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JCPSLP
Volume 17, Number 2 2015
Journal of Clinical Practice in Speech-Language Pathology
Data collection tools
Data were gathered through two instruments, both
administered prior to and on completion of the placement.
First, a survey “Confidence and interest in working with
people 65 years and older” was purposefully developed by
the research team. Part 1 of the survey gathered
demographic information including age group, clinical
placement setting, prior qualifications, and past clinical and
non-clinical experience with an older population. Part 2
posed questions relating to perceptions about knowledge
and confidence for working with an older population, as
well as preferred future employment relating to caseload
age and context. Item selection was informed through
review of literature and practice guidelines (ASHA, 1988;
SPA, 2005). Likert scales were used to gather information
on perceptions of knowledge and confidence about (a)
communication and swallow changes that occur as people
grow older, (b) acquired communication disorders of motor
speech, language, and cognitive-communication abilities,
(c) dysphagia in medically well and medically complex older
people, and (d) communication and swallowing changes
specific to dementia. A preference ranking scale allowed for
exploration of interest in future employment based on client
age and practice setting, and items relating specifically to
dementia were included. Pilot testing of the survey design
and content was completed by four speech pathologists
working with older people in acute and residential settings
respectively.
The second instrument used, the University of California
at Los Angeles Geriatrics Attitudes Scale (UCLA-GAS;
Reuben et al., 1998), explored attitudes about older people.
The UCLA-GAS is a 14-item, 5-point scale, in which a
mean score above 3 is interpreted as a positive attitude.
The UCLA-GAS has demonstrated a positive relationship
between students’ attitudes toward older people and
interest in geriatrics as a career and has been shown to be
sensitive to change over time (Reuben et al., 1998).
Data analysis
Data from the anonymous pre-coded instruments were
entered into a spreadsheet and analysed using the
Statistical Package for the Social Sciences. For research
question 1, the total cohort (n = 74) was described in
relation to initial responses to knowledge and confidence
questions. A mean score on the complete UCLA-GAS was
calculated for all participants. In addition, items that related
specifically to interest in, and/or enjoyment of service
provision to older people, were described individually in line
with the aims of this study. Weighted group ranking scores
for each item relating to future employment interests were
reported, and were created by combining all participants’
ranking scores for each item and then dividing the score by
the number of participants.
Research question 2 was addressed by exploring
change that occurred following a placement (n = 52)
through comparison of aggregate scores of knowledge
and confidence analysed using the Wilcoxon signed
ranks test. Weighted ranking was used to report on
future employment preference trends by comparing pre-
and post-placement group weighted preference scores
Analyses of interaction between placement setting and
post-placement knowledge, confidence, and attitudes,
were completed using a split-plot model ANOVA for 45 of
the 52 participants who completed a placement in either
(a) an acute hospital setting (n = 25) or (b) a placement that
prior contact with older adults are critical to developing
an interest in geriatric care (Andrews, Brodie, Andrews,
Wong, & Thomas, 2005; Hobbs, Dean, Higgs, & Adamson,
2006). Little is known about speech pathology students’
knowledge, confidence, and interest in working with older
people, nor about factors that influence their interest in
pursuing positions that specialise in service provision to
older people. Therefore, this study explored two research
questions, namely:
1. What are speech pathology students’ knowledge,
confidence, and interest levels in working with older
people prior to a clinical placement in adult services?
2. What impact do different placement settings (acute
hospital, residential, out-patient rehabilitation) have on
students’ reported knowledge, confidence, attitudes,
and interest in working with older people following a
clinical placement?
Method
Design
An observational cohort design, utilising a pre-post survey
methodology, was used.
Participants
A convenience sample of 74 participants provided informed
consent and met the inclusion criteria of (a) being a speech
pathology student at an Australian university, (b) who had
completed academic courses in adult communication and
swallowing disorders as part of their speech pathology
degree, and (c) was due to undertake a clinical placement
in an adult service. Participants were predominantly female
(96%), reflective of the student cohort in speech pathology
in Australia (Health Workforce Australia, 2014), and 70%
were younger than 25. Fifty-two were enrolled in an
undergraduate program and 22 in a graduate entry masters
program. Twenty-six participants had completed a
qualification prior to enrolling in the speech pathology
program. Sixteen participants (22%) reported that they had
no contact with medically unwell older people before
starting their placement in an adult service, 44 reported
some (48%) or a lot (11%) of contact with medically unwell
older people not directly related to them, and 14
participants (19%) reported that prior contact was only with
older family members. Of the 74 participants who
completed pre-placement surveys, 52 also completed the
post-placement survey following a clinical placement in an
acute hospital setting (n = 25), in a residential setting
exclusively or partly (n = 19), or in an out-patient
rehabilitation setting (n = 8).
Procedure
Ethical approval was obtained from the research ethics
committees of the relevant university and health service. All
eligible students were invited to participate in the research
by a university clinical education liaison manager through a
blind copied group email that provided information on the
study and directed those interested in participating to an
on-line survey where they were prompted to create their
own unique participant code. The students were informed
that their participation was voluntary and that non-
participation or request to withdraw would not result in any
penalty, nor interfere with their current or future placement
allocation. Consenting participants completed the survey
and attitude scale by accessing a hyperlink contained in the
study invitation email.
Anne E. Hill (top)
and Lucy Hunter