Children's neurosciences, Evelina London Children's Hospital, London, UK.
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Int J Lang Commun Disord. 2024 Mar-Apr;59(2):762-778. doi: 10.1111/1460-6984.12961. Epub 2023 Oct 12.
When parents bring their child to appointments and then adhere to agreed speech and language therapy (SLT) recommendations, there is the potential to increase the intensity of the intervention, support generalization and improve outcomes. In SLT, however, little is known about factors that may promote attendance or adherence. Studies in other clinical areas such in medicine, psychology and physiotherapy have identified risk factors for non-attendance or non-adherence that are multifactorial and variable dependent on, for example, population and intervention.
To identify rates of non-attendance and non-adherence, and to identify parent or child factors associated with parent involvement in intervention for children under 5 years of age receiving SLT.
Parents completed questionnaires at two time points assessing the domains of parents' beliefs (problem perceptions, self-efficacy), personal circumstances (socio-demographics, family functioning), treatment experience and child factors. Predictors of parent attendance and adherence were identified through multiple regression analyses. Non-attendance rates were identified via local health records and non-adherence ascertained using a specific parent-reported measure within the treatment experience domain.
Participants (N = 199) were predominantly mothers, and were ethnically and socio-economically diverse, speaking a wide range of languages. Their children presented with a range of speech, language communication needs (SLCN). The rate of non-attendance was 25% and the main predictors of non-attendance were maternal age, education level and two factors within the parent beliefs domain. This model explained 40% of the variance in attendance. The rate of non-adherence in this cohort was 26% with parental rating of the importance of a recommendation and self-efficacy beliefs predicting adherence; this explained 56% of the variance in adherence to SLT recommendations at home.
CONCLUSIONS & IMPLICATIONS: Our research has provided preliminary evidence of the influence of parents' beliefs, personal circumstances and treatment experiences on their involvement in their child's therapy. Speech and language therapists should consider factors impacting attendance and adherence to treatment and explore parental perceptions of their child's SLCN before embarking on an intervention, a foundation for collaborative practice. A possible limitation of this study is that the levels of attrition in our sample led to generally high measured rates of participation, which should be considered in future studies. Future research should explore adherence in treatments with varying doses, with different types of SLCN or interventions and in different settings.
What is already known on the subject It is acknowledged that parent involvement in their child's therapy, such as attending and adhering to recommendations, is important but little is known about the rates of involvement and what factors may be associated with attendance and adherence in SLT. Qualitative research has explored parental involvement suggesting that beliefs about an intervention may be pertinent. Extensive research in other clinical areas suggest multiple and varied factors are influential and further exploration of particular populations and interventions is necessary. What this paper adds to the existing knowledge This study identified rates of parental non-attendance and non-adherence in a cohort of predominantly mothers of children under the age of 5 years. It is the first study to measure parent adherence in SLT and identify factors that are associated parental adherence to SLT recommendations. It adds to the small body of SLT specific research in understanding risk factors for non-attendance. What are the potential or actual clinical implications of this work? This study highlights the need for a speech and language therapist to consider and explore parents' perspectives of their child's SLCN as a part of achieving collaboration with a parent in order to achieve the best outcomes. It provides a foundation for further systematic research into parent involvement with the ultimate aim of enhancing outcomes for children with SLCN.
当父母带孩子就诊并遵循商定的言语和语言治疗 (SLT) 建议时，有可能增加干预的强度、支持泛化并改善结果。然而，在 SLT 中，我们对可能促进就诊或依从性的因素知之甚少。在医学、心理学和物理治疗等其他临床领域的研究已经确定了与非就诊或非依从性相关的风险因素，这些因素是多因素的，并且取决于人口和干预等变量。
确定就诊和依从率，并确定与父母参与 5 岁以下接受 SLT 治疗的儿童干预相关的父母或儿童因素。
父母在两个时间点完成了评估父母信念（问题认知、自我效能感）、个人情况（社会人口统计学、家庭功能）、治疗经验和儿童因素的问卷。通过多元回归分析确定了父母就诊和依从的预测因素。通过当地健康记录确定就诊缺席率，并通过治疗经验领域内的特定父母报告测量来确定依从率。
参与者（N=199）主要是母亲，他们在种族和社会经济方面多样化，讲多种语言。他们的孩子有各种言语、语言交流需求（SLCN）。就诊缺席率为 25%，就诊缺席的主要预测因素是母亲的年龄、教育水平和父母信念领域的两个因素。该模型解释了就诊率的 40%。该队列的依从率为 26%，父母对建议重要性的评价和自我效能信念预测依从性；这解释了在家中依从 SLT 建议的 56%的方差。
我们的研究初步证明了父母的信念、个人情况和治疗经验对他们参与孩子治疗的影响。言语和语言治疗师应考虑影响就诊和治疗依从性的因素，并在开始干预之前探讨父母对孩子 SLCN 的看法，这是协作实践的基础。这项研究的一个可能局限性是，我们样本中的流失率导致了普遍较高的参与率，这在未来的研究中应该考虑。未来的研究应探讨不同剂量、不同类型的 SLCN 或干预措施以及不同环境下的依从性。
目前已知的主题：人们承认父母参与孩子的治疗，例如就诊和遵守建议，是很重要的，但对父母参与 SLT 的程度以及哪些因素可能与就诊和依从性相关知之甚少。定性研究探讨了父母对干预的看法，表明对干预的信念可能是相关的。其他临床领域的广泛研究表明，有多个和不同的因素具有影响力，需要进一步探索特定人群和干预措施。
本文对现有知识的贡献：本研究确定了一个以 5 岁以下儿童的母亲为主的队列中父母就诊缺席和不依从的比例。这是第一个测量 SLT 中父母依从率并确定与 SLT 建议依从性相关的因素的研究。它增加了 SLT 特定研究中关于就诊缺席风险因素的少量研究。
这项工作的潜在或实际临床意义是什么？本研究强调言语和语言治疗师需要考虑和探讨父母对其孩子 SLCN 的看法，作为与父母合作以实现最佳结果的一部分。它为进一步系统研究父母参与治疗提供了基础，最终目标是提高有 SLCN 的儿童的治疗效果。
