A task-shifted speech therapy program for cleft palate patients in rural Nepal: Evaluating impact and associated healthcare barriers. (July 2020)

• Record Type: Journal Article
• Authors: Lindeborg, Michael M.; Shakya, Pramila; Pradhan, Bhawani; Rai, Shiba Kala; Gurung, Kabita Bhattarai; Niroula, Suman; Rayamajhi, Badri; Chaudhary, Hema; Gaire, Bhagwati; Mahato, Naina; Rana, Lila; Rokaya, Phana; Shrestha, Nilam; Shrestha, Renuka; Tamang, Januka; Joshi, Hemanta Dhoj; Gaha, Pushpa; Khorja, Dhana Kumari; Nakarmi, Kiran K.; Mitnick, Carole D.; Rai, Shankar Man; Shaye, David A.
• Is Part Of: International journal of pediatric otorhinolaryngology. Volume 134(2020:Jul.)
• Publication Date: 2020-07
• Subjects: Cleft palate -- Task shifting -- Speech therapy -- Low−/−middle income country -- Nepal; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Oto-rhino-laryngologie -- Périodiques; Pédiatrie -- Périodiques; 618.9209751
• DOI: 10.1016/j.ijporl.2020.110026
• Languages: English
• ISSNs: 0165-5876

Abstract

Abstract: Introduction: 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. Methods: 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. Results: 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 ( p<0.0001 ) 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. Conclusions: 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. Highlights: Task-shifted speech therapy can improve speech in cleft palate patients. Speech therapy provides an invaluable community network for families. Poverty and lack of outreach/care coordination are major barriers in Nepal. Task-shifted speech therapy can expand cleft care in low-income countries.