Charlton, Jenna

Gilroy, Vicky

Holme, Caitlin

Law, James

McKean, Cristina

Roulstone, Sue

English

Early identification is advocated for preschool children at risk of developing DLD (Law, Charlton, &amp; Asmussen, 2017) Parents are key to the identification process (Marshall et al., 2017), and it is vital that their perspectives are considered to ensure that the process is acceptable. The Theoretical Framework of Acceptability (TFA) has been developed as a framework for exploring the acceptability of interventions from patients’ perspectives (Sekhon, Cartwright &amp; Francis, 2018). This study aimed to explore the applicability of the TFA to the context of screening for speech and language during children’s developmental reviews. Parents attending the nationally mandated 24-30 month developmental review completed a survey (n=433) based on the TFA. Follow-up interviews with 40 parents explored perspectives of the speech and language component of the developmental review. Parents were recruited purposively on the basis of their level of concern about their child’s language development, and the outcomes of the developmental review, which were available from the Ages &amp; Stages Questionnaire (ASQ) and Early Language Identification Measure (ELIM). Descriptive statistics and thematic analysis were used to explore the survey results and qualitative interviews. Some themes from the TFA were relevant, including coherence of the assessment, while additional themes specific to the developmental review context included the parent’s relationship with the practitioner and the value placed on the outcome of the assessment for their child. The TFA provided a useful framework for exploring acceptability. However, this study identified additional elements of acceptability that were specific to the context of speech and language screening during the developmental review

