UniSA Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-70 Corbett Hall, Edmonton, AB T6G 2G4, Canada.
J Fluency Disord. 2024 Dec;82:106076. doi: 10.1016/j.jfludis.2024.106076. Epub 2024 Aug 24.
This study initiated a program of research that aims to develop a program theory underlying integrated cognitive-behavioural fluency enhancing stuttering treatments for school-age children. This research asks, what in the treatment program works (or does not work), for whom, in what contexts, and why.
Using a critical realist evaluation approach, seven speech-language pathologists (SLPs) with extensive experience in treating children who stutter were asked about barriers and facilitators of optimal treatment outcomes within the context of the Comprehensive Stuttering Program - School-aged Children (CSP-SC). From these data discrete resource mechanisms, contexts, within child reasoning mechanisms, and outcomes were derived and a preliminary program theory was proposed.
Facilitating and impeding child physiology, treatment and SLP resource mechanisms, family and school contexts, and within-child mechanisms were identified. Facilitating mechanisms included motivation, personality/psychological characteristics, understanding and trust of the treatment process, experience of speaking with less effort, and self-efficacy. Impeding mechanisms included reduced motivation, impeding personality/psychological characteristics, lack of buy-in, and, for some children, a prohibitive cost of effort in using learned strategies.
A preliminary program theory was hypothesized which will be further developed in future analysis of data obtained from children and parents who participated in the CSP-SC at the same centre from which the SLPs came. Subsequent research with new cohorts of SLPs, children, and parents from other treatment programs and centres will be needed to establish the generalizability of the program theory generated in this program of research.
本研究启动了一项旨在为学龄期儿童开发综合认知行为流畅性增强口吃治疗的基础理论的研究计划。该研究旨在探讨治疗方案中哪些因素（或不起作用）对谁、在什么情况下、为什么起作用。
采用批判现实主义评估方法，七位具有丰富治疗口吃儿童经验的言语语言病理学家（SLP）被要求根据全面口吃治疗计划-学龄儿童（CSP-SC）的背景，讨论治疗效果的最佳结果的障碍和促进因素。从这些数据中，推导出离散的资源机制、儿童推理机制内的治疗和 SLP 资源机制、家庭和学校背景以及内在机制，并提出了初步的方案理论。
确定了促进和阻碍儿童生理、治疗和 SLP 资源机制、家庭和学校背景以及儿童内在机制的因素。促进因素包括动机、个性/心理特征、对治疗过程的理解和信任、说话省力的体验以及自我效能感。阻碍因素包括动机降低、阻碍个性/心理特征、缺乏参与、以及对于一些儿童来说，使用所学策略的努力成本过高。
假设了一个初步的方案理论，该理论将在未来对来自同一中心的参与 CSP-SC 的儿童和家长的数据进行分析中进一步发展。需要对来自其他治疗计划和中心的新 SLP、儿童和家长进行后续研究，以确定在该研究计划中生成的方案理论的普遍性。
