Browsing by Author "Gerber, Berna"

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    Challenges to infection control in early communication intervention : a scoping review
    (AOSIS (Pty) Ltd., 2022-08-03) Achmat, Bilqees; Gerber, Berna
    Background: Personal protective equipment (PPE) and infection prevention and control (IPC) measures are crucial to preventing the spread of coronavirus disease 2019 (COVID-19). This study used a scoping review to investigate the challenges that exist when speech–language therapists (SLTs) use IPC measures for providing early communication intervention (ECI). Objectives: To describe existing, recent literature on PPE and IPC measures used in early intervention through a scoping review (steps 1–5) and to consult local clinicians to investigate how SLTs who provide ECI in South Africa relate to these findings (step 6 of the scoping review). Method: A scoping review was performed which followed the PRISMA-ScR framework. Because of limited literature on PPE and IPC measures used by SLTs in providing ECI, the inclusion criteria were adjusted to include PPE and IPC measures used by healthcare workers (HCWs) who provide early intervention to the population of infants and toddlers up to 3 years old. At the time of the review, articles were not older than 10 years and were published between 2011 and 2020. The scoping review included a consultation with South African SLTs who provide ECI, including during the COVID-19 pandemic. A pilot study was conducted prior to the consultations. Seventeen clinicians were included in total. Data from both the pilot study and main consultation were transcribed and analysed in the results using thematic analysis. Results: Fourteen articles were included in the study. The scoping review of existing literature identified challenges to implementing IPC measures, namely the care and behaviour of young children, infrastructure and system challenges, poor compliance and lack of training and a lack of standard IPC protocols. Clinicians in the consultation phase confirmed these challenges and reported that IPC measures did not consider ECI populations nor the settings in which services were provided. Suggestions from the literature for improved infection control included hand hygiene, improved supplies and infrastructure and education and training. Clinicians in the consultation added practical suggestions for implementing IPC measures within ECI, which included an increase in parent-led intervention as well as cleaning and disinfection strategies. Conclusion: This study identified challenges and recommendations of SLTs who use PPE and IPC measures whilst providing ECI. Understanding these challenges can benefit ECI services and future research efforts focused on improving ECI services whilst maintaining IPC standards.
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    Cross-linguistic and -cultural early communication intervention : the experiences of caregivers
    (LitNet Akademies, 2024-07-02) Botha, Mariette; Gerber, Berna; Van der Merwe, Anita
    There is an increase in the prevalence of linguistic and cultural diversity worldwide. This requires speech-language therapists and other early childhood development practitioners to provide effective and equitable services to clients with a language and cultural background that often differs from their own. When the speech-language therapist and the client’s mother tongue and cultural background differ, the therapy is referred to as cross-linguistic and -cultural speech-language therapy. Early communication intervention refers to the intervention that speech-language therapists usually provide when young children (from birth to the age of 3) with communication delays or disorders are involved. Early communication intervention aims at addressing the needs of children with established communication problems, or those who are at risk for speech, language, communication and/or emerging literacy problems. Effective and equitable services may be restricted due to a variety of challenges experienced by professionals in South Africa. These challenges may include a general shortage of speech-language therapists and in particular a shortage of speech-language therapists who can speak South African languages ​​other than English and Afrikaans. Traditionally, speech-language therapy involves one-on-one treatment, which poses another challenge to service provision to the large South African population in great need thereof. A lack of culturally relevant resources and a lack of trained interpreters and cultural brokers add to the list of challenges. Speech and language therapists’ clinical decision-making regarding assessment and intervention with young children and their caregivers is informed by high-quality evidence-based practices. Evidence-based practices are backed by three pillars, namely (1) peer-reviewed research, (2) the speech-language therapist’s clinical experience, and (3) the client’s values, preferences and perspectives. Until now, and to the best of our knowledge, the first and third pillars involving the client (in this case the caregiver’s experience, perception, values, ​​and preferences during cross-linguistic and -cultural early communication intervention), have not been well researched and presented in South Africa. This may affect speech-language therapists’ clinical decision-making and therefore possibly limit the effectiveness of intervention as well as limit the promotion of caregiver cooperation, mutual respect, and trust. The aim of this exploratory study was, therefore, to develop an in-depth understanding of Xhosa-speaking caregivers’ experiences, perceptions, values and preferences during cross-linguistic and -cultural early communication intervention. This in-depth understanding of the caregiver’s experience, including the challenges experienced, will inform evidence-based practices and provide speech-language therapists with practical strategies to utilise in the early communication intervention context. The study answers three research questions, namely: What are the lived experiences of caregivers who receive cross-linguistic and -cultural early communication intervention? What are the challenges that caregivers experience? What strategies do caregivers suggest for overcoming these challenges? Our research design followed