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! The!'Acceptability'!Of!Skype!Mediated ! ! The!‘acceptability’!of!Skype!mediated!Speech!and!Language!Therapy! provision!to!school!aged!language!impaired!children! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! Rebecca!Alison!Matthews! ! UCL! ! Doctorate!in!Clinical!Communication!Science! 1! ! Declaration! ! I,!Rebecca!Alison!Matthews,!confirm!that!the!work!presented!in!this!thesis!is!my!own.!! Where!information!has!been!derived!from!other!sources,!I!confirm!that!this!has!been! indicated!in!the!thesis.! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! Signed:! Date:!8th!June!2014! 2! ! Abstract! ! There!is!high!demand!for!Speech!and!Language!Therapy!but!even!with!initiatives!to! address!the!shortage!of!therapists,!Speech!and!Language!Therapy!services!struggle!to! satisfy!demand!O!teleOtechnology!could!be!a!solution.!!A!Speech!and!Language!Therapy! service! for! a! paediatric! caseload! using! a! desktop! videoOconferencing! system! (Skype)! was!established.!!A!pilot!study!with!three!participants!determined!the!feasibility!of!the! Skype!Speech!and!Language!Therapy!service!and!trialled!measures!of!clinical!activity,! therapistOchild! interaction,! technological! utility,! and! costs.! ! Eleven! participants! aged! between!7!and!14!years!with!varying!therapy!needs!took!part!in!the!main!study.!!Each! received!a!mix!of!faceOtoOface!(F2F)!and!Skype!Speech!and!Language!Therapy!over!the! ten!session!trial!period.!!Data!were!collected!for!every!session!using!a!session!profile;! adults!supporting!the!children!were!asked!for!their!views!using!a!questionnaire!at!the! beginning!and!end!of!the!trial;!the!child!participants!were!interviewed!after!the!trial! period! was! over;! one! F2F! and! one! Skype! session! was! video! recorded! for! each! participant;! work! activity! was! recorded! along! with! identifiable! costs! of! the! F2F! and! Skype!Speech!and!Language!Therapy!sessions!!!! ! The! level! of! clinical! activity! was! equivalent! between! F2F! and! Skype! Speech! and! Language! Therapy! sessions,! with! parents! reporting! positive! views! concerning! Skype! intervention,! and! growing! acceptance! of! Skype! interaction.! !The! analysis! of! the! therapistOchild!interaction!showed!broadly!similar!patterns!between!the!Skype!and!F2F! sessions,!with!the!exception!on!the!use!of!requests,!clarifications,!acknowledgements! and! confirmations! where! differences! were! observed.! ! Technological! utility!was! acceptable! with! minimal! audio! and! visual! distortions.! ! Costs! for! Skype! Speech! and! Language! Therapy! were! substantially! lower! than! the! F2F! sessions.! !This! research! showed! that,! for! the! families! participating! in! this! research,! Speech! and! Language! Therapy!services!delivered!using!teleOtechnology!can!provide!an!acceptable!alternative! to!F2F!intervention.!! ! ! 3! ! Table!of!Contents! ! Declaration! ! ! ! ! ! ! ! ! ! 2! ! Abstract! ! ! ! ! ! ! ! ! ! 3! ! List!of!Tables! ! ! ! ! ! ! ! ! ! 9! ! List!of!Figures! ! ! ! ! ! ! ! ! ! 11! ! Acknowledgements! ! ! ! ! ! ! ! ! 15! ! Chapter!1! Introduction! ! ! ! ! ! ! ! 16! !! ! 1.1! Acceptability!for!a!Speech!and!Language!Therapy!! ! ! service!using!Skype! ! ! ! ! ! ! 16! ! 