Exploring the acceptability for parents of preschool children of the language component in the 24-30 month review in England’s Healthy Child programme

Parents are key stakeholders in the assessment and intervention of speech and language during the preschool years. Parents observe their child’s speech and language development over time and across contexts, and are often the first to raise concerns (Marshall et al., 2017). It is therefore vital for speech and language therapy services that parents are consulted at each stage of assessment and intervention. This is particularly important for preschool aged children, for whom parents often act as advocates across services (Davies et al., 2017)

A key measure used to assess service users’ views about any healthcare assessment or intervention is acceptability. However, a review by Sekhon, Cartwright, & Francis (2017) demonstrated a lack of theoretical basis to systematically assess acceptability. Instead, it has often been measured according to user behaviours, such as the extent of dropout from an intervention (Dyer, Owens, & Robinson, 2016). In response to the absence of theory, Sekhon, Cartwright and Francis (2018) developed the ‘Theoretical Framework of Acceptability’ (TFA).

However, the TFA has been developed with reference to patients undergoing healthcare treatments, and therefore primarily focusses on the person in direct receipt of an intervention. In contrast, parents of preschool children act as a third party advocating for their child. Also, while many healthcare interventions have clear parameters for what is an acceptable outcome, parents are likely to vary in terms of their communication goals and priorities for their child.

The aim of this study was to explore what the concept of acceptability means for parents, in the context of assessment and intervention of preschool children’s speech and language.

A survey was completed by 433 parents and qualitative telephone interviews were conducted with 40 parents from diverse demographic backgrounds. PPI groups were consulted during development of study materials. This study formed part of a project to develop a new assessment for speech and language at England’s nationally mandated 24-30 month developmental review. Participants had recently attended the review and also had a follow-up appointment with an SLT.

Descriptive statistics were used to explore survey results and thematic analysis was conducted on the interviews and qualitative responses to the survey. Themes arising showed that key elements of acceptability for parents included their relationship and rapport with the practitioner and the coherence and communication of the assessment. However the overarching theme that was key to acceptability for parents was the perceived value of the final outcome of the assessment for their child.

When considering the acceptability of an assessment or intervention from parents’ perspectives, we need to move beyond the traditional patient and healthcare focus on attendance and compliance. This study found that what parents valued most went beyond the actual assessment and related to what happened afterwards. For an assessment or intervention to be valued by families, it must be continually evaluated in relation to children’s and parents’ goals and priorities for communication.

Outcomes will be discussed in relation to relevance for speech and language therapy assessment, referral and intervention.