{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:12:13Z","timestamp":1773015133786,"version":"3.50.1"},"reference-count":56,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:00:00Z","timestamp":1747353600000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016337","name":"Department for the Economy","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016337","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp;amp; Comm Disor"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Children with moderate to severe speech sound disorder (SSD) need intensive therapy to increase intervention effectiveness and efficiency. However, worldwide speech and language therapists (SLTs) report that it is difficult to implement recommended intervention intensities in clinical practice. Supporting parents\/carers to deliver home\u2010intervention, facilitated through digital tools, has the potential to circumvent these difficulties and increase practice intensity. This realist evaluation builds on our earlier realist review on intensive, digital, parent\u2010implemented interventions for children with SSD through exploring the experiences of stakeholders to optimally understand what might work best, for whom, and why in clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We undertook a realist evaluation to test and refine our initial programme theories developed in our earlier realist review through focus groups with key stakeholders. Five focus groups were conducted with SLTs (<jats:italic>n<\/jats:italic> = 22), and two focus groups with parents\/carers of children with SSD aged 4\u20135 years (<jats:italic>n<\/jats:italic> = 6). A realist methodology approach was used to collect and analyse the data, including the development of context\u2010mechanism\u2010outcome configurations. Middle\u2010range theories of adult\u2010learning, self\u2010efficacy and parenting styles were used to develop our theoretical thinking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Programme theories from the earlier realist review about how the intervention works were refined, refuted, or confirmed. The refined theories are presented across three areas to demonstrate the journey of engaging in a digital, intensive parent\u2010implemented intervention: (1) Readiness to engage; (2) Implementation\u00a0of the intervention; and (3) Sustaining momentum. The theories offer insight into mechanisms that support and train families to engage in home\u2010practice through digital tools, including important contextual factors needing consideration in implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Digital, intensive, parent\u2010implemented interventions for children with SSD have the potential to improve the effectiveness and efficiency of SLT services in certain contexts and improve children's outcomes worldwide. Mechanisms of change, and impactful contexts at each point of the journey of involvement need consideration to successfully empower and support parents\/carers and their children with SSD.<\/jats:p><\/jats:sec><jats:sec><jats:title>WHAT THIS PAPER ADDS<\/jats:title><jats:p><jats:italic>What is already known on this subject<\/jats:italic>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Clinicians worldwide face challenges providing the optimal intensity of intervention for children with SSD. Studies have explored parent\u2010implemented interventions and digital tools to increase intervention intensity. These new and innovative service delivery models can be effective in certain circumstances; however, further exploration is required to understand why digital, parent\u2010implemented interventions may work, for whom, and how.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><jats:p><jats:italic>What this study adds<\/jats:italic>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>This paper uses a realist methodology approach to capture stakeholder experiences to develop underpinning theories about digital, intensive, parent\u2010implemented interventions for children with SSD. The new theoretical insight from this realist evaluation builds upon our understanding of what makes this intervention work (or not), who it works for, and why.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><jats:p><jats:italic>What are the clinical implications of this study?<\/jats:italic>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>SLTs and health services will have a clearer understanding of how to support parents\/carers to implement intensive home\u2010intervention through digital tools, and which factors impact its effectiveness. New understanding demonstrates how digital tools to support parents\/carers have the potential to support more intensive practice for children with SSD.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1111\/1460-6984.70049","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T18:13:19Z","timestamp":1747419199000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["\u2018To Know That You Are a Link in the Chain\u2019: A Realist Evaluation to Explore How Digital, Intensive, Parent\u2010Implemented Interventions Work for Children With Speech Sound Disorder, Why, and for Whom"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8548-0637","authenticated-orcid":false,"given":"Naomi","family":"Leafe","sequence":"first","affiliation":[{"name":"Institute of Nursing and Health Research Ulster University  Belfast UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4703-3163","authenticated-orcid":false,"given":"Emma","family":"Pagnamenta","sequence":"additional","affiliation":[{"name":"School of Psychology and Clinical Language Sciences University of Reading  Reading UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1250-265X","authenticated-orcid":false,"given":"Mark","family":"Donnelly","sequence":"additional","affiliation":[{"name":"School of Computing Ulster University  Belfast UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0954-2127","authenticated-orcid":false,"given":"Laurence","family":"Taggart","sequence":"additional","affiliation":[{"name":"Institute of Nursing and Health Research Ulster University  Belfast UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5968-158X","authenticated-orcid":false,"given":"Jill","family":"Titterington","sequence":"additional","affiliation":[{"name":"Institute of Nursing and Health Research Ulster University  Belfast UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,16]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1044\/1092-4388(2012\/11-0076)"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0605-9"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-295X.84.2.191"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1037\/h0030372"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272431691111004"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1044\/0161-1461(2013\/12-0029)"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0265659020960766"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/13645579.2020.1803528"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0265659016671169"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1460-6984.12462"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0265659018784702"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2014.10.017"},{"key":"e_1_2_11_14_1","unstructured":"Greenhalgh T. 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