Speech and Hearing Sciences - Masters by Research Theses
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Item The development of a health communication passport for stroke(University College Cork, 2024) O'Leary, Norma; Kelly, Helen; O'Toole, CiaraIntroduction: The Irish National Stroke Strategy (2022-2027) (HSE, 2022) has recommended the introduction of a Stroke Passport. However, the perspectives of stakeholders on the purpose, design, format, and content of a stroke passport are not yet known. Moreover, given that a Stroke Passport can be categorised as a complex intervention, characterised by multiple interacting components and the need to modify established practices, it is crucial to examine current practices related to information provision across the stroke care continuum. Consequently, this study also seeks to investigate the methods currently employed by Healthcare Professionals (HCPs) to provide information to stroke patients and their families or caregivers. Additionally, it aims to identify the barriers and facilitators influencing information provision throughout the stroke care continuum from the perspective of HCPs. Methods: The study took place over two phases. A cross-sectional online survey initially explored the perceptions of HCPs working in stroke care in Ireland and UK. Focus groups interviews were then conducted with HCPs who worked in an acute stroke ward and/or Early Stroke Discharge (ESD) team. Phase one quantitative data was analysed using descriptive and inferential statistics. Qualitative survey data was analysed using content analysis mapped onto the Theoretical Domains Framework (TDF). Phase two interview data were analysed using Braun & Clark’s (2022) six-step Thematic Analysis framework. Results: The survey was completed by 111 HCPs (64% Ireland:36% UK). Wide variation in methods and terminology was noted. Differences across countries was observed relating to opinions about patient and family satisfaction with current information provision. There was consensus that information be provided at multiple care pathway timepoints and be available in both digital and paper formats. Phase two consisted of 22 HCPs who took part in one of the four focus groups (acute stroke ward n=19, ESD n=3). Participants included: Allied Health Professionals (n=10), Nursing staff (n=6), Medical doctors (n=3), Pharmacy (n=1), Psychology (n=1) and Medical Social Work (n=1). Findings suggest that a Stroke Passport, as a central source of information, has the potential to empower patients and family/caregivers. Participants offered suggestions regarding the ideal content, format, and timing of the provision of information. There was a general agreement that a Stroke Passport should be digital rather than paper based. They suggested that issues relating to data protection, longevity of the Stroke Passport, and user buy-in are more challenging with a paper version. Key factors were identified that pose potential obstacles to implementation. This includes a lack of digital infrastructure and the ability of Healthcare Information Systems (HIS) to communicate across systems (interoperability). In addition, the identification of the HCP(s) who would take responsibility for updating the Stroke Passport beyond acute care was considered a necessary component to successful implementation. Conclusion: The provision of a resource such as a Stroke Passport was considered an important asset to patient care. Our findings emphasise the critical role of co-design in its development to better address the complex needs of stroke patients, improving outcomes, satisfaction, and engagement. However, greater attention to addressing current gaps in our stroke healthcare system, particularly digital infrastructure, and interoperability, during the transition from hospital to home is required prior to implementation of a Stroke Passport.Item Using Lámh signs in mainstream primary schools: an application of the COM-B model(University College Cork, 2024) Sheehan, Michaela; Frizelle, Pauline; O'Toole, CiaraBackground: Children with speech, language and communication needs (SLCN) attending mainstream primary schools often rely on key word sign systems (KWS) such as Lámh to support their communication. However, the success of KWS systems will depend on the consistency in which communication partners use signs and the potential for changing their behaviour in a positive light. In this case, communication partners include teachers and special needs assistants (SNAs) as they most frequently interact with children in school. One model developed to change people’s behaviour is the Capability, Opportunity, Motivation and Behaviour (COM-B) model. In this study we apply the COM-B model, to explore how we can potentially increase the use of signing by teachers and SNAs in mainstream school by ascertaining what factors influence use of Lámh. This study will also examine what similarities and differences are evident in how these factors of capability, opportunity and motivation influence teachers’ compared to SNAs’ use of Lámh in the classroom setting. Method: Teachers (n= 55) and SNAs (n=36) who currently has or previously