a hermeneutic phenomenological philosophy which focuses on the investigation and interpretation of individuals’ lived experiences. The participants’ context-specific and subjective experiences were collected and analysed through interviews to develop a deeper understanding of the phenomenon (cross-linguistic and -cultural early communication intervention). We attempted to put ourselves in the shoes of the participants, although this is never entirely possible, and tried to make sense of the participants’ attempt to make sense of their experience. In doing so, we worked with the participants to explore and develop our understanding of the phenomenon. In accordance with hermeneutic phenomenological research practice participants were purposively selected because they have experienced the phenomenon first hand and all share certain characteristics. Seven caregivers met the selection criteria, namely: All were the biological mothers of the children who have received early communication intervention from public hospitals or clinics in the Eastern Cape; all were Xhosa mother-tongue speakers; the speech-language therapist which served them was not a Xhosa mother-tongue speaker; all were older than 18 years and had a child with a diagnosed speech-language disorder or delay. In-depth narrative interviews are the ideal data collection method to investigate the essential aspects of the participants’ feelings, needs and perceptions by means of a comfortable conversation. The participants took part in a 45–80-minute in-depth interview conducted in Xhosa with the assistance of an interpreter. She was a fluent Xhosa-speaking speech-language therapist with seven years’ work experience, one year’s experience as an interpreter, and a master’s degree student in speech, language and hearing therapy. Her roles included serving as an interpreter and cultural broker, where she served the participants with regards to their best interest before, during and after the interviews. Lindseth and Norberg’s phenomenological-hermeneutic data analysis approach was used due to the transparency of its process and its practical application. This approach is inspired by Ricoeur’s (1976) interpretation theory and offers a framework where data in text form (such as interviews) can be analysed on three levels. The first level, or naive understanding, involves the researcher’s reading through the data repeatedly and developing a first impression of the participants’ experiences of the phenomenon. The second phase or the structural analysis requires the researcher to structure each interview into meaningful units that relate to the research questions. At this stage the software program Atlas.ti (v23) was used to extract codes and themes from the meaningful units that were central to the participants’ conceptualisation of the phenomenon. After each transcript had been reviewed, 151 codes were created and reduced to 15 code groups by merging recurring codes and deleting codes that did not answer the research question. These code groups were finally processed into six themes. The third level involved the in-depth understanding where the researcher moved back and forth between the naive understanding, structural analysis, aim of the study and relevant literature. At this level the researcher attempted to make sense of the participants’ experiences, form a deeper understanding of the essential meaning thereof and used literature to highlight these essential meanings. The participants’ accounts of their experiences revealed the value they placed on information; details about the profile of the speech-language therapists they were served by; the effectiveness of early communication intervention; the caregivers’ expectations, buy-in and role; the value of Xhosa as a language and the Xhosa culture; and the challenges experienced and solutions to overcome these challenges during cross-linguistic and -cultural early communication intervention. Some participants’ negative feelings toward play and child-directed speech means that sharing information about the philosophy of early communication intervention must be prioritised by speech-language therapists. The participants expressed a lack of information about their child’s diagnoses, especially in the case of autism spectrum disorders. Autism spectrum disorders can be difficult to identify in young children, which is further complicated by a lack of linguistically and culturally relevant assessment material in South Africa. Some caregivers told of their use of social media as source of information, and to some extent compared their child’s speech-language therapist with overseas online speech therapists. This means that caregivers require guidance from their own speech-language therapists when navigating social media pages, ensuring that caregivers are equipped with trustworthy and relevant information. The participants made several recommendations for improving their experiences of cross-linguistic and -cultural early communication intervention, such as longer and more frequent speech-language therapy sessions, fewer home programmes and more actual therapist-child interaction. They suggested that caregivers assist the speech-language therapist with translating, offer their help to the speech-language therapist and make use of a telephone call after the session to clarify events from the session that had not been clearly understood. They highlighted the need for more speech-language therapists and more Xhosa-speaking therapists. Some caregivers recommended that at least one other child or sibling be involved in the speech-language therapy session to facilitate the transfer of skills to the natural environment. The participants’ experiences varied and were influenced by their social context, the healthcare system, the nature of the child’s communication disorder and the speech-language that served them. This study makes a valuable contribution towards the field of knowledge regarding ways in which speech-language therapists can make early communication intervention more accessible and culturally appropriate in our overburdened and under-supplied public healthcare system. Furthermore, the recommendations made by the caregivers will be used in the development of a practice guideline document aimed at speech-language therapists in South Africa as the end users.
