What’s important in AAC decision making for children? Evidence from a best–worst scaling survey

Abstract

The choice of which AAC device to provide for a child can have long lasting consequences, but little is known about the decision-making of AAC professionals who make recommendations in this context. A survey was conducted with AAC professionals using best–worst scaling methodology examining what characteristics of children and attributes of AAC devices are considered most important in decision-making. A total of 19 child characteristics and 18 device attributes were selected by the authors from lists generated from literature reviews and from focus groups with AAC professionals, people who use AAC, and other stakeholders. The characteristics and attributes were used to develop two best–worst scaling surveys that were administered to 93 AAC professionals based in the UK. The relative importance of characteristics/attributes was estimated using statistical modelling. Child characteristics related to language and communication, cognitive and learning abilities, and personality traits were generally found to be more important than physical features. Communication, language, and interface-related AAC device attributes were generally more important than hardware and physical attributes. Respondent demographics (e.g., experience, professional background) did not seem to influence the importance assigned to device characteristics or attributes. Findings may inform both future quantitative research into decision-making and efforts to improve decision-making in practice.

Keywords:

• Clinical decision-making
• AAC recommendations
• best–worst scaling
• stated preference

Acknowledgement

The views expressed are those of the authors, and not necessarily those of the NHS, the NIHR, or the Department of Health. We would like to thank Communication Matters for assistance in recruitment, Muireann McCleary and the Speech and Language Therapy team at the Central Remedial Clinic who piloted and gave feedback on the survey, and participants who responded to the survey.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Case 1, also known as object case, distinguishes our method from the closely related methods of BWS Case 2 (or profile case) and BWS Case 3 (or multi-profile case); for more information about the latter two see Cheung et al. (2016).

2 Note: “characteristic” is used rather than “attribute” for children because it better represents person-first inclusive language; however, this does not imply a meaningful distinction between characteristics and attributes in terms of BWS methodology.

3 Sawtooth is a product of Sawtooth Software, Inc., Provo, Utah, United States, www.sawtoothsoftware.com

4 Online Surveys is a product of Jisc, Bristol, United Kingdom, www.onlinesurveys.ac.uk

Additional information

Funding

This project was funded by the NIHR Health Services and Delivery Program (project 14/70/153). Stephane Hess acknowledges additional support by the European Research Council through the consolidator grant 615596-DECISIONS.