Journal Articles
Permanent URI for this collectionhttps://mro.massey.ac.nz/handle/10179/7915
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Item Decoloniality and healthcare higher education: Critical conversations.(Wiley, 2024-05-08) Pillay M; Kathard H; Hansjee D; Smith C; Spencer S; Suphi A; Tempest A; Thiel LBACKGROUND: We explore the theoretical and methodological aspects of decolonising speech and language therapy (SLT) higher education in the United Kingdom. We begin by providing the background of the Rhodes Must Fall decolonisation movement and the engagement of South African SLTs in the decoloniality agenda. We then discuss the evolution of decoloniality in SLT, highlighting its focus on reimagining the relationships between participants, students, patients and the broader world. OBJECTIVE: The primary objective of this discussion is to fill a gap in professional literature regarding decoloniality in SLT education. While there is limited research in professional journals, social media platforms have witnessed discussions on decolonisation in SLT. This discussion aims to critically examine issues such as institutional racism, lack of belonging, inequitable services and limited diversity that currently affect the SLT profession, not just in the United Kingdom but globally. METHODS: The methods employed in this research involve the engagement of SLT academics in Critical conversations on decolonisation. These conversations draw on reflexivity and reflexive interpretation, allowing for a deeper understanding of the relationship between truth, reality, and the participants in SLT practice and education. The nature of these critical conversations is characterised by their chaotic, unscripted and fluid nature, which encourages the open discussion of sensitive topics related to race, gender, class and sexuality. DISCUSSION POINTS: We present our reflections as academics who participated in the critical conversations. We explore the discomfort experienced by an academic when engaging with decolonisation, acknowledging white privilege, and the need to address fear and an imposter syndrome. The second reflection focuses on the experiences of white academics in grappling with their complicity in a system that perpetuates racism and inequality. It highlights the need for self-reflection, acknowledging white privilege and working collaboratively with colleagues and students toward constructing a decolonised curriculum. Finally, we emphasise that while action is crucial, this should not undermine the potential of dialogue to change attitudes and pave the way for practical implementation. The paper concludes by emphasising the importance of combining dialogue with action and the need for a nuanced understanding of the complexities involved in decolonising SLT education. CONCLUSION: Overall, this paper provides a comprehensive overview of the background, objectives, methods and key reflections related to the decolonisation of SLT higher education in the United Kingdom. It highlights the challenges, discomfort and responsibilities faced by academics in addressing decoloniality and emphasizes the importance of ongoing critical conversations and collective action in effecting meaningful change. WHAT THIS PAPER ADDS: What is already known on this subject Prior to this paper, it was known that the decolonial turn in speech and language therapy (SLT) was a recent focus, building on a history of professional transformation in South Africa. However, there was limited literature on decoloniality in professional journals, with most discussions happening on social media platforms. This paper aims to contribute to the literature and provide a critical conversation on decolonising SLT education, via the United Kingdom. What this paper adds to existing knowledge This paper adds a critical conversation on decolonising SLT higher education. It explores theoretical and methodological aspects of decoloniality in the profession, addressing issues such as institutional racism, lack of sense of belonging, inequitable services and limited diversity. The paper highlights the discomfort experienced by academics in engaging with decolonisation and emphasizes the importance of reflection, collaboration and open dialogue for meaningful change. Notably we foreground deimperialisation (vs. decolonisation) as necessary for academics oriented in/with the Global North so that both processes enable each other. Deimperialisation is work that focuses the undoing of privilege exercised by academics in/with the Global North not only for localising their research and education agenda but checking their rite of passage into the lives of those in the Majority World. What are the potential or actual clinical implications of this work? The paper highlights the need for SLT practitioners and educators to critically examine their practices and curricula to ensure they are inclusive, decolonised and responsive to the diverse needs of communities. The discussions emphasise the importance of addressing institutional racism and promoting a sense of belonging for research participants, SLT students and patients. This paper offers insights and recommendations that can inform the development of more equitable and culturally responsive SLT services and education programmes.Item Sustainable workforce: South African Audiologists and Speech Therapists.