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                          Holme, C., Roulstone, S., McKean, C., Gilroy, V., Charlton, J., & Law,J. (2021). Exploring the acceptability of speech and languagescreening for preschool children from parents’ perspectives. Abstractfrom International Developmental Language Disorder ResearchConference.Peer reviewed versionLink to publication record in Explore Bristol ResearchPDF-documentUniversity of Bristol - Explore Bristol ResearchGeneral rightsThis document is made available in accordance with publisher policies. Please cite only thepublished version using the reference above. Full terms of use are available:http://www.bristol.ac.uk/red/research-policy/pure/user-guides/ebr-terms/Exploring the acceptability of speech and language screening for preschool children from parents’ perspectivesCaitlin Holme1, Sue Roulstone1, Cristina McKean2, Vicky Gilroy3, Jenna Charlton2 and James Law21 Bristol Speech and Language Therapy Research Unit (UK)2 University of Newcastle (UK)3 Institute of Health Visiting (UK)Contact information: caitlin.holme@bristol.ac.uk, @HolmeCaitlinPresented online at the 1st International Developmental Language Disorder Research Conference (IDLDRC2021), 20-22 September. 2021 –The DLD ProjectAcknowledgementsThank you to...- The parents and children who took part in the study- Public Health England- Dr. Mandeep Sekhon for reviewing our interpretations of her framework- The ELIM research team!Overview• Screening of children’s language promotes early identification of speech, language and communication needs (SLCN)• Effective screening involves consultation with parents to ensure acceptability• Frameworks for acceptability have not been applied to children’s developmental screening• This study will present parents’ perceptions of speech and language screening in the context of acceptabilityAcceptability• ‘Theoretical Framework of Acceptability’ (TFA) developed by Sekhon, Cartwright and Francis (2017)Affective attitudeHow an individual feels about the interventionBurdenThe perceived amount of effort that is required to participate in the interventionEthicalityThe extent to which the intervention has a good fit with an individual’s value systemIntervention coherenceThe extent to which the participant understands the intervention and how it worksOpportunity costsThe extent to which benefits, profits or values must be given up to engage in the interventionPerceived effectivenessThe extent to which the intervention is perceived as likely to achieve its purposeSelf-efficacyThe participant’s confidence that they can perform the behaviour(s) required to participate in the interventionProspective acceptabilityPrior to participating in the interventionConcurrent acceptabilityWhile participating in the interventionRetrospective acceptabilityAfter participating in the interventionHow does the TFA apply to parents and children?• Additional considerations – parent acting on behalf of child• Authors report the framework is useful but additional elements are key for paediatrics –➢Trust in practitioner(Deja et al., 2021; Toomey et al., 2021)➢Communication and delivery of a message (Bhatti et al., 2021; Abel et al. 2020)Acceptability of developmental screening• Parents of children with SLCN report negative experiences (Marshall et al., 2017; Rannard, Lyons & Glenn, 2004)• Acceptability depends on how screening is delivered (Kendall et al. 2019; Roche et al. 2005) • Practical and ethical concerns of screening for speech and language• Aim of this study: to explore the acceptability of speech and language screening for pre-school aged children from parents’ perspectivesMethod• Study part of development of Early Language Identification Measure (Law et al. 2020) for use by health visitors at 2 – 2 ½ year review• Quantitative survey of 433 parents’ experiences of review• Follow-up qualitative interviews with 40 parents• TFA used to create questions for survey and interview• Framework Analysis used to map responses to TFA (Ritchie & Spencer, 1994)• Reflexive thematic analysis to check for themes not present in TFA (Braun & Clarke, 2006) Quantitative results support acceptability…94%Were very satisfied with the review (Affective Attitude)99%Were very or quite comfortable answering questions (Ethicality)91%Said information received was very or quite clear (Intervention Coherence)99%Were very or quite confident in ability to answer questions (Self-Efficacy)Qualitative results were more complex…• Dyer et al. (2016) – people tend to be more positive in surveys • Carlton et al. (2021) - qualitative research methods needed to facilitate in-depth understanding of behaviours and parents’ feelingsQualitative results and the TFAAffective AttitudeTied in with other elements of acceptabilityBurden/Opportunity Costs“The pace went with what [child] was doing so if [child] needed a bit more time they would've given him more time”“If they've got any form of concern definitely attend it, but if not, it really depends on whether or not they have the time or want to”Ethicality“I was comfy, because obviously she knew our background and everything like that”“As an individual, a child's gonna do something different to a different child, so I don't personally understand the questionnaire sheet”Qualitative results and the TFAIntervention Coherence“When we first get the questionnaire…you think 'oh my goodness, she's not doing that, he's not doing that'”“There was only a couple but she, she explained what it meant…And then I understood after that” Perceived Effectiveness“Because I do them anyway, there wasn't really anything, anything extra that I was told to do…she said just to continue what you're doing”“It would've been absolutely brilliant if there was a sheet with ideas of things you could do to help in certain areas”Self-Efficacy“I was not very worried why they are not referring, because they are giving me the tools…and yeah I will work on it”“It's just like someone has been assigned a task and they just want to say OK yes I've seen the kid and I've done my job, that's it”Qualitative results – additional elements• “She didn't pressure me or it was all about her job, like she had to do it, sort of thing, she made it about us”Individualisation• “She went through everything that I was worried about, all my concerns with the speech and everything like that and she was really good”Relationship with practitioner“I think oh God what if he gets to 3 and then he's still behind and then what happens then. She didn't really go into anything further what happens at 3, she just said ‘oh just give us a call if you are concerned.”“Feedback on development and language would be nice as well as any activities that are beneficial”Outcomes are keyAn acceptability framework for families?Value of time and opportunityRelationship and empower-mentCoherence and accessibilityExpertiseImportance of outcomes and individualisationDiscussion• Like previous studies, trust in practitioner and a positive relationship is key (Deja et al. 2021, El-Yousfi et al. 2020)• Tailoring of an intervention is important for parents and children (Abel et al 2020)• Positive outcome for child is key (Pennington et al. 2020) • Conclusion – TFA useful as a framework, but additional elements apply in context of developmental screeningReferencesAbel, K. M., Bee, P., Gega, L., Gellatly, J., Kolade, A., Hunter, D., Callender, C., Carter, L. 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Exploring the acceptability of speech and language screening for preschool children from parents’ perspectives

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Exploring the acceptability of speech and language screening for preschool children from parents’ perspectives

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