A qualitative study exploring the effect of communicating with partially intelligible speech

Figures & data

Table 1. Participant demographics, including age, condition, and intelligibility as classified by their speech-language therapist; and current SGD use.

Participant	Disability	Age	Intelligibility (as defined at recruitment)	SGD use	Communication method (s) used during interview	Communication partner
1	Cerebral palsy	28	Partial	None	Speech	Family member
2	Cerebral palsy	43	Partial	None	Speech	None
3	Head injury	46	Partial	None	Speech	Family member
4	Cerebral palsy	38	Partial	None	Speech	Family member
12	Cerebral palsy	36	Partial	None	Speech	Family member, Personal support assistant
10	^a	31	Partial	SL40^b/Grid2^c	Speech, SGD	Personal support assistant
6	Cerebral palsy	12	Unintelligible	Vmax^d	Speech, vocalization, SGD	Family member
8	Cerebral palsy	41	Unintelligible	Vantage^e	Speech, SGD	Family members
9	Cerebral palsy	29	Unintelligible	Liberator (LLL)^f	Speech, vocalization, SGD	Family member
11	Cerebral palsy	25	Unintelligible	Tellus^g	Speech, vocalization, SGD	Family member

SGD: speech-generating device.

^aThis participant did not declare disability, which was not a requirement for the study

^bSL40 was a product of Abilia, https://www.abilia.com.

^cGrid2 is a product of Smartbox AT, http://www.thinksmartbox.com, and can be used on Windows based devices.

^dVMax was a product of TobiiDynavox, https://www.tobiidynavox.com/

^eVantage was a product of Liberator, https://www.liberator.co.uk/

^fLiberator (LLL), LLL is a language package available from Liberator https://www.liberator.co.uk/

^gTellus is a product of Techcess, https://www.techcess.co.uk/

Figure 1. Model of communication with partially intelligible speech.

Table 2. Themes and Subthemes Forming Explanatory Model.

Theme	Subtheme	Subtheme notes made by researchers	Explanatory Model
Considerations Around VOCA (Voice Output Communication Aid) Use	Access (to VOCA) considerations	Where physical use of the device (as opposed to usability) is a constraint/consideration	How shall I communicate?
	Negative perceptions of VOCA use	Participants negative perceptions of VOCA use	Shall I communicate: Who is communication partner?
			Communication loop
	Positive perception of VOCA use	Participants’ positive perceptions of VOCA use	Shall I communicate: Who is communication partner?
			Communication loop
	Practicing VOCA use	Perceptions of the need to practice or learn the device	How shall I communicate?
	Specific strategies of VOCA use	Personal choices/characteristics of VOCA use (that imply successful use)	How shall I communicate: How do I prefer to communicate?
			Communication loop
	Usability considerations	Considerations/constraints around device usability (i.e., the operation and functions of the device	Shall I communicate: How much time is available?
Conversational Examples	Breakdown and recovery in conversation	Breakdowns in conversation (initiated by speech or other method) and repaired using various methods	Shall I communicate: Who is the communication partner?
			Communication loop
	Communication partner interventions	Situations where the communication partner has supported the communication	Shall I communicate: Who is the communication partner?
Person	Experience of VOCA use	Past experience of VOCA use	How shall I communicate: How does my personality affect my communication?
			Communication loop
	Highly motivated to communicate	Participants demonstrating motivation to communicate	Shall I communicate: Is the Message Important Enough?
			How shall I communicate: How does my personality affect my communication?
			Communication loop
	Other people’s perceptions of individual’s communication	Comments on how other people (usually unfamiliar) respond to participants communication	Shall I communicate: Who is the communication partner?
			How shall I communicate: How does the situation affect my communication?
			Communication loop
	Supportive Communicative Environment	Where a supportive environment as a reason for success is referenced	How shall I communicate: How does the situation affect my communication?
			Communication loop
Role and Context of VOCA use	Decision making Around When to NOT use VOCA	Where the participant decides not to use VOCA	How shall I communicate?
			Communication loop
	Decision making re: when to use VOCA	When the participant decides to use VOCA	How shall I communicate?
			Communication loop
	Use of VOCA after other methods (backup)	When VOCA is used as “last resort” or after attempts with speech, other methods	How shall I communicate: How important is the message?
			Communication loop
	Use of VOCA as main or preferred method	Examples where participants use, or prefer to use, their VOCA as their main/predominate method	How shall I communicate: How do I prefer to communicate?
	Use of VOCA in specific environments	Specific environments refers to particular places where the participant communicates	How shall I communicate: How does the situation affect my communication?
			Communication loop
	Use of VOCA in specific situations	Specific environments refers to particular circumstances where the participant communicates	How shall I communicate: How does the situation affect my communication
			Communication loop
	Use of VOCA with specific people	Specific environments refers to particular people the participant communicates with	Shall I communicate: Who is communication partner?
			Communication loop
	Difficulty in introflection around VOCA use	Where participants discuss the difficulty in considering their communication/AAC/VOCA use	Shall I communicate?
			Communication loop
	Experience of communication breakdown with VOCA	Where participants discuss the effect of communication breakdown	How shall I communicate: How does the situation affect my communication?
			Communication loop
	Motivated to innovate with VOCA	Where participants demonstrate a desire to improve or innovate their use of their VOCA	How shall I communicate: How am I feeling?
	Potential for VOCA use	Participants perceptions of the potential benefits of using a VOCA - either the one they currently have, or could have	How shall I communicate?
	Rationale and motivation for use of VOCA	Rational for the reason a participant has chosen to use a VOCA	How shall I communicate?
			Communication loop
	Rationale and motivations for NOT using VOCA	Reasons for not using VOCA in situations/environments or generally	How shall I communicate?
			Communication loop
Use of Other Communication Methods	Communication partner interpretation	Experience of communication partner interpretation to support communication	Shall I communicate: Who is communication partner?
	Experience of breakdown of spoken communication	Experience of breakdown rather than recognition that breakdown occurs or solutions to breakdown	Shall I communicate?
	Non-aided strategies to support communication	Experience of alternative communication methods such as vocalizations, signs	How shall I communicate?
Rationale for Using Speech	Practice and therapy to improve speech	Identification of wanting to use speech to enable practice of or therapy for speech	How shall I communicate?
	Preference and strong motivation to use speech	Participants reflections on their preferences around speech	How shall I communicate: How do I prefer to communicate?
	Speed	Participants reflections on the speed of communicating with speech	Shall I communicate: How much time is available?
			How shall I communicate: How long will it take?
	Self-perceptions of speech	Participants reflections on their own speech in the context of communication	How shall I communicate: How do I prefer to communicate?
			How shall I communicate: How am I feeling?
	Recognition of difficulty with spoken communication	Participants reflections on the challenges with their own speech	Shall I communicate?
			Communication loop
	Use of other aided communication methods and media	Participants that use alternative aided systems (e.g., alphabet board) and media (e.g., email)	How shall I communicate?