(BioMed Central Ltd, 2020-07-01) Pillay M; Tiwari R; Kathard H; Chikte UBackground 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. Methods 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. Results 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. Conclusions 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.Item A survey of communication supports in Grade R classrooms in the Western Cape, South Africa(AOSIS, 2022-10-28) Kathard H; Parusnath P; Thabane L; Pillay M; Jing Hu Z; Le Roux J; Harty M; O Carrol S; Mallick RBBackground: Early classroom communication supports are critical in influencing oral language development and emergent literacy skills. It is both support from peers and adults, as well as the environment that impacts the quality and efficacy of language learning. Schools in particular play a key role in communication development, which will be further explored in this article. Objectives: To describe how communication was being supported in the classroom by teachers in the areas of language-learning environment (LLE), language-learning interactions (LLIs) and language-learning opportunities (LLOs) to focus on classroom communication supports to strengthen literacy outcomes for Grade R learners. Method: A cross-sectional descriptive survey of classrooms was conducted using a structured observation method in 136 classrooms. The Communication Supporting Classroom Observation Tool was used to make 223 observations across classrooms of LLE (19 items), LLI (20 items) and LLO (5 items). A descriptive analysis of frequency of occurrence of items was conducted for each domain. Results: Language-learning environment had more frequently occurring observations, with 12 out of 19 items being observed with a frequency of occurrence greater than 65%, indicating that the environment had adequate basic resources (e.g. good light). Language-learning interactions scores indicated that 3 out of 20 items were observed frequently, while 17 out of 20 items were observed less frequently (56.5%), including interactive strategies (e.g. turn-taking). Language Learning Opportunities scores indicated that teacher-led behaviours (e.g. including children in small group activities) were infrequently observed on all items. Conclusion: While the physical environment was generally supportive, the behaviours in the interactive domains of LLI and LLO were observed less frequently. There is potential for speech–language therapists to work collaboratively with teachers to develop communication supporting classrooms as a critical primary-level intervention for language-literacy learning.Item The Classroom Communication Resource (CCR) intervention to change peer’s attitudes towards children who stutter (CWS): study protocol for a randomised controlled trial(BioMed Central Ltd, 2018-01-17) Mallick R; Kathard H; Thabane L; Pillay MBackground 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. Methods 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. Discussion 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. Trial registration The trial number is NCT03111524. It was registered with clinical trials.gov Protocol registration and results system (PRS) retrospectively on 9 March 2017.Item A cluster randomised trial of a classroom communication resource program to change peer attitudes towards children who stutter among grade 7 students(BioMed Central Ltd, 2018-11-29) Mallick R; Kathard H; Borhan ASM; Pillay M; Thabane LBackground Classroom-based stuttering intervention addressing negative peer attitudes, perceptions, teasing and bullying of children who stutter (CWS) is required as part of holistic stuttering management because of its occurrence in primary school. This study was conducted in 2017, in 10 primary schools in the Western Cape, South Africa within lower (second and third) and higher (fourth and fifth) quintiles. Objectives The primary objective of this study was to determine treatment effect at six months after intervention of grade 7 participants (Classroom Communication Resource [CCR] intervention versus no CCR) using global Stuttering Resource Outcomes Measure (SROM) scores in school clusters. The secondary objective was to determine grade 7 participant treatment effect on the SROM subscales including Positive Social Distance (PSD), Social Pressure (SP) and Verbal Interaction (VI). The subgroup objective was to determine any difference in the primary outcome between schools between and across quintile clusters (lower and higher). Methods Once schools were stratified into lower and higher quintile (which are defined according to geographical location, fee per school and resources) subgroup clusters, schools were assigned randomly to control and intervention groups consisting of grade 7 participants who were typically aged ≥ 11 years. Teachers received 1 h of training before administering the single-dose CCR intervention over a 60–90-min session. The CCR intervention included a social story, role-play and discussion. All participants viewed a video of a CWS and stuttering was defined at baseline. The SROM measured peer attitudes at six months after intervention. Randomisation was stratified by quintile group using a 1:1 allocation ratio. Full blinding was not possible; however, the outcome assessor was partially blinded and the analyst was also blinded. Generalised estimating equations (GEE) was used assuming an exchangeable correlation structure to analyse the data adopting an intention-to-treat principle. Multiple imputation was used to handle missing data. Criterion for statistical significance was set at alpha = 0.05. Results Ten schools were randomly allocated to control (k = 5) and intervention groups (k = 5), with n = 223 participants allocated to intervention and n = 231 to control groups. A total of 454 participants completed the SROMs in control (n = 231) and intervention (n = 223) groups and were analysed at baseline and six months after intervention. There was no statistically significant difference on the global SROM score (mean difference − 0.11; 95% confidence interval [CI] − 1.56–1.34; p = 0.88). There were also no significant differences on SROM subscales: PSD (mean difference 1.04; 95% CI − 1.02–311; p = 0.32), SP (mean difference − 0.45; 95% CI − 1.22–0.26; p = 0.21) and VI (mean difference 0.05; 95% CI − 1.01–1.11; p = 0.93). Additionally, there was no significant subgroup effect on the global SROM score (lower versus higher quintile subgroups) (interaction p value = 0.52). No harms were noted or reported. Conclusion No statistically significant differences were noted. It is possible that the time frame was too short to note changes in peer attitudes and that further study is required to confirm the findings of this study. Trial registration Clinicaltrials.gov, NCT03111524. Registered on 9 March 2017.