{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:23:26Z","timestamp":1747182206622,"version":"3.40.5"},"reference-count":26,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T00:00:00Z","timestamp":1721260800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp;amp; Comm Disor"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Speech and language therapy (SLT) services are fundamental for communication, academic and social development. Evidence shows that demand for services is increasing, and this can adversely affect the quality of care. There are limited published studies in relation to the demand and quality of speech and language services in Malta.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To elucidate the perspectives of speech\u2013language pathologists (SLPs), service managers and parents of clients about the impact of factors pertaining to human resource development (HRD), human resource management (HRM) and the environment on the quality of the children's SLT service in western Malta. Also, to outline the beneficial strategies or recommendations to improve the quality of the service provided.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods &amp; Procedures<\/jats:title><jats:p>A mixed\u2010method study was used. Quantitative data provided by the Speech and Language Center (SLC) were analysed to determine demand over time using descriptive statistics. Qualitative data from one\u2010to\u2010one interviews using a bespoke questionnaire with managers, SLPs and parents were transcribed and analysed. Common and distinct themes in relation to the quality of services were then formulated and evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome &amp; Results<\/jats:title><jats:p>Quantitative results highlighted that clients were not receiving the required number of the therapeutic sessions. In total, nine themes in relation to the quality of the SLT service were identified by parents, SLPs and managers. The factors affecting the service quality were outlined and subdivided under three branches: HRD, HRM and the environment. All factors within these subgroups are expected to enhance the quality of the service provided if they are enhanced and improved upon. Additionally, the results showed that a discrepancy between the perceived and offered SLT services was felt from the managers\u2019 and SLPs\u2019 perspectives; however, this was not felt by parents. For parents, the main concern was the availability and frequency of the therapeutic sessions provided.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion &amp; Implications<\/jats:title><jats:p>Insights from SLPs, managers and parents of clients highlighted the barriers and enablers of quality of service in SLT services for children. These findings can be used to improve services in Malta and other countries with similar contexts, mainly by altering time management, reducing demands and improving availability.<\/jats:p><\/jats:sec><jats:sec><jats:title>WHAT THIS PAPER ADDS<\/jats:title><jats:sec><jats:title>What is already known on the subject<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>SLT is proven to enhance a child's communication skills. Increasing demands for therapy can affect the quality of the service provided, ultimately affecting the child's progress. There is a gap in the evidence base regarding the quality of speech and language services for children in Malta and the factors which affect the quality of the service.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What this study adds to the existing knowledge<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>This is the first study of its kind in Malta. It seeks to identify the quality of SLT services for children from three different perspectives: service managers, SLPs and parents. In addition, this study investigated what affects the quality of SLT services positively or negatively. Through this study, the impeding factors were divided into three domains; HRD factors, HRM factors and environmental factors. These domains were mentioned by all three groups of participants because they affected the service negatively or positively. The main negative aspects included bad time management, high demands, and reduced availabilities and accessibilities, whilst positive aspects included improved support, relationships and the environment.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What are the practical and clinical implications of this work?<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>This study suggests reducing the managerial and administrational demands on SLPs and improving session frequency would enhance the quality of service. In relation to the three domains, the HRD factors that would enhance the quality of service are: SLPs\u2019 and parental competencies, enhancing SLPs\u2019 positive characteristics, positive attitudes and cooperation from all personas; for HRM resources the factors important for quality are strategic and risk management, workforce and recruitment; and for the environmental factors the physical environment and resources are important as they affect the service depending on their condition, that is, improved resources result in improved service. Such alterations would reduce the SLPs\u2019 demotivation and burnout due to reduced responsibilities, whilst improving accessibility and availability, ultimately enhancing the quality of the service provided.