Cross-linguistic and -cultural early communication intervention : the experiences of caregivers
Date
2024-07-02
Journal Title
Journal ISSN
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Publisher
LitNet Akademies
Abstract
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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The original publication is available at: https://www.litnet.co.za
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Citation
Botha M, Gerber B & Van der Merwe A .2024. Cross-linguistic and -cultural early communication intervention: the experiences of caregivers. LitNet Akademies 21(2):33 pages. doi.10.56273/1995-5928/2024/j21n2d2