SPEECH-LANGUAGE PATHOLOGISTS' PERCEPTIONS AND EXPERIENCES OF AUGMENTATIVE AND ALTERNATIVE COMMUNICATION IN PAKISTAN: A QUALITATIVE STUDY

Abstract

Objective: To explore the perceptions and experiences of speech-language pathologists (SLPs) regarding augmentative and alternative communication (AAC) in Pakistan, with particular emphasis on AAC knowledge and awareness, clinical implementation, professional training, barriers to implementation, and the role of caregivers and interdisciplinary collaboration.

Methods: A qualitative study was conducted among 10 speech-language pathologists recruited through purposive sampling from clinical settings in Peshawar, Islamabad, and Lahore. Participants had at least three years of clinical or academic experience in speech-language pathology. Data was collected through face-to-face and online interviews. The interviews were recorded, transcribed, and analyzed using thematic analysis based on the Braun and Clarke framework. The analysis involved familiarization with the data, coding, identification and review of themes, and definition of the final themes.

Results: Three major themes emerged: AAC knowledge and awareness; training and implementation challenges; and collaboration and patient-centered care. Participants demonstrated awareness of aided and unaided AAC and described low-, mid-, and high-tech approaches; however, low-tech and no-tech systems were reported to be more commonly used. Participants emphasized individualized AAC selection based on communication, cognitive, motor, sensory, physical, and environmental factors. Major barriers to implementation included limited availability and high cost of AAC devices, particularly mid-tech and high-tech systems, inadequate professional training, and limited institutional resources. Participants also emphasized caregiver education, interdisciplinary collaboration, and patient-centered assessment as important components of successful AAC implementation.

Conclusion: SLPs demonstrated awareness of AAC and recognized its potential role in supporting individuals with communication difficulties. However, the implementation of AAC in Pakistan was constrained by limited availability and affordability of AAC technologies, professional training needs, and limited institutional support. Strengthening AAC-specific professional training, improving access to affordable communication technologies, and promoting caregiver and interdisciplinary involvement may facilitate more effective AAC implementation in Pakistan.