1.2! Research!Questions! ! ! ! ! ! ! 17! ! 1.3! Research!Design! ! ! ! ! ! ! 18! ! 1.4! Research!Method! ! ! ! ! ! ! 19! ! 1.5! Research!Results! ! ! ! ! ! ! 20! ! 1.6! Conclusion! ! ! ! ! ! ! ! 20! ! Chapter!2! Literature!Review! ! ! ! ! ! ! 22! ! ! 2.1! Current!Issues!Delivering!Speech!and!Language!Therapy!! ! ! Services!in!the!UK! ! ! ! ! ! ! 22! ! ! 2.1.1! Size!of!Profession! ! ! ! ! !!!! 22 ! ! 2.1.2! Size!of!Service!Demand! ! ! ! ! 23 ! ! 2.1.3! Service!Delivery!Solutions! ! ! ! ! 23 ! ! 2.1.4! Personnel!Retention! ! ! ! ! ! 24 ! 2.2! TeleOtechnology! ! ! ! ! ! ! 25 ! ! 2.2.1! TeleOmedicine!! ! ! ! ! ! 26 ! ! 2.2.2! Service!Activity!using!TeleOtechnology! ! ! 27 ! ! 2.2.3! Descriptive!Terminology! ! ! ! ! 26 ! 2.3! The!Experience!of!Other!Health!Professions!!! ! ! 28 ! ! Using!TeleOtechnology! ! ! ! ! ! ! ! 2.3.1! Identified!Benefits! ! ! ! ! ! 28 ! ! 2.3.2! Identified!Drawbacks! ! ! ! ! ! 29 ! ! 2.3.3! Addressing!the!Drawbacks! ! ! ! ! 29! ! 2.4! TeleOtechnology!use!to!provide!Speech!and!Language!Therapy! 30! ! ! 2.4.1! Locating!the!Literature! ! ! ! ! 32! ! ! ! 2.4.1.1!Establishing!Criteria!for!Inclusion!in!this!Literature! ! ! ! ! ! Review!! ! ! ! ! ! 32! ! ! 2.4.2! Overview!of!TeleOtechnology!used!to!provide!! ! ! ! Speech!and!Language!Therapy! ! ! ! 33! ! ! ! 2.4.2.1!Range!of!teleOtechnology!used! ! ! 34! ! ! ! 2.4.2.2!Range!of!client!groups!and!service!activity! ! 35! ! !2.5! Evaluation!of!Speech!and!Language!Therapy!Services!! ! ! using!teleOtechnology!! ! ! ! ! ! 43! 4! ! ! ! 2.5.1! Feasibility! ! ! ! ! ! ! 44! ! ! 2.5.2! Acceptability! ! ! ! ! ! ! 45! ! ! 2.5.3! Cost! ! ! ! ! ! ! ! 46 ! 2.6! Appraisal!of!the!Research! ! ! ! ! ! 47! ! 2.6.1! Methods!used!by!other!research!into!Speech!! ! ! and!Language!Therapy!provided!using!teleOtechnology! 47! ! ! 2.6.2! Drawbacks!with!the!Research!Methods!used! ! 51! ! ! ! 2.6.2.1!Specific!Measures! ! ! ! ! 51! ! 2.7! Factors!impacting!on!the!use!of!teleOtechnology!to!provide!! ! ! ! Therapy! ! ! ! ! ! ! ! 54! 2.7.1! American!Therapist!View!of!TeleOtechnology! ! 54 ! 2.7.2! Professional!Barriers! ! ! ! ! ! 55 ! 2.7.3! Technology!Barriers!! ! ! ! ! ! 56 ! 2.7.4! Clinical!Barriers! ! ! ! ! ! 56 ! ! 2.7.4.1!Interaction!and!Rapport! ! ! ! 56 ! ! 2.7.4.2!Time! ! ! ! ! ! ! 59 ! 2.7.5! Cost!Barriers! ! ! ! ! ! ! 60! ! 2.8! A!UK!Survey!of!Therapist!Working!Practice!and!Attitude!to!the! ! ! use!of!TeleOtechnology!to!provide!Speech!and!Language!Therapy! 60! ! ! 2.8.1! Survey!Methodology! ! ! ! ! ! 61! ! ! ! 2.8.1.1!Participant!Recruitment! ! ! ! 61! ! ! ! 2.8.1.2!Survey!Design!Measure! ! ! ! 62! ! ! 2.8.2! UK!Therapist!Working!Practice! ! ! ! 63! ! ! 2.8.3! UK!Therapist!Knowledge!and!Attitude!to!! ! ! ! videoOconferencing! ! ! ! ! ! 65! ! 2.9! Conclusion! ! ! ! ! ! ! ! 66! 2.9.1! Acceptability!from!the!Therapist!Perspective! ! 67! ! Chapter!3! Designing!a!Speech!and!Language!Therapy!Service!! ! ! Delivered!Using!Skype! ! ! ! ! ! 70! ! ! ! 3.1! Location! ! ! ! ! ! ! ! 70! ! 3.2! Caseload! ! ! ! ! ! ! ! 71! ! ! 3.2.1! Age! ! ! ! ! ! ! ! 71! ! ! 3.2.2! Medical!Aetiologies! ! ! ! ! ! 72! ! ! 3.2.3! Communication!Impairments!Treated!! ! ! 72! ! 3.3! Speech!and!Language!Therapy!Intervention!Offered! ! 73! ! 3.4! Practice!Activity! ! ! ! ! ! ! 74! ! 3.5!! Practice!Improvement! ! ! ! ! ! 