-structured interviews and a focus group were conducted with 8 ECD teachers and 8 parents of children with CCNs, who were purposively selected. Data were imported into NVivo 1.5 software and analysed using an inductive thematic analysis approach. Findings from the study revealed the following themes: i. Perceived benefits of inclusive education; ii. Preference for special needs education; iii. Shortcomings of special needs education in addressing the needs of learners with CCNs; iv. Factors informing school placement; v. Communication as a barrier to learning, teaching and socializing; vi. The need for disability conscientization. Although both parents and teachers of learners with CCNs acknowledge the value of inclusive education in facilitating access to education, they have a mistrust of inclusive education because of fear of stigma, discrimination, exclusion, bullying and exclusionary teaching practices. While they preferred special education, they acknowledged the gaps in teacher’s knowledge on communication disorders, training of teachers, teaching aids and assistive devices. Educating a child with a disability is expensive because of other additional costs, especially transportation.

Background: Access to technology (and data) through mobile health (mHealth) can alleviate some of the challenges children experience in accessing healthcare services. However, the South African context is unique with children living in under-resourced and rural communities, with limited transport, long commute times to reach clinics, and poor access to technology. Therefore, even though mHealth tools can be beneficial, researchers need to determine the feasibility of such an application for the South African context. Aim: The study focussed on determining the feasibility of the PicPecc application (app) (an mHealth tool) in South Africa for children requiring mental health support. Setting: The study included 20 children between the age of 7 years and 18 years in different mainstream schools and a special school. Methods: A qualitative research design was used to conduct structured interviews with children, either via an online meeting (e.g., Google Meet) or in a natural setting (in the child’s school or home context). Results: The data were analysed and themes were identified according to five dimensions of access to healthcare and technology, namely acceptability, availability, accessibility, affordability, and accommodation. Conclusion: This study found that the PicPecc app is promising for implementation in the South African clinical setting. Participants reported various advantages when utilising the app to self-report health symptoms and thus considered it feasible for implementation in the South African context. Contribution: The study highlights important considerations for the implementation of mHealth technologies in the South African context.

In 2012, the southern African country of Eswatini ratified the United Nation’s Convention on the Rights of Persons with Disabilities (CRPD), and in 2013 developed the national disability policy reform documents to implement the CRPD across different domains, including health care. The current study aimed to analyze these policy reform documents for the actors, context, and processes involved in the development and implementation of the national disability policy reform documents. It also examined the provisions made for access to health care for persons with disabilities by utilizing a novel disability policy analysis framework. In-depth interviews with key informants were conducted to substantiate the findings obtained from document reviews. Focus group discussions were then conducted with persons with disabilities, caregivers of persons with disabilities, and health care professionals as the end users of the policy documents. The goal was to establish their knowledge of these documents and to ascertain how effective they perceived these documents to be. Findings indicated that while the content of the policy documents mirror most of the CRPD’s principles, certain aspects related to geographical and financial accessibility should be reconsidered. There is evidence to suggest a gap in policy implementation, owing to the lack of disability conscientization in general and among policymakers in particular, and manifested through political, financial, and attitudinal factors. This implies a need for disability sensitivity programs, as well as clearer implementation guidelines and government’s commitment to disability rights and the process of implementing the national disability policy reform documents.