JCPSLP Vol 17 No 2 2015_web

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

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JCPSLP Volume 17, Number 2 2015

Journal of Clinical Practice in Speech-Language Pathology