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    Cross-linguistic and -cultural early communication intervention: the lived experiences of speech-language therapists
    (Litnet, 2023-08) Botha, Mariette; Gerber, Berna
    ABSTRACT: In a population-diverse country like South Africa the speech-language therapist (SLT) and the client do not always represent the same language and culture. Clients are therefore often served in their second or even third language. This brings about various challenges, but also rewards, which can have an impact on the SLT’s experience of what it means to be an SLT providing early communication intervention (ECI) services. ECI refers to therapy provided to children with communication delays or disorders between the ages of 0 and 3 years in collaboration with their families. ECI must be culturally appropriate because it involves the child’s caregiver and natural environment. The study we describe here aims to capture the essence of the lived experiences of SLTs who practise cross-linguistically and cross-culturally (CLAC) in public hospitals and clinics in the Eastern Cape and along with that, aims to develop a deeper, richer understanding of their experiences working in this complex public health context. The public health sector provides 84% of South African citizens with healthcare services, which means that only 16% are served by the private sector (Pillay, Tiwari, Kathard and Chikte 2020). According to the country’s most recent population group analysis, the South African public consists of 81% black, 8,8% brown, 2,5% Indian and 7,9% white persons (Department of Communication 2019). Regarding the analysis of home language speakers, Zulu is spoken by most individuals nationwide (25,3%), Xhosa by 14,8% and Afrikaans by 12,2%. English is a home language to 8% of individuals (Statistics South Africa 2018). Since the start of the Department of Health’s community service programme in 1998, the demographic profile of local SLTs has not changed significantly, with 94,6% of SLTs still being female and 59,9% of SLTs white and female (Pillay et al. 2020). The remaining 40% of SLTs represent other cultural groups, which indicates progress. Pillay et al. (2020) found that in a population of 58 million people, only 2,643 persons are qualified SLTs.
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    An evaluation of informed consent comprehension by adult trial participants in South Africa at the time of providing consent for clinical trial participation and a review of the literature
    (Dove Medical Press, 2019) Burgess, Lesley Jean; Gerber, Berna; Coetzee, Kathleen; Terblanche, Marli; Agar, Gareth; Kotze, Theunis J. V. W.
    Introduction: The informed consent process is a fundamental part of clinical trials and is driven by both a legal and ethical agenda. The process may be seriously compromised if trial participants sign the informed consent document without fully understanding its contents. In developing countries such as South Africa, this concern is important due to the potential vulnerability of these patients and their risk for research exploitation. Aim: To evaluate the understanding of 11 important components and concepts related to clinical research by adult trial participants in a developing country at the time of providing consent for trial participation. Methods: 46 consecutive adult patients who qualified and consented to being enrolled in ongoing cardiovascular risk clinical trials at TREAD Research in the Western Cape, South Africa, were included in this study. After giving informed consent, participants were subjected to both a close-ended (self-report) and an open-ended method (descriptive narrative) to assess their understanding of various components and concepts related to clinical research pertaining to the initial informed consent document. The descriptive narrative was recorded and then later transcribed and assessed by two independent assessors. Results: There was a marked difference between the two methodologies used to assess patient comprehension of the various components. With the exception of concepts voluntariness and right to withdraw, trial participants’ understanding of the informed consent document was poor – especially with regard to the following concepts: randomization, risks, placebo and blinding. Higher levels of comprehension were obtained for the participant self-reports and lower levels for the narrative descriptions. Conclusion: The participant comprehension at this site was poor, and the process for taking informed consent subsequently needs to be modified so as to improve informed consent comprehension.
