A task-shifted speech therapy program for cleft palate patients in rural Nepal: Evaluating impact and associated healthcare barriers
| Autor: | Shiba Kala Rai, Pramila Shakya, Hema Chaudhary, Michael M Lindeborg, Bhawani Pradhan, David A. Shaye, Naina Mahato, Nilam Shrestha, Phana Rokaya, Kabita Bhattarai Gurung, Shankar Man Rai, Carole D. Mitnick, Dhana Kumari Khorja, Renuka Shrestha, Bhagwati Gaire, Januka Tamang, Hemanta Dhoj Joshi, Pushpa Gaha, Lila Rana, Kiran Nakarmi, Badri Rayamajhi, Suman Niroula |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Speech Therapy Health Services Accessibility Speech Disorders Speech therapy Task (project management) Postoperative Complications Nepal Intervention (counseling) Health care otorhinolaryngologic diseases Humans Medicine Single-Blind Method Child Qualitative Research business.industry Surgical care General Medicine Focus group Biosocial theory Cleft Palate Treatment Outcome Otorhinolaryngology Child Preschool Family medicine Pediatrics Perinatology and Child Health Female Speech deficits business Follow-Up Studies |
| Zdroj: | International Journal of Pediatric Otorhinolaryngology. 134:110026 |
| ISSN: | 0165-5876 |
| Popis: | Though access to surgical care for cleft lip/palate has expanded in low- and middle-income countries (LMICs), post-palatoplasty speech therapy is often lacking due to limited healthcare infrastructure and personnel. This mixed-methods study seeks to: 1) evaluate the impact of task-shifted speech therapy on a standardized speech score; 2) describe the experiences of families with post-operative cleft care and associated barriers; and 3) understand how to optimize cleft care by exploring the experiences of children who had nominal improvements after task-shifted speech therapy.A convergent parallel mixed-methods study was conducted in Nepal. Standardized speech scores were compared by a blinded speech-language pathologist before and after the speech intervention. Semi-structured interviews (SSIs) and focus groups with families evaluated cleft care experiences and barriers. Qualitative and quantitative data were merged and analyzed.Thirty-nine post-palatoplasty children with speech deficits (ages 3-18) underwent task-shifted speech therapy, and demonstrated significant improvements in composite speech scores targeted by exercises (p0.0001) and weakness (p=0.0002), with improvements in misarticulation (p=0.07) and glottal stop (p=0.05) that trended towards significance. Forty-seven SSIs demonstrated that the greatest barriers to follow-up were family responsibilities (62%), travel/distance (53%), and work (34%). In five focus groups, families expressed a desire to improve their child's speech and seek formal speech therapy. The speech intervention was found to be beneficial because of the compassionate staff, free lodging/food, and ability to socialize with other cleft patients and families. After merging quantitative and qualitative data, we noted that younger children between 3 and 5 years old and families who traveled greater distances for healthcare access benefited less from the speech therapy intervention.Task-shifted speech therapy has the potential to improve cleft lip/palate speech in LMICs. Multiple biosocial issues limit access to appropriate post-operative care. |
| Databáze: | OpenAIRE |
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