AAC services for multilingual and non-English clients : perspectives of speech-language therapists in the public healthcare setting in Gauteng

Abstract

Background: South Africa recognizes 12 official languages and despite its commitment to supporting them equally, English still dominates in the healthcare and education sectors. Discrimination against multilingual clients who do not receive services in their languages is a concern, making appropriate communication assessment and intervention challenging for speech-language therapists (SLTs). The study aims to explore the perspectives of South African SLTs on augmentative and alternative communication (AAC) service provision for multilingual and non-English clients with complex communication needs (CCN) in the public healthcare sector in Gauteng.

Methods: This study was conducted using a qualitative research design. Semi-structured interviews were conducted via Zoom conferencing with nine SLTs working in the public healthcare sector who had more than one year of experience providing AAC to multilingual and/or non-English clients. Interviews were transcribed using the Happy Scribe software and transcriptions were checked by a research assistant. Thematic analysis (codebook approach) was used to analyse the data with the help of ATLAS.ti software.

Results: Three themes were identified in the data, namely (i) current practice in assessment and intervention, (ii) factors influencing practice, and (iii) best practice. Thematic coding showed that SLTs hold positive views of multilingualism and attempt to provide linguistically and culturally congruent services. However, several systemic challenges impede this process. Several initiatives were suggested to address this situation, such as policy development, development of linguistically and contextually appropriate AAC systems, continuous professional development and up-skilling of SLTs on best practices, and the implementation of family- and client-centred practices.

Conclusions: Understanding the perspectives of SLTs working in the public healthcare sector in Gauteng provides insights into the challenges they face in providing equitable services to all and the creative avenues they employ to overcome them. Gaps in policy, appropriate assistive technology provision and SLT training need to be addressed to ensure more appropriate AAC services for multilingual and non-English clients with CCN in South Africa. The findings highlight the pressing need for culturally sensitive and linguistically appropriate AAC practices for individuals from diverse backgrounds. Increased resources and support are essential to develop AAC systems that are linguistically and culturally relevant for multilingual clients. By actively involving individuals from multicultural communities, promoting cross-cultural competence among professionals, and tailoring interventions to specific linguistic and cultural contexts, we can bridge the gap between current AAC practices and the diverse needs of individuals, ensuring that everyone has equitable access to effective communication tools.