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    Identity and discourse : a critical philosophical investigation of the influence of the intellectual self-image of the medical profession on communicatively effective care to patients
    (Stellenbosch : Stellenbosch University, 2013-12) Gerber, Berna; Van Niekerk, Anton A.; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy.
    ENGLISH ABSTRACT: Communication between doctors and patients in clinical settings is notorious for being difficult. This problem has inspired a wealth of empirical research from a variety of academic fields on the subject of doctor-patient communication. However, very little attention has been paid to the role of modern medicine's intellectual self-image as natural science in interactions within clinical medical settings. The aim of the current study was to philosophically investigate the influence of the medical profession's intellectual self-image on communication between doctors and patients. Jürgen Habermas' work on Universal Pragmatics was used to comment on doctor-patient communication as it is described in the existing empirical research literature. Michel Foucault's work on discourse and power was used to analyse and describe medical discourse and the nature of power in doctor-patient relationships. The outcome of this philosophical analysis leads to the conclusion that modern medicine's intellectual self-image has a pervasive and negative influence on communication between doctors and patients during clinical consultations. This is because medicine's positivist world-view results in an almost exclusive focus on the physical aspects of disease in clinical medicine. The patient's mind and his/her social world are not of great significance from the natural scientific perspective. Medical professionals may thus easily regard their clinical task solely as the physical treatment of physical disorders. They are very likely to consider many communicative activities as unrelated to their clinical task. Inadequate doctor-patient communication can easily affect the quality of medical care and patient outcomes in a negative manner, as well as diminish the quality of the doctor's occupational experience. For this reason I conclude that medicine's natural scientific intellectual self-image is not appropriate for the task of providing medical care to individual patients. Two additional reasons support this conclusion, namely the misidentification of clinical medicine as a natural science and the inappropriateness of a scientific conception of truth for the context of doctor-patient interactions. The implications of these conclusions are that the intellectual self-image and world-view of modern medicine should change to better agree with the nature of clinical practice and to make room for the psychological and social dimensions of the patient's life within health care. The medical profession should also revise its conception of science to a theory that acknowledges that interpretive reasoning and knowledge without guaranteed certainty are legitimate elements of science. I advocate for consciousness among the medical profession of the reality of medical discourse and its effects on doctors, patients and on their interaction with one another.
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    Ototoxicity management : an investigation into doctors’ knowledge and practices, and the roles of audiologists in a tertiary hospital
    (AOSIS Publishing, 2016) Wium, Anna; Gerber, Berna
    Background: A significant number of medications that are prescribed by doctors to treat cancers, tuberculosis and infections are ototoxic. Disclosure of ototoxic risks is ethical practice as patients have the right to be properly informed about and involved in decisions about their health care. Often, doctors fail to disclose such information. Aim: This research investigated whether a group of doctors working in a South African academic hospital inform their patients about the ototoxic risks associated with specific medications, and if not, explore the reasons for it. It was determined what the participants’ knowledge levels of ototoxicity were as knowledge is seen as a precursor to disclosing information to their patients. A further aim of the research was to determine whether audiologists should expand their role by sharing information with patients and other professionals in the management of ototoxicity and in the hospital. Method: There were 90 participants included in the study through convenience sampling, which represented interns, medical officers, registrars and consultants in the neonatal intensive care unit, intensive care unit, ear–nose–throat, and internal and family medicine departments. The research made use of a descriptive survey design that collected mainly quantitative data and a limited amount of qualitative data through questionnaires. The data were descriptively analysed, and the qualitative data were listed and quantified. Results: The research firstly determined the participants’ knowledge and understanding of ototoxicity, and it was found that there was room for improvement. With reference to the current practices of doctors in the prescription of ototoxic medicines, it was found that disclosure of ototoxic risks was limited, mostly because of a lack of time and insufficient knowledge. In comparing knowledge and practices between levels of employment, it was found that particular post levels performed better than others. The participants regarded the role of the audiologist as team member important, although very few referred their patients for audiological monitoring when they prescribe ototoxic medication. Conclusion: A need for additional support to doctors was identified, which indicates that audiologists should expand their role to include the provision of continued professional development activities and to renew their efforts to advocate their role in the hospital so that doctors are made aware of the importance to refer their patients for ototoxic screening and monitoring.
