Harsha Kathard

Promoting change through political consciousness: a South African speech-language pathology response to the World Report on Disability.

Abstract In the context of the World Report on Disability, 34 question how speech-language pathologists (SLPs) change practices to benefit under-served people with communication disability. This commentary provides a South African response premised on Political Consciousness. In South Africa, a grossly unequal society, the under-served population is not only those with communication disability but also include those who are at a communication disadvantage due to disabling conditions. As a consequence of the combined effects of a severe shortage of SLPs as well as maldistribution in service provision, the under-served are mainly poor Black South Africans who are the majority population. Political Consciousness allows one to examine how selected forces at the macro-level, meso-level, and micro-level may enable or limit services to the under-served majority. At a macro-level, this study appraises policies and actions advancing and impeding service delivery. At the meso-level it is argued that hegemonic professional knowledge is limiting and an equity-driven population-based approach is advocated. At a micro-level, the Relationship of Labouring Affinities is offered as a conceptual tool for critical engagement. In conclusion, it is suggested that the speech-language pathology profession must collectively become political actors at all levels to effect change.

On becoming someone: Self-identity as Able

This paper illuminates the nature of and processes shaping self-identity formation as Able for People Who Stutter (PWS). It responds to the question: How have adults who stuttered over their life courses created understanding of themselves as Able? Seven participants between 19 and 65 years shared life course stories of living with stuttering. Data was generated through biographical narrative life history interviews and analysed at two levels. The first level narrative analysis yielded seven research stories which were subjected to a secondary level inductive, cross-case analysis. The findings revealed that the genesis of self-identity as Able began early in childhood for some participants with significant others playing an important role in shaping an empowered sense of self. In addition, critical events, catalysts and turning points at different moments in life spurred the development of self-identity as Able. Self-identity trajectories were individual, non-linear and unfolded variably over the life course. Their trajectories were strengthened, reinforced and sedimented during adulthood through adopting enabling philosophies for self-development; constant resourcing and actioning; accepting stuttering; social validation and reconfiguring public narratives. As participants constructed themselves as Able they felt empowered to live successfully with stuttering. The clinical practice and research implications and limitations of the study are discussed.

Voices from the periphery: A narrative study of the experiences of sexuality of disabled women in Zimbabwe

abstract This article forms part of a larger biographical narrative study in which the experiences of sexuality of 16 Shona women with disability in Zimbabwe were explored. The purpose of this article is to use a single case, that of Tsitsi,to illuminate the intersectional nature of her experiences of sexuality. Her narrative is robust in illuminating the confluence of four themes found to be common across all the narratives of the larger study: 1) disregard and rejection; 2) health consequences of gendered sexual stigma; 3) gendered differences in experiences of disability; and 4) gendered cultural discourses on disability. These themes indicate that Tsitsi is located at the centre of a complex, intersecting web of gender, disability, culture and sexuality. Her experiences of sexuality occur in a context in which her disability interacts with normative gender roles and power relations within heteronormative practices and popular cultural constructions of disability; these contribute to her vulnerability to coercive sexual practices, resulting in her infection with HIV. Despite these challenges her determination and resilience emerge through her strong entrepreneurial effort, strategy and hope.

A Study of Teacher–Learner Interactions: A Continuum Between Monologic and Dialogic Interactions

PURPOSE Teachers and learners must be able to shift flexibly along the continuum of monologic and dialogic interactional repertoires to advance learning. This article describes how teachers and learners interacted during whole-class instruction along the continuum between monologic and dialogic interaction in primary school classrooms in Western Cape, South Africa. METHOD A video-observation method was used to analyze teacher-learner interactions (TLIs) across 15 lessons in intermediate-phase classrooms. TLIs were analyzed in relation to indicators such as authority, questions, feedback, explanation, metalevel connection, and collaboration. The transcriptions of TLIs were described using quantitative and qualitative techniques. RESULTS The study found that teachers sustained dominant monologic interactions by asserting their authority, asking mainly closed-ended questions, and providing confirming/correcting feedback that constrained the interaction. Learners had limited opportunities for explanations or collaboration. Across most lessons, there were episodic shifts from monologic TLIs to transitional TLIs. These transitions were achieved by using mainly open-ended questions and feedback to expand the interaction. Dialogic TLIs were not evident. CONCLUSIONS Monologic TLIs were dominant, closing down opportunities for communication. Although transitional TLIs were evident, they were episodic and showed the potential for opening interaction opportunities. The absence of dialogic TLIs suggested that collaborative engagement opportunities were unavailable. The opportunity for intervention to increase dialogic TLIs is discussed.