had a child who uses Lámh in their class in mainstream primary school participated in this study by completing an online questionnaire that targeted each of the components of the COM-B model. Four focus groups (n=16) were also held to explore the findings in further detail, 2 groups of teachers and 2 groups of SNAs. Data was collected in the latter half of the academic year and subsequently analysed using descriptive statistics and qualitative content analysis, employing a deductive approach based on the theoretical framework of the COM-B model. Results: There are numerous factors within the components of the COM-B model that impact teachers and SNAs use of Lámh in the school environment. Overall, teachers and SNAs indicated that they would need increased psychological capability, specifically 65% stated they would need to know how to integrate Lámh, 62% would need increased knowledge of the importance and benefits of Lamh and 59% would need a supportive environment. Eighty five percent of teachers and SNAs noted that they required the materials to support their use of Lámh and 78% of participants felt triggers and reminders would be a relevant component of physical opportunity. Social opportunity in the form of support from others and use of Lámh by others were central to the establishment of a whole school approach to using Lámh. Both reflexive and automatic components of motivation were important factors, specifically developing the habit of signing (87%) having to feel the desire to (84%). Finally, there were numerous barriers encountered by staff, including time and training which can be classified within physical opportunity and psychological capability. Overall, teachers and SNAs demonstrated similar levels of responses across the subcomponents of the COM-B model. Some differences were evident in social opportunity, reflexive motivation and psychological capability specifically. Conclusion: The application of the COM-B model has identified what components require attention when considering effective behaviour change relating to teachers and SNAs use of Lámh in the mainstream environment. To increase signing in a mainstream school environment and alter the behaviour of teachers and SNAs, the components outlined need to be addressed. The findings of this study will help inform the content of a school specific Lámh training course and resources for teachers and SNAs working with Lámh users in a mainstream environment.Item Profiling the meaningful reading habits of young people and adults with Down syndrome(University College Cork, 2023) Jolley, Mary; Frizelle, Pauline; O'Toole, Ciara; Hart; Hart, Nicola; University College CorkIntroduction: Given the technological advancements over the last 20 years, the impact of how we use written language in society and therefore the ability to read is particularly pertinent for people with Down syndrome. Adults with Down syndrome are now more than ever, accessing their communities, further education and employment. All of these facets of daily life can require aspects of reading, such as the ability to read street signs, text messages or work contracts. However, to date, no large scale, international study has profiled the reading habits of adults with Down syndrome in everyday contexts, or how they feel about reading. This information is invaluable as it can inform reading interventions which are functional to adults with Down syndrome; thus, having a meaningful impact on their quality of life. Aim: This study aimed to 1) Explore the reading habits of adults with Down syndrome, informed by the priorities of adults with Down syndrome themselves 2), Gather a large, international profile of meaningful reading for young people and adults with Down syndrome using a valid Meaningful Reading Measure (MRM) (Frizelle et al., 2023) and 3), Investigate whether age, education and place of residence influence meaningful reading for people with Down syndrome. Method: The research was carried out in two phases. Phase-1: Research questions for the study were prioritised and refined following a structured focus group of adults with Down syndrome (n=9). Phase-2: Using a combination of online survey and paper forms, data on the meaningful reading habits of people with Down syndrome were gathered using the MRM. The refined research questions were then addressed. Results: Phase-1 Results: The focus group members prioritised research questions such as whether people with Down syndrome liked reading, and what they felt was difficult or the ‘best thing’ about reading. They indicated an interest in those questions that referred to the impact of age and place of residence on meaningful reading. Phase-2 Results: Ninety-eight people with Down syndrome completed the survey. On average, the participants read 34 of the 46 items in the MRM. Scores ranged from 0-46. The most common item read by the sample was cards and food brands and the most common medium for reading was a tablet or computer (45.3%). The most common reason for reading was to pursue personal learning and interests. Many people with Down syndrome felt that reading novel or complex words was difficult and detailed the