Professionals’ decision-making in recommending communication aids in the UK: competing considerations

Figures & data

Table 1. Focus group demographics.

Focus group	Number of participants	Professional background
1	4	1 independent speech and language therapist
		1 specialist speech and language therapist
		2 teaching assistants
2	13^a	5 specialist speech and language therapists
		4 specialist clinical scientists
		3 specialist occupational therapists
		1 therapy assistant
3	3	1 specialist speech and language therapist
		1 specialist occupational therapist
		1 specialist healthcare scientist
4	5	1 local speech and language therapist
		1 local occupational therapist
		1 local physiotherapist
		1 specialist speech and language therapist
		1 specialist occupational therapist
5	4	2 local speech and language therapists
		1 specialist speech and language therapist
		1 specialist occupational therapist
6	2	1 local speech and language therapist
		1 specialist speech and language therapist

Each focus group was made up of the professionals involved in clinical decision-making for an individual child during a single assessment appointment (i.e., an appointment with a family that constituted all or part of a communication aid assessment).

^a During this focus group, the team operated using a prescription review model (Lindsay, 2010) with a smaller team assessing the child before consulting a larger specialized team for discussion and decision-making.

Table 2. Demographics of the children discussed by focus group participants (all names are pseudonyms).

Name/gender	Age (years)	Diagnosis	Type of assessment
Valerie (F)	5	Cerebral palsy (CP), ambulant, direct access for AAC	First communication aid
Naraah (F)	5	Physical disability and medical condition, wheelchair user, direct access for AAC	First communication aid
Indie (F)	18	Learning disability, features of autism spectrum condition (ASC) ambulant, direct access for AAC	Assessment for new communication aid following experience with a number of communication aids
Mark (M)	7	CP, wheelchair user, indirect access for AAC	Assessment for a second communication aid
Owen (M)	9	Physical disability and medical condition, wheelchair user, direct access	Assessment for a new communication aid following experience with a number of communication aids
Paul (M)	4	CP, wheelchair user, ASC features, AAC access via partner-assisted scanning and eye-gaze	Assessment for first communication aid
Noel (M)	5	CP, hearing impairment, wheelchair user, AAC access via partner-assisted scanning and eye-gaze	Assessment for first communication aid

Table 3. Global themes, organizing themes, and basic codes.

Global theme 1: competing characteristics	Global theme 2: cultural and contextual influencers^a
Organizing theme: Child characteristics	Organizing theme: Ways of working
Age	Balancing decisions
Assumed abilities	Basis for referral
Child preference	Extraneous factors
Communication ability	How decisions are made
Cognitive skills	Information brokering
Diagnosis	Inheriting decisions
Expectations and aspirations	Policy
Linguistic level	Roles and responsibilities
Motor abilities and operational competence	Service delivery model
Personality and temperament	Team theory
Progress and communication opportunities
Organizing theme: Access features	Organizing theme: Transitions
Access method	Future planning
Positioning and mounting	Technology change
Organizing theme: Communication aid attributes	Organizing theme: Available resources
Hardware aesthetics	Attitude
Hardware reliability	Cost
Hardware data storage and processing	Intervention
Software consistency and intuitiveness of design	Support
Software ease of editing	Team knowledge and skill
Software graphic representation	Training
Software vocabulary

^a Global theme 2: Cultural and contextual influencers is not discussed in this paper, but is the subject of a companion paper (Lynch et al., 2019).

Figure 1. An explanatory model of specialist professional AAC decision-making.

Lindsay, S. (2010). Perceptions of health care workers prescribing augmentative and alternative communication devices to children. Disability and Rehabilitation: Assistive Technology, 5, 209–222. doi:10.3109/17483101003718195

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Lynch, Y., Murray, J., Moulam, L., Meredith, S., Goldbart, J., Smith, M., … Judge, S. (2019). Decision making in communication aid recommendations in the UK: Cultural and contextual influencers. Augmentative and Alternative Communication,

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