title: Language development, delay and intervention-the views of parents from communities that speech and language therapy managers in England consider to be under-served.
abstract: Evidence-based practice includes research evidence, clinical expertise and stakeholder perspectives. Stakeholder perspectives are important and include parental ethno-theories, which embrace views about many aspects of speech, language and communication, language development, and interventions. The Developmental Niche Framework provides a useful theory to understand parental beliefs. Ethnotheories, including those about language development, delay and interventions, may vary cross culturally and are less well understood in relation to families who may be considered 'under-served' or 'hard-to-reach' by speech and language therapy services. Who is considered to be under-served and the reasons why some families are under-served are complex.
  
  
  
  To describe beliefs and reported practices, in relation to speech and language development, delay and intervention, of parents and carers from a small number of groups in England who were perceived to be under-served in relation to SLT services.
  
  
  
  As part of a wider National Institute for Health Research (NIHR)-funded study (Child Talk), seven focus groups (with a total of 52 participants) were held with parents from three communities in England. Topics addressed included beliefs about language development, language delay and parents' reported responses to language delay. Data were transcribed and analysed using adapted framework analysis, which also drew on directed content analysis.
  
  
  
  Four themes resulted that broadly matched the topics addressed in the focus groups: language development and the environment; causes and signs of speech and language delay; responses to concerns about speech, language and communication; and improving SLT. These produced some previously unreported ideas, e.g., about how language develops and the causes of delay.
  
  
  
  The findings are discussed in relation to previous literature and the Developmental Niche Framework. Clinical implications include ideas about issues for SLTs to discuss with families and the need to recognize that parents may see themselves as competent facilitators of language. Suggestions are made for future research, including: expanded investigation of a wider range of under-served groups, an exploration of who parents consult when concerned about their child's language, and how key community figures advise parents in relation to language delay.
authors.affiliation: Health Professions Department, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK.|School of Health Sciences, University of Kwa Zulu-Natal, Kwa Zulu-Natal, Durban, South Africa.
authors.forename: Julie
authors.initials: J
authors.lastname: Marshall
authors.affiliation: Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Harding
authors.affiliation: Faculty of Health and Applied Sciences, Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, University of the West of England, Bristol, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Roulstone
mesh_terms: D000367:Age Factors; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002663:Child Language; D002675:Child, Preschool; D003142:Communication; D003466:Cultural Characteristics; D065246:Culturally Competent Care; D004739:England / Q000453:epidemiology; D004777:Environment; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007805:Language Development Disorders / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000534:rehabilitation*; D008297:Male; D008507:Medically Underserved Area; D010290:Parents / Q000523:psychology*; D011368:Professional-Family Relations; D036301:Qualitative Research; D013060:Speech; D013066:Speech-Language Pathology / Q000458:organization & administration*; D016896:Treatment Outcome; D035862:Vulnerable Populations / Q000208:ethnology / Q000523:psychology*
keywords: explanatory models; hard-to-reach; language delay; language development; speech and language therapy; under-served