Kerstin Tönsing

This scoping review aimed to synthesise empirical studies on communication access during face-to-face service encounters in the service sector for people who have communication support needs in low-and middle-income countries. The methodological framework by Arksey and O'Malley guided this review. Studies were identified from nine electronic databases and independently screened for inclusion. Data were extracted aligned to the research questions and the environmental categories highlighted in the International Classification of Functioning, Disability and Health. Sixty studies met the inclusion criteria. Most studies focused on communication access for people who are hard of hearing or d/Deaf and service encounters in health care services. Various barriers and facilitators were identified, including factors related to the service system, policies, assistive technology, and the physical environment. The attitudes, knowledge, and skill of service providers were frequently mentioned as barriers. A variety of factors influencing communication access were identified in the review. Many of these are amenable to change and may be productively addressed to increase communication access for people who have communication support needs. Studies are needed to document the development, implementation, and effects of integrated and comprehensive intervention efforts in close collaboration with people who have communication support needs.

The design of non-English Augmentative and Alternative Communication (AAC) resources is an urgent necessity. Human centered design (HCD) may be a useful framework for involving stakeholders in establishing design requirements for a non-electronic Sepedi graphic symbol-based AAC resource. This framework foregrounds the voice of stakeholders in the design process to counter the hegemony of Western Anglo-centric methodologies and approaches. This study aimed to obtain initial input on the need for and design requirements of a non-electronic Sepedi GS-based AAC resource from the stakeholders. A qualitative descriptive design was used. The perspectives of 21 stakeholders including special school teachers, speech-language therapists, parents of participants in need of AAC, Sepedi linguists and adults using AAC were obtained via focus groups and interviews. Recordings were transcribed and analyzed using qualitative content analysis. Participants highlighted a need for a culturally and linguistically appropriate AAC resource. They furthermore indicated that the resource should promote communication access, social inclusion and the development of various communication and language skills. The school and the home environment were identified as primary contexts of use. Specific suggestions regarding the vocabulary, the graphic symbols, the lay-out and organization of the vocabulary as well as the physical properties of the resource were obtained. The participants highlighted a need for a team to design and develop the resource. The study showed that diverse stakeholders could contribute meaningfully to the design process of an AAC resource for young individuals from a Sepedi language background.

Training parents to support augmentative and alternative communication (AAC) implementation for children with severe communication disabilities is a critical component of family-centered intervention. Social validity ensures that training goals, procedures, and outcomes are acceptable and meaningful to stakeholders and is essential for achieving sustainable, long-term improvements. The findings indicate an increasing emphasis on social validity assessments since 2020. This review examined social validity assessment practices in parent-implemented AAC intervention training. Three theoretical and four practical components of social validity assessments were analyzed across 30 records reporting on 28 studies. Results demonstrate increased attention to social validity assessment since 2020. However, significant conceptual and methodological limitations persist. Theoretical frameworks underlying social validity assessments are frequently poorly conceptualized, with only half of the authors providing a clear rationale for their assessments. Definitions lack coherence across studies. Maintenance data and stakeholder perceptions were collected, and perspectives were predominantly gathered post-intervention and primarily from parents rather than children. These findings reveal shortcomings in current social validity assessment approaches. Therefore, rigorous theoretical grounding and methodological sophistication are needed to ensure social validity assessment transcends tokenistic inclusion, thus becoming a purposeful and integral component of intervention research.

Most individuals with disabilities live in low-and middle-income countries (LMICs) where healthcare services such as speech-language therapy are limited. The challenge of accessing services was compounded by the COVID-19 global pandemic, leaving many people who use augmentative and alternative communication (AAC) vulnerable. The aim of this study was to investigate the nature of tele-AAC across three LMICs as described by speech-language therapists (SLTs). Although studies have been published about speech-language therapy services provided via telepractice, some specifically on AAC services, none of these have examined the impact of having to rapidly pivot to tele-AAC in LMICs. Semi-structured interviews were conducted with 15 SLTs from three LMICs to explore their experiences. SLTs shared the impact that tele-AAC had on their work, their experiences, benefits and challenges including broader challenges of service provision in LMIC contexts.

Augmentative and alternative communication (AAC) can be used effectively by persons with speech or speech-related disabilities to accomplish a variety of communicative functions. However, the majority of AAC interventions reported in the literature focused on requesting. While it is important to initially teach requesting skills, commenting should not be neglected. As AAC emerges, commenting is essential for social engagement, social closeness and information transfer. The purpose of this systematic review (INPLASY protocol 3160) was to describe and critically appraise the existing research on AAC interventions for commenting. A systematic search and application of inclusion criteria yielded 14 single case design studies that examined the effect of an AAC intervention on commenting of children with communication disabilities. A quality appraisal indicated that the rigor of most studies was acceptable. However, there are areas in which research can be improved, especially around the number of points per phase, blinding of personnel, and clear reporting of procedures. Interventions fell into three types of teaching procedures, including prompt hierarchies, aided modeling and direct prompting. Likewise, three teaching contexts (i.e., book reading, play/toys/preferred activities, intensive teaching) and four types of commenting behaviors (i.e., one-symbol utterances, two-symbol utterances, sentences frames and grammatically correct utterances) were identified. Findings suggest the strongest evidence exists to support the use of least-to-most prompt hierarchies that include aided modeling in the context of book reading. However, there are too few studies to recommend their use with certainty.

