Attitudes towards Low-tech AAC use for Clients in Acute Hospital Settings: A Systematized Review

Ms Shaeron Murray1, Ms  Suzanne Hopf

1Charles Sturt University, Albury, Australia

Introduction: Poor communication in hospitals between patients, families and hospital employees all contribute to a reduced level of patient care. Patients who have been mechanically ventilated, intubated or have a neurological injury rendering them unable to talk, may experience frustration, depression and isolation. This increases the risk of adverse events occurring and incurs increased financial costs for the hospital, often at personal cost to the patient and their family.

Aim: To investigate attitudes of stakeholders towards low-tech augmentative and alternative communication (AAC) devices in acute and sub-acute hospital settings.

Method: A systematized literature search was conducted using four databases, snowball reference checking, in-depth key journal review, and key-author cross-check. Twenty-three articles were identified that consequently underwent quality assessment, data extraction and deductive thematic analysis using the International Classification of Functioning, Disability and Health (ICF) as the initial coding framework.

Results: Two major themes (Environmental and Personal Context) were identified. Within the  Environmental Context four sub-themes emerged: attitudes of (1) family and friends, (2) nursing staff, and (3) other health professionals, and (4) the organisation.

Conclusion: Low-tech AAC devices are not consistently used, nor available in acute/sub-acute medical settings, despite evidence demonstrating their effectiveness when training and support was provided from Speech Pathologists. Both negative and positive attitudes were expressed by all stakeholders, ranging from frustration about the time taken to construct a message and the impersonal nature of many AAC devices, to appreciation and improved outcomes for the patients when the devices were used effectively.

Clinical Implications: AAC needs to be available and used consistently to be truly effective and part of the normal working routine.



Dr. Suzanne Hopf is the Master of Speech Pathology Course Lead at Charles Sturt University. Suzanne teaches from her home in Fiji. Suzanne’s research focuses on service access and equity. In addition, she has a passion for igniting curiosity in her students and supporting their research skill development.

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