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    Should we use philosophy to teach clinical communication skills?
    (AOSIS Publishing, 2016) Gerber, Berna
    ENGLISH SUMMARY : Effective communication between the doctor and patient is crucial for good quality health care. Yet, this form of communication is often problematic, which may lead to several negative consequences for both patients and doctors. Clinical communication skills have become important components of medical training programmes. The traditional approach is to teach students particular communication skills, such as listening to patients and asking open-ended questions. Despite their importance, such training approaches do not seem to be enough to deliver medical practitioners who are able and committed to communicate effectively with patients. This might be due to the pervasive negative influence of the medical profession’s (mistaken) understanding of itself as a natural science on doctor–patient communication. Doctors who have been trained according to a positivist framework may consider their only responsibility to be the physical treatment of physical disorders. They may thus have little regard for the patient’s psychological and social world and by extension for communication with the patient and/or their caregivers. To address this problem, I propose a curriculum, based on the academic field of philosophy, for teaching clinical communication.
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    Struikelblokke in kruislinguistiese en -kulturele pediatriese spraak-taalterapie en strategiee vir die bevordering van kultuurveilige praktyke : 'n omvangsbepaling
    (LitNet, 2021) Botha, Mariette; Gerber, Berna; Van der Merwe, Anita
    In ’n kultureel en linguisties diverse land soos Suid-Afrika bestaan daar ’n belangrike behoefte om spraak-taalterapiedienste te lewer wat kultuurveilig van aard is. ’n Omvattende lys van strategiee wat terapeute kan volg om hierdie behoefte te vervul, ontbreek egter. ’n Lys van verwagte struikelblokke in kruislinguistiese en -kulturele praktyke kan spraak-taalterapeute (STT’s) help om voor te berei vir kruislinguistiese en -kulturele interaksies en om begrip, eerbied en empatie vir hul kliente te ontwikkel. Met die doel om ’n raamwerk vir kultuurveilige spraak-taalterapie-praktyke voor te stel, het hierdie omvangsbepaling internasionale en plaaslike literatuur deursoek vir die struikelblokke wat verwag kan word asook doeltreffende strategiee wat STT’s wereldwyd ontwikkel het waar hulle kruislinguisties en -kultureel praktiseer. Die aard en omvang van die navorsing wat reeds op die gebied van kruislinguistiese en -kulturele pediatriese spraak-taalterapie gedoen is, is ook bepaal. ’n Soekstrategie is as metode ontwikkel om toepaslike artikelsin elektroniese databasisse uit te wys. Twaalf artikels is in die omvangsbepaling ingesluit. Primere struikelblokke tydens kruislinguistiese en -kulturele spraak-taalterapie wat geidentifiseer is, het taal- en kommunikasiestruikelblokke, tekorte aan toepaslike evaluasie- en terapiemateriaal, en tekort aan toepaslike opleiding behels. Voorgestelde strategiee vir goeie kruislinguistiese en -kulturele spraak-taalterapie het bestaan uit die uitbreiding tot ’n meer diverse werkerskorps, die vestiging van goeie verstandhoudings met versorgers, en aanpassings in kommunikasie. Hierdie omvangsbepaling bied die enigste opsomming van die strategiee vir kruislinguistiese en -kulturele pediatriese spraak-taalterapie wat STT’s wereldwyd in die afgelope twintig jaar ontwikkel het, asook moontlike struikelblokke wat verwag kan word. Die bydrae word vergroot deur verwysing na die Suid-Afrikaanse konteks. Bevindinge aangaande die aard en omvang van die literatuur stel ook ’n basislyn as vertrekpunt vir die beplanning van verdere navorsing.