This qualitative study aimed to describe speech-language pathologists' (SLPs') perspectives on augmentative and alternative communication (AAC) use for people with post-stroke aphasia focusing on: (a) current AAC practice, (b) factors that influence the use of AAC, and (c) the success and relevance of AAC interventions. Semi-structured interviews took place with ten South African SLPs with experience in aphasia intervention. The transcribed interviews were thematically analyzed using a six-phase process of inductive and deductive analysis within a phenomenological framework. All the participants use AAC with their clients, employing a variety of approaches that reflect their diverse settings, experiences, and perspectives on AAC. AAC use is complex, and SLPs make conscious choices considering multiple factors. Barriers to use were often associated with limited resources in the low- and middle-income country (LMIC) context, but most participants retained a positive view of AAC, actively working to circumvent barriers to use. Participants consistently emphasized the vital role of partners in communication interactions, linked to the importance of defining AAC broadly. It is necessary to advance the integration of AAC into rehabilitation plans to improve communication and social participation outcomes for people with post-stroke aphasia, especially in LMICs such as South Africa.

Background: Over 8 million children with disabilities live in Africa and are candidates for augmentative and alternative communication (AAC), yet formal training for team members, such as speech–language therapists and special education teachers, is extremely limited. Only one university on the continent provides postgraduate degrees in AAC, and other institutions provide only short modules at an undergraduate level. The need for an introductory training course on AAC that is accessible by university students continent‐wide was identified. An online programme, namely an intelligent tutoring system (ITS), was identified as a possible option to facilitate interactive learning without the need for synchronous teaching. The use of an ITS is shown to be effective in developing knowledge and clinical reasoning in the health and rehabilitation fields. However, it has not yet been applied to student teaching in the field of AAC.Aim: To determine both the feasibility of an ITS to implement an AAC curriculum for students in four African countries, and the usability and effectiveness of such a system as a mechanism for learning about AAC.Method & Procedures: The study included two components: the development of a valid AAC curriculum; and using the ITS to test the effectiveness of implementation in a pre‐ and post‐test design with 98 speech–language therapy and special education students from five universities.Outcomes & Results: Statistically significant differences were obtained between pre‐ and post‐test assessments. Students perceived the learning experience as practical, with rich content.Conclusions & Implications: The findings suggest that the ITS‐based AAC curriculum was positively perceived by the students and potentially offers an effective means of providing supplementary AAC training to students, although modifications to the system are still required.What this paper adds: What is already known on the subject: Professionals typically lack formal training in AAC. In Africa, this presents a serious challenge as there are over 8 million children who are candidates for AAC. A need for an introductory training course on AAC, which can be accessed by university students continent‐wide, was identified. What this paper adds to existing knowledge: An AAC curriculum was developed and integrated into an ITS, an online programme allowing interactive learning through asynchronous teaching. Students from four African countries completed the AAC ITS curriculum. The curriculum was positively received by the students and statistically significant changes in knowledge were identified. What are the practical and clinical implications of this work?: This feasibility study shows that the use of an ITS is an effective means of providing AAC training to university students in these African countries. The results provide a valuable contribution toward ensuring the equitable distribution of AAC training opportunities in the African context. This will have a significant positive impact on those who are candidates for AAC.

In South Africa, many children with extensive support needs-including children who require AAC-are accommodated in care centers rather than the public schooling system. Caregivers employed at these centers need training in order to support children's communication using augmentative and alternative methods. A total of 29 center-based caregivers took part in this study. A single group pretest-posttest design was used to evaluate the effect of a 5-day training workshop on caregivers' ability to demonstrate and implement five AAC strategies. The effect of the workshop on caregivers' perceptions of their own skills as well as the social validity of the training were also evaluated. Results suggest that the workshop effectively taught caregivers to demonstrate the skills in a simulated roleplay situation. A proportion of caregivers also supplied video footage after the workshop that suggests the ability to implement the strategies in the care center contexts. Caregivers also perceived their own skills to have improved post workshop, and evaluated the training positively.

Police officers increasingly come into contact with persons with a communication disability in their line of duty. This study describes the challenges officers face when taking statements from such victims. Focus group discussions were conducted with South African police officers. Findings showed that they face a myriad of challenges in the statement-taking process. These could be categorised under four main themes: the transactional nature of communication, lack of resources to support communication during statement-taking, the vulnerability of complainants with communication disabilities, and police pessimism. The article recommends that disability sensitivity training, as well as training on communication disability, be provided to police officers.