Protocol for a Qualitative Study on the Acceptability of High- and Low-Intensity Speech Intervention in Children With Cleft Palate: Perceptions of Children, Their Caregivers and Speech–Language Pathologists

Background

Traditional low-intensity speech therapy in children with cleft palate with or without cleft lip (CP ± L), provided twice weekly for 30 min over months or even years, lacks solid scientific evidence and may lead to poor outcomes, treatment fatigue, and high costs. Different authors have proposed the implementation of high-intensity speech intervention through promising proof-of-concepts. However, this approach has not yet been widely adopted in clinical practice. To assess its impact on a broader scale, the investigation will focus on the perceptions and acceptability of high- and low-intensity speech intervention as provided by primary care speech–language pathologists (SLPs).

Aims

This protocol article outlines a qualitative study designed to explore the perceptions and experiences of intervention providers (primary care SLPs) and recipients (children with CP ± L [4–12 years old] and their caregivers) regarding high- and low-intensity speech interventions. The study aims to evaluate the acceptability, feasibility, and perceived impact of both intervention approaches.

Methods and Procedures

Both providers and recipients of the intervention from a previous randomized controlled trial (RCT) conducted by our research group—which will compare the outcomes of high- versus low-intensity speech intervention—will be recruited. Separate, tailored semi-structured interview guides will be used for SLPs, caregivers, and children to explore their unique perspectives on the intervention, including its acceptability and feasibility. Age-appropriate methods such as play-based activities, puppets, and emotion mapping will be used to facilitate engagement with younger children. Additionally, all participants will complete a questionnaire regarding their demographics. Qualitative data will be evaluated using inductive coding for emergent themes and deductive coding based on the theoretical framework of acceptability (TFA).

Expected Outcomes and Results

Drawing from prior qualitative investigations by the research group, a hypothesis is put forth suggesting that a high-intensity speech intervention could garner greater acceptance from both intervention recipients and their caregivers. This hypothesis stems from the expectation that an intensified intervention can reduce therapy fatigue, dropout rates, and emotional strain. Furthermore, it is anticipated that such an approach might enhance intrinsic motivation. The findings will provide valuable insights into the feasibility and acceptability of different intervention intensities, contributing to the development of evidence-based speech therapy practices for children with CP ± L.

WHAT THIS PAPER ADDS

What is already known on this subject

• There is an increasing interest in assessing the effectiveness of intensive speech therapy interventions in children with CP ± L. Several quantitative studies have demonstrated positive speech outcomes following high-intensity interventions. Nevertheless, the extent to which both recipients and providers perceive these interventions as acceptable remains uncertain. This study aims to compare the acceptability of high-intensity speech therapy (i.e., 5 × 30 min/week for 2 × 4 weeks [2 × 10 h]) with low-intensity speech therapy (i.e., 2 × 30 min/week for 20 weeks [20 h]), from the viewpoint of children with CP ± L, their caregivers, and primary care SLPs.

What this study adds

• This study will contribute significantly to the existing literature by examining the perceptions and acceptability of high-intensity speech intervention among children with CP ± L. By investigating the differences between high- and low-intensity speech therapy approaches, it aims to provide valuable insights into the acceptability and feasibility of these interventions from the viewpoint of both recipients and providers. These findings will be crucial for informing clinical practices and enhancing the delivery of speech therapy services to children with CP ± L, ultimately striving for optimal outcomes in their speech development and overall well-being.

What are the clinical implications of this study?

• Depending on the findings of this study, we might have to rethink the conventional methods of delivering cleft speech interventions, often characterized by low-intensity speech therapy. By comparing perceptions of high- and low-intensity speech interventions, we aim to identify the most feasible and acceptable method for both recipients and providers. Insights gained from this study could lead to improvements in the overall delivery of speech therapy services, potentially enhancing treatment adherence and outcomes for children with CP ± L, guiding clinical practice with evidence-based recommendations.