Audiologists and Speech Therapists play a vital role in addressing sustainable development goals by supporting people who are marginalised due to communication challenges. The global burden of ...disease and poor social living conditions impact negatively on the development of healthy communication, therefore requiring the services of Audiologist and Speech therapists. Against this background, we examined the demographic profile and the supply, need and shortfall of Audiologists and Speech Therapists in South Africa. The data set was drawn from the Health Professions Council of South Africa (HPCSA) registers (for 2002-2017) for the speech, language and hearing professions. This demographic profile of the professions was created based on the category of health personnel; category of practice, geographical location, population group (race) and sex. The annual supply was estimated from the HPCSA database while the service-target approach was used to estimate need. Additional need based on National Health Insurance Bill was also included. Supply-need gaps were forecast according to three scenarios, which varied according to the future intensity of policy intervention to increase occupancy of training places: 'best guess' (no intervention), 'optimistic' (feasible intervention), and 'aspirational' (significant intervention) scenarios up to 2030. Most (i.e. 1548, 47.4%) of the professionals are registered as Audiologists and Speech Therapists, followed by 33.5% registered as Speech Therapists and 19.1% registered as Audiologists. Around 88.5% professionals registered as Audiologists and Speech Therapists are practising independently, and 42.6% are practising in the Gauteng province. The profession is comprised majorly of women (94.6%), and in terms of the population groups (race), they are mainly classified as white (59.7%). In 2017, in best guess scenario, there is a supply-need gap of around 2800 professionals. In the absence of any intervention to increase supply capacity, this shortfall will remain same by the year 2030. By contrast, in aspirational scenario, i.e. supply is increased by 300%, the forecasted shortfall for 2030 reduces to 2300 from 2800 professionals. It is clear that without significant interventions, South Africa is likely to have a critical shortfall of Audiologists and Speech Therapists in 2030. Policy-makers will have to carefully examine issues surrounding the current framework regulating training of these and associated professionals, in order to respond adequately to future requirements.
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Every person who seeks health care should be affirmed, respected, understood, and not judged. However, trans and gender diverse people have experienced significant marginalization and discrimination ...in health care settings. Health professionals are generally not adequately prepared by current curricula to provide appropriate healthcare to trans and gender diverse people. This strongly implies that health care students would benefit from curricula which facilitate learning about gender-affirming health care.
Trans and gender diverse people have been pathologized by the medical profession, through classifications of mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Disease (ICD). Although this is changing in the new ICD-11, tension remains between depathologization discourses and access to gender-affirming health care. Trans and gender diverse people experience significant health disparities and an increased burden of disease, specifically in the areas of mental health, Human Immunodeficiency Virus, violence and victimisation. Many of these health disparities originate from discrimination and systemic biases that decrease access to care, as well as from health professional ignorance. This paper will outline gaps in health science curricula that have been described in different contexts, and specific educational interventions that have attempted to improve awareness, knowledge and skills related to gender-affirming health care. The education of primary care providers is critical, as in much of the world, specialist services for gender-affirming health care are not widely available. The ethics of the gatekeeping model, where service providers decide who can access care, will be discussed and contrasted with the informed-consent model that upholds autonomy by empowering patients to make their own health care decisions.
There is an ethical imperative for health professionals to reduce health care disparities of trans and gender diverse people and practice within the health care values of social justice and cultural humility. As health science educators, we have an ethical duty to include gender-affirming health in health science curricula in order to prevent harm to the trans and gender diverse patients that our students will provide care for in the future.
Case study and narrative inquiry as merged methodological frameworks can make a vital contribution that seeks to understand processes that may explain current realities within professions and broader ...society. This article offers an explanation of how a critical perspective on case study and narrative inquiry as an embedded methodology unearthed the interplay between structure and agency within storied lives. This case narrative emerged out of a doctoral thesis in occupational therapy, a single instrumental case describing a process of professional role transition within school-level specialized education in the Western Cape, South Africa. This case served as an exemplar in demonstrating how case study recognized the multiple layers to the context within which the process of professional role transition unfolded. The embedded narrative inquiry served to clarify emerging professional identities for occupational therapists within school-level specialized education in postapartheid South Africa.
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As a profession, speech-language pathology (SLP) continues to struggle with equitable service delivery to both people with communication challenges and disabilities. SLP clinical practice in its ...traditional form has an individual focus and therefore cannot adequately serve the large population in need, which, in South Africa is the majority population. Using the concept of social embeddedness of professions as a guiding frame, the article explores the history of the profession and the influence of the medical model and coloniality in shaping SLP profession’s knowledge and practices. As such, we argue that professionalisation in its current form perpetuates injustice. The article proposes innovation across clinical practice, education and research as leverage points for imagining new practices.
This paper explores professional identity formation in undergraduate education. The paper positions professional identity formation within coloniality. A qualitative case study was conducted using ...critical theory as a guiding conceptual framework. Data collection included document reviews, observations and arts-based research methodologies. We present a case study of a speech-language pathology student, Aqueelah, transitioning from a traditional clinical placement to a learning site which encourages the development of an emerging practice. The paper focuses on how Aqueelah forms her emerging professional identity through her learning. We foreground the concept of “centring the self” as essential in developing patient-centred care and challenge coloniality of being embedded in clinical education. The paper argues that liminal spaces are necessary to allow students to explore different ways of thinking and doing to support new ways of being. The paper advocates for arts-based methodologies and critical reflection as essential pedagogic tools in shaping professional identity.