75! ! 3.6! Issues!to!Address!for!Speech!and!Language!Therapy!Service!! ! ! using!videoOconferencing!! ! ! ! ! ! 76! ! ! 3.6.1! Professional!Issues! ! ! ! ! ! 76! ! ! 3.6.2! TeleOtechnology!Issues! ! ! ! ! 78! ! ! ! 3.6.2.1!VideoOconferencing!Systems! ! ! ! 78! ! ! ! 3.6.2.2!Protocols! ! ! ! ! ! 79! ! ! ! 3.6.2.3!Training! ! ! ! ! ! 80! ! ! 3.6.3! Clinical!Issues! ! ! ! ! ! ! 80! ! ! ! 3.6.3.1!Patient!Suitability! ! ! ! ! 80! ! ! ! 3.6.3.2!Session!Format! ! ! ! ! 81! 5! ! ! ! ! 3.6.3.3!Clinical!Administration!of!Sessions! ! ! 82! ! ! ! 3.6.3.4!Clinical!Equipment! ! ! ! ! 82! ! ! ! ! 3.6.3.4.1&Equipment&Adaptation& & & 83& & & & & 3.6.3.4.2&Equipment&Management&&& & & 85& & & & & 3.6.3.4.3&Infra&Structure& & & & 85& & & & & 3.6.3.4.4&Reward&Adaptation&& & & 86& ! ! 3.6.4! Cost!Issues! ! ! ! ! ! ! 87! ! ! ! 3.6.4.1!TeleOtechnology!Equipment! ! ! ! 87! ! ! ! 3.6.4.2!Clinical!Materials!Management! ! ! 88! ! ! ! 3.6.4.3!Session!Charges! ! ! ! ! 88! ! 3.7! Conclusion! ! ! ! ! ! ! ! 89! ! Chapter!4! Methods! ! ! ! ! ! ! ! 90! ! 4.1! Research!Design! ! ! ! ! ! ! 90! 4.2! Pilot!Study! ! ! ! ! ! ! ! 92! 4.3! Participants! ! ! ! ! ! ! ! 94! ! ! 4.3.1! Participant!Selection!! ! ! ! ! ! 94! ! ! 4.3.2! Inclusion!Criteria! ! ! ! ! ! 95! ! ! 4.3.3! Participant!Invitation!Process!! ! ! ! 96! ! ! 4.3.4! Participant!Background! ! ! ! ! 97! ! ! 4.3.5! Participants!not!recruited! ! ! ! ! 104! ! ! 4.3.6! Session!Attendance!and!Drop!Out! ! ! ! 105! 4.4!! Measures! ! ! ! ! ! ! ! 106! ! ! 4.4.1! Development!of!Session!Profile!Measure! ! ! 106! ! ! ! 4.4.1.1!Clinical!Activity!! ! ! ! ! 107! ! ! ! 4.4.1.2!Technology! ! ! ! ! ! 107! ! ! ! 4.4.1.3!Participation! ! ! ! ! ! 108! ! ! ! 4.4.1.4!!Therapist!Work!Activity/Cost!! ! ! 109! ! ! 4.4.2! Session!Profile!Summary! ! ! ! ! 111! ! ! 4.4.3! Development!of!Questionnaire!Measure! ! ! 115! ! ! 4.4.4! Questionnaire!Scoring! ! ! ! ! 118! ! ! 4.4.5! Development!of!the!Child!Interview!Measure! ! 119! ! ! 4.4.6! Development!of!Interaction!Measure! ! ! 122! ! ! ! 4.4.6.1!Video!Recording!Process! ! ! ! 123! ! ! ! 4.4.6.2!Development!of!Transcription!and!! Discourse!Coding!Process! ! ! ! 124! 4.5! Procedures! ! ! ! ! ! ! ! 132! ! ! 4.5.1! Session!Profile,!Questionnaires!and!Interview!Measures!! Data!Collection! ! ! ! ! ! 134! ! ! 4.5.2! Interaction!Measure!Data!Collection!! ! ! 136! ! ! 4.5.3! Data!Storage! ! ! ! ! ! ! 138! ! Chapter!5! Results!! ! ! ! ! ! ! ! 139! ! ! 5.1! Session!Profile!Results! ! ! ! ! ! 139! ! ! 5.1.1! Clinical!Activity! ! ! ! ! ! 140! ! ! 5.1.2! Technology! ! ! ! ! ! ! 140! ! ! 5.1.3! Participation! ! ! ! ! ! ! 142! 6! ! ! ! 5.1.4! Cost! ! ! ! ! ! ! ! 143! ! 5.2! Questionnaire!Results!! ! ! ! ! ! 145! ! ! 5.2.1! Computer!Competence! ! ! ! ! 145! ! ! 5.2.2! Pre!and!Post!Views!of!Skype!Therapy! ! ! 146! ! ! 5.2.3! Pre!and!Post!Views!on!the!Skype!Technology!! ! 148! ! ! 5.2.4! Pre!and!Post!Views!on!the!interaction!in!the!Skype!! ! ! ! Therapy!! ! ! ! ! ! ! 149! ! ! 5.2.5! Pre!and!Post!Views!on!Clinical!Activity!! ! ! 150! ! ! 5.2.6! Acceptance!of!the!Skype!Therapy!Sessions! ! ! 151! ! ! 5.2.7! Expanded!Questionnaire!Answers! ! ! ! 152! ! 5.3! Child!Interview!Results! ! ! ! ! ! 155! ! ! 5.3.1!! Child!Participant!Computer!Competence!
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