Clinical education in transition: Creating viable futures

The lead article illuminates the tensive intersections between theory and practice debates, traditional and new ways of educating, medical and social approaches to interventions as well as the multiplicity of social, economic and political forces currently shaping clinical education. The issues raised apply to South Africa. Clinical education in the speechlanguage pathology profession (henceforth referred to as the profession) is becoming increasingly difficult to sustain for many reasons. Among them:

Primary school teachers’ opinions and attitudes towards stuttering in two South African urban education districts

Background As teachers form an important part of the intervention process with children who stutter in primary school, the primary aim was to describe primary school teachers’ attitudes in South Africa. The secondary aim was to compare teachers’ attitudes towards stuttering in South Africa with those from a pooled group of respondents in the Public Opinion Survey of Human Attributes–Stuttering (POSHA-S) database from different countries collected in 2009–2014. Method A quantitative, cross-sectional survey research design was used. Primary schools in two education districts in Western Cape, South Africa, were sampled. The POSHA-S, a self-administered questionnaire, was completed by a cluster sample of 469 participants. Results Overall positive attitudes towards stuttering were found, specifically related to the potential of people who stutter, although the result should be interpreted with caution as the sample was not homogenously positive. Teachers still had misconceptions about personality stereotypes and the cause of stuttering. The attitudes of the South African sample were slightly more positive compared with the samples in the current POSHA-S database. Conclusion When developing stuttering intervention strategies, there are a number of key considerations to take into account. The study provides a basis for speech-language therapists to think about intervention with teachers and which areas of stuttering to consider.

To be or not to be: Stuttering and the human costs of being “un-disabled”

Purpose: The centrality of communicating in human life means that communication difficulties are experienced at a deeply personal level and have significant implications for identity. Intervention methods may interact positively or negatively with these experiences. Method: This paper explores this intersection in the case of stuttering, suggesting that some intervention styles may dovetail unhelpfully with the “mainstream” prizing of normalcy. In particular, most “western” societies offer a performance-oriented milieu which prizes efficiency, immediacy and competitiveness, diverting energy from the equally important work of understanding and integrating difference. Result: Given that a person who stutters speaks fluently and with a stutter, stuttering can lean toward a complex view of disability identity—being both able and disabled. This split repertoire invites psychologically costly efforts at being “un-disabled”. Conclusion: Interventions which amplify this tendency can contribute to an alienation from self amid strivings for normalcy.

Identifying a context-effective school hearing screening test: An emic/etic framework

Abstract Objective: To identify a context-effective hearing screening test for primary schools in the Western Cape, South Africa using an emic-etic framework for test selection. Design: A sequential mixed methods design was used to: (1) Identify test properties needed to successfully screen hearing in primary school children in the Western Cape, (2) select the hearing screening test most likely to succeed in this context, and (3) assess the use of the test in context. Study sample: Three nurses, two nursing assistants, two paediatric audiologists, and 100 grade-one children participated. Results: Distortion product otoacoustic emissions (DPOAEs) were identified as the test most likely to succeed as a hearing screening test in primary school children in the Western Cape. While school nurses were able to successfully apply OAE testing in this context, its sensitivity to hearing loss in these children was 57.14%. Conclusions: The sensitivity would need to be improved before OAE testing could be used as a context-effective screening test for primary school children in the Western Cape. The study demonstrated the value of collaborative program planning using an emic-etic framework to ensure that screening tests are contextually appropriate.

Health Sciences undergraduate education at UCT: A story of transformation

Undergraduate education and training in the Faculty of Health Sciences at the University of Cape Town has become socially responsive. A story of transformation that is consonant with wider societal developments since the 1994 democratic elections, outlining the changes in undergraduate curricula across the faculty, is presented.

First-language raters’ opinions when validating word recordings for a newly developed speech reception threshold test

Background The purpose of this study was to consider the value of adding first-language speaker ratings to the process of validating word recordings for use in a new speech reception threshold (SRT) test in audiology. Previous studies had identified 28 word recordings as being suitable for use in a new SRT test. These word recordings had been shown to satisfy the linguistic criteria of familiarity, phonetic dissimilarity and tone, and the psychometric criterion of homogeneity of audibility. Objectives The aim of the study was to consider the value of adding first-language speakers’ ratings when validating word recordings for a new SRT test. Method A single observation, cross-sectional design was used to collect and analyse quantitative data in this study. Eleven first-language isiZulu speakers, purposively selected, were asked to rate each of the word recordings for pitch, clarity, naturalness, speech rate and quality on a 5-point Likert scale. The percent agreement and Friedman test were used for analysis. Results More than 20% of these 11 participants rated the three-word recordings below ‘strongly agree’ in the category of pitch or tone, and one-word recording below ‘strongly agree’ in the categories of pitch or tone, clarity or articulation and naturalness or dialect. Conclusion The first-language speaker ratings proved to be a valuable addition to the process of selecting word recordings for use in a new SRT test. In particular, these ratings identified potentially problematic word recordings in the new SRT test that had been missed by the previously and more commonly used linguistic and psychometric selection criteria.