A realist process evaluation of the TreatPaCS-trial for preschool age children who stutter: to bridge current knowledge to future practice

Abstract

Background: In Belgium, the Lidcombe Program, Mini-KIDS and the Social-Cognitive Behaviour Therapy are frequently used to treat preschool age children who stutter (PCWS). The TreatPaCS-trial compares the outcome of these approaches. If Speech-Language Therapists (SLTs) will be advised to use these approaches in daily practice, a clinical decision process will precede the choice of treatment. A tailored treatment, requires understanding of challenges, limitations, benefits and facilitators linked to child and family characteristics for each treatment approach.

Aim: The aim of this study was to identify challenges, limitations, benefits and facilitators of the Lidcombe program, Mini-KIDS and the Social Cognitive Behaviour Therapy from the perspective of the Flemish SLTs and parents of PCWS who are participating or who participated in the TreatPaCS-trial.

Methods: A qualitative process evaluation was conducted, to understand how and why an intervention works, for which groups, and in which settings. To explore SLTs’ and parents’ perspectives, individual semi-structured interviews and focus groups were conducted. A realistic approach to thematic analysis was used to analyse data.

Results: Context-Mechanism-Outcome-configurations show how child, parent, and family-related contextual factors influence treatment mechanisms and lead to facilitating or challenging implementation of the treatment approaches. Also, benefits and limitations of implementation were identified. Child characteristics to consider are age, comorbidities, language and cognition, and personality. For parents, characteristics include engagement, expectations, tolerance, cognition, and personality. Regarding family organization, the number of children, busy life, bilingualism, and parenting style can be considered.

Conclusion and key findings: Findings highlight the importance of considering characteristics of the PCWS, parent(s), and family to support the clinical decision process. Facilitating contexts can provide more direction in this process and allow SLTs to match the treatments to specific families. Challenging contexts can make SLTs more alert to challenges in therapy, so they are able to anticipate them. Finally, understanding benefits and limitations allow SLTs to frame them to parents during therapy.

Recommendations: To bridge current results, implementation research involving a stakeholder group and creating a decision tool would be valuable to support the shared decision process. Finally, SLT characteristics that possibly affect treatment implementation could be explored.