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><\/jats:sec>","DOI":"10.1111\/1460-6984.13093","type":"journal-article","created":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T15:54:53Z","timestamp":1721318093000},"page":"2412-2422","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Elucidating managerial, staff and client perspectives on the Speech and Language Therapy service in Malta"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0949-4641","authenticated-orcid":false,"given":"Ann\u2010Marie","family":"Sant","sequence":"first","affiliation":[{"name":"The University of Sheffield School of Health and Related Research  Sheffield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Black","sequence":"additional","affiliation":[{"name":"University of Liverpool, Institute of Population Health\u2014Public Health, Policy and Systems  Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,7,18]]},"reference":[{"issue":"6","key":"e_1_2_11_2_1","first-page":"181","article-title":"Determinants of customer satisfaction with hospitals: a managerial model","volume":"11","author":"Andaleeb S.","year":"1988","journal-title":"International Journal of Health Care Quality Assurance Incorporating Leadership In Health Services"},{"key":"e_1_2_11_3_1","unstructured":"ASHA. (2016)Scope of practice in speech\u2013language pathology. Available from:https:\/\/www.asha.org\/policy\/sp2016\u201000343"},{"key":"e_1_2_11_4_1","unstructured":"ASHA. (2022a)Supply and demand resource list for speech\u2013language pathologists in American Speech\u2010Language\u2010Hearing Association. Available from:https:\/\/www.asha.org\/siteassets\/surveys\/supply\u2010demand\u2010slp.pdf"},{"key":"e_1_2_11_5_1","unstructured":"ASHA. (2022b)Caseload and workload. Available from:https:\/\/www.asha.org\/practice\u2010portal\/professional\u2010issues\/caseload\u2010and\u2010workload\/."},{"issue":"1","key":"e_1_2_11_6_1","first-page":"1","article-title":"Health systems in transition","volume":"19","author":"Azzopardi\u2010Muscat N.","year":"2017","journal-title":"Malta"},{"volume-title":"Early childhood education becoming a professional","year":"2013","author":"Biddle K.A.G.","key":"e_1_2_11_7_1"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2010.05336.x"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","unstructured":"Cacciattolo M.(2015).Ethical considerations in research. In SensePublishers eBooks 61\u201379.http:\/\/doi.org\/10.1007\/978\u201094\u201063\u201000\u2010112\u20100_4c","DOI":"10.1007\/978-94-6300-112-0_4"},{"volume-title":"Early childhood curriculum: A creative play model","year":"2007","author":"Catron C.","key":"e_1_2_11_11_1"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/17439760.2016.1262613"},{"key":"e_1_2_11_13_1","unstructured":"Council for the Professions Complementary to Medicine. (2021)Benchmarking documents."},{"issue":"15","key":"e_1_2_11_14_1","first-page":"91","article-title":"The usefulness of qualitative and quantitative approaches and methods in researching problem\u2010solving ability in science education curriculum","volume":"7","author":"Daniel E.","year":"2016","journal-title":"Journal of Education and Practice"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/17549507.2020.1758210"},{"key":"e_1_2_11_16_1","unstructured":"Government of Malta. (2021)City Populations\u2010 Population Statistics in Maps and Charts for Cities Aggkimerations and Administrative Divisions of all Countries of the World. Available from:https:\/\/www.citypopulation.de[August 2022]."},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1159\/000314788"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/1053815111429968"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ridd.2021.104139"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-6984.2011.00036.x"},{"key":"e_1_2_11_21_1","unstructured":"Lockton Affinity. (2022)Positive attitude in healthcare\u2010 LA Health LA Health. Available from:https:\/\/locktonaffinityhealth.com\/2022\/03\/01\/positive\u2010attitude\u2010in\u2010healthcare\/[August 2022]."},{"key":"e_1_2_11_22_1","unstructured":"McLeod S.A(2022).Qualitative quantitative. Available:http:\/\/www.simplypsychology.org\/qualitative\u2010quantitative.html[August 2022]."},{"volume-title":"Mental disorders and disabilities among low\u2010income children","year":"2015","author":"NASEM\u2014National Academies of Sciences, Engineering and Medicine","key":"e_1_2_11_23_1"},{"key":"e_1_2_11_24_1","doi-asserted-by":"crossref","unstructured":"Rosenbaum S.&Simon P.(2016)Speech and Language disorders in children. Implications for the Social Security Administration's Supplemental Security Income Program. In National Scademies Press eBooks.http:\/\/doi.org\/10.17226\/21872.","DOI":"10.17226\/21872"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2003-42827"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1108\/02689230210428625"},{"key":"e_1_2_11_27_1","doi-asserted-by":"crossref","unstructured":"Winter K.(1999)Speech and language therapy provision for bilingual children: aspects of the current service.","DOI":"10.1080\/136828299247658"}],"container-title":["International Journal of Language &amp; Communication Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1460-6984.13093","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T17:50:26Z","timestamp":1744393826000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1460-6984.13093"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,18]]},"references-count":26,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1111\/1460-6984.13093"],"URL":"https:\/\/doi.org\/10.1111\/1460-6984.13093","archive":["Portico"],"relation":{},"ISSN":["1368-2822","1460-6984"],"issn-type":[{"type":"print","value":"1368-2822"},{"type":"electronic","value":"1460-6984"}],"subject":[],"published":{"date-parts":[[2024,7,18]]},"assertion":[{"value":"2023-11-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}