For the professions of audiology and speech-language therapy (A/SLT), there continues be a dire need for more equitable services. Therefore there is a need to develop emerging practices which have a ...specific focus on equity as a driving force in shifting practices. This scoping review aimed to synthesise the characteristics of emerging practices in A/SLT clinical practice in relation to equity with an emphasis on communication professions.
This scoping review followed the Joanna Briggs Institute guidelines and aimed to map the emerging practices in A/SLT to identify the ways in which the professions are developing equitable practices. Papers were included if they addressed equity, focused on clinical practice and were situated within A/SLT literature. There were no time or language restrictions. The review included all sources of evidence across PubMed, Scopus, EbscoHost, The Cochrane Library and Dissertation Abstracts International, Education Resource Information Centre from their inception. The review uses PRISMA Extension for scoping reviews and PRISMA-Equity Extension reporting guidelines.
The 20 included studies ranged from 1997-2020, spanning over 20 years. There were a variety of papers including empirical studies, commentaries, reviews and research. The results demonstrated that the professions were increasingly considering addressing equity through their practice. However, there was a prominent focus around culturally and linguistically diverse populations, with limited engagement around other intersections of marginalisation. The results also showed that while the majority of contributions to theorising equity are from the Global North with a small cluster from the Global South offering critical contributions considering social categories such as race and class. Collectively the contributions from the Global South remain a very small minority of the professional discourse which have a focus on equity.
Over the last eight years, the A/SLT professions are increasingly developing emerging practices to advance equity by engaging with marginalised communities. However, the professions have a long way to go to achieve equitable practice. The decolonial lens acknowledges the impact and influence of colonisation and coloniality in shaping inequity. Using this lens, we argue for the need to consider communication as a key aspect of health necessary to achieve health equity.
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In this paper, we engage in productive resistance through exploring the application of an arts-based method in expanding the critical research methodology repertoire in the profession of ...speech-language pathology. There is a specific focus on the value of painting in the data representation process. We explore how a playful, creative analysis deepened the critical interpretative meaning-making process. In particular, we explain how artful representations in the data analysis process can broaden communication in research beyond the written modality to generate alternative knowledges. We use the concepts of productive ambiguity and unknowing as key conceptual tools to reimagine the data analysis process with particular focus on the process of data representation. We conclude that embracing the uncertainty of creative ways of knowing create possibilities for new meanings and knowledges to emerge.
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We explore school-aged (6-14 years old) stuttering interventions for children who stutter (CWS) using a scoping review. Database searches were conducted (EBSCO host, PubMed, PsycINFO, Academic Search ...Premier, MEDLINE, Education Resources Information Center (ERIC), Health Source (consumer edition), Africa-wide Information, Cumulative Index to Nursing and Allied Health (CINAHL), Dissertation abstracts International, the Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), 15 Cochrane Methodology Register, Education Resource Information Center, Google Scholar, manual searching using reference lists and gray literature) from the inception of the databases until June 2018. Ten school-aged stuttering intervention studies met the inclusion criteria of this study, which were conducted between 1982 and 2016. The 10 studies used quantitative pretest posttest designs with low to moderate quality, according to GRADE. ICF showed a dominance of interventions targeted and measured within the domain of body structures and function with treatment effects focused predominantly on traditional individualized speech fluency measures. Studies were conducted in Australia (n = 3), United States of America (n = 3), Canada (n = 2), Islamic Republic of Iran (n = 1) and South Africa (n = 1). The findings lead to the authors questioning knowledge production and its influence on evidence-based literature and practices.
Children who stutter (CWS) are at a high-risk of being teased and bullied in primary school because of negative peer attitudes and perceptions towards stuttering. There is little evidence to ...determine if classroom-based interventions are effective in changing peer attitudes towards stuttering. The primary objective is to determine the effect of the Classroom Communication Resource (CCR) intervention versus usual practice, measured using the Stuttering Resource Outcomes Measure (SROM) 6-months post-intervention among grade 7 students. The secondary objective is to investigate attitude changes towards stuttering among grade participants on the SROM subscales.
A cluster randomised controlled trial (RCT) will be conducted with schools as the unit of randomization. Schools will be stratified into quintile groups, and then randomized to receive the CCR intervention or usual practice. Quintile stratification will be conducted in accordance to the Western Cape Department of Education classification of schools according to geographical location, fee per school and allocation of resources and funding. Participants will include primary schools in the lower (second and third) and higher (fourth and fifth) quintiles and children aged 11 years or older in grade 7 will be included. The study will consist of the CCR intervention program or usual practice as a no-CCR control. The CCR is a classroom-based, teacher led intervention tool including a story, role-play and discussion. The grade 7 teachers allocated to the CCR intervention, will be trained and will administer the intervention. The analysis will follow intention-to-treat (ITT) principle and generalized estimating equations (GEE) to compare groups on the global SROM and its subscales to account for possible clustering within schools. The subgroup hypothesis will be tested by adding an interaction term of quintile group x intervention.
This study is designed to assess whether the CCR intervention versus usual practice in schools will lead to positive shift in attitudes about stuttering at 6-months post-intervention among grade 7 participants.
The trial number is NCT03111524 . It was registered with clinical trials.gov Protocol registration and results system (PRS) retrospectively on 9 March 2017.
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