various challenges they faced with reading. No relationship between age and MRM score was observed. Younger individuals (aged 16-25) read significantly more new media items (p = .007) than older individuals (aged 26-37). Conclusion: Adults with Down syndrome read a variety of different items in everyday contexts, which are not dissimilar to typical populations. The participants in the study provided a unique insight into the challenges they face with reading; such as the accessibility of texts, complex words, and reading comprehension. In addition, it is evident that reading for both functional use and pleasure is focal in the lives of people with Down syndrome. This information can inform future reading interventions which are motivating, functional and meaningful for people with Down syndrome.Item The development of a core school-based Lámh vocabulary to facilitate effective communication between children with Down syndrome and their communication partners in the first year of mainstream primary school(University College Cork, 2021-01-08) Lyons, Caoimhe; Frizelle, Pauline; Irish Research CouncilBackground: In Ireland, the entry-level key word sign (KWS) training for teachers and school staff is the Lámh Module 1 training course, which does not contain vocabulary specifically chosen to support school-age Lámh users. However, if KWS is to be used successfully by children with Down syndrome (DS) in a mainstream school environment, it is essential that communication partners have access to a meaningful, contextually appropriate sign vocabulary. Aim: To identify the Lámh vocabulary needs of children with DS and their communication partners over the course of the first year of mainstream primary school, with the aim of developing a core school-based Lámh vocabulary. Method: Five key groups contributed signs to the core vocabulary: participants with DS in junior infants (n=6), their teachers (n=5), special needs assistants (n=8), and peers (n=9), and the researcher (a Speech and Language Therapist). The researcher contributed signs based on observations of the classroom, the participants with DS contributed signs during guided tours of the school environment, and the teachers, SNAs and peers contributed signs by means of structured interviews. This data collection took place at four time points over the school year. Signs were considered to be part of the core vocabulary if they were contributed five times or more over the course of the year, and by three or more of the groups. Results: The core school-based Lámh vocabulary contained 140 words, including 132 Lámh signs and eight words that do not currently have a Lámh sign. Only 55 (39%) of the 140 signs recommended as core vocabulary for schools are part of the training currently most commonly accessed by school staff. The remaining 77 signs (55%) are part of more advanced training. Conclusion: The current study provides new insights into the complex process of vocabulary selection for children who use Lámh in a mainstream school environment. In addition, it highlights the importance of access to a functional sign vocabulary in facilitating an inclusive approach to education, and enhanced communicative practice by all of those engaging with children with DS in mainstream primary school.Item Predicting expressive vocabulary change in young children growing up in Ireland(University College Cork, 2018-06) Bowles, Caoimhe; O'Toole, Ciara; Lee, AliceDuring the preschool years expressive vocabulary development is highly variable, which makes it difficult for healthcare and education professionals to identify children with delays that require early intervention services. Previous research has highlighted the need to identify a reliable set of risk and protective factors which predict expressive vocabulary outcomes. The current study explored patterns of expressive vocabulary development between 3 and 5 years using a large population-based sample of 8,266 children. Expressive vocabulary was measured using the naming vocabulary subtest of the British Abilities Scales (BAS) and information relating to additional risk factors was gathered through questionnaires with the primary caregiver. Four patterns of expressive vocabulary development were identified, 89.9% of children had no expressive vocabulary delay, 2.8% of children were delayed at 3 years only (resolving delay), 5.0% were delayed at 5 years only (late onset delay) and 2.3% had a persisting expressive vocabulary delay. Five factors differentiated between the no delay and late onset delay groups. These factors were, learning English as an additional language, low parent education levels, low frequency of book reading, low frequency of home learning activities and few children’s books in the home. Learning English as an additional language was the only factor which differentiated between resolving delay group and children with a persisting delay. The information gleaned from the current study has implications for clinical practice and identifies the need for a service delivery model which incorporates monitoring over time and providing intervention on the basis of language abilities and associated risks.