Awareness of Speech and Language Therapy amongst Pakistani women in Edinburgh Alia Yasin* and Ineke Mennen** *NHS Forth Valley, **Bangor University

Overview:  Background Awareness of healthcare Attitudes towards disability  The aim of the study  The methodology  The results  The conclusion

Awareness of healthcare Research shows importance of parental involvement/awareness ▫identifying difficulties in child’s development ▫benefits the therapy process Many parents from ethnic minority backgrounds disadvantaged by lack of knowledge of and ability to use health system (e.g. Crutchley et al. 1997; Stow and Dodd, 2003) They often “did not know how to access professionals’ help, were not aware that they needed to, or were not willing to do so” (Crutchley, 2000, p72).

Attitudes towards disability/disorder Disability stigmatised among some cultures, presenting a barrier between those who need help and those who can provide it (Glogowska, 1998) Different cultures have varying perceptions of childhood difficulties which may affect parental expectation of language development (Law, 1992). Some cultures put blame on child with communication difficulty (Bebout and Arthur, 1992) These attitudes are sometimes taken to explain low service uptake amongst minority ethnic families.

Why Pakistani females? Pakistanis form the largest minority ethnic group in Edinburgh (Census, 2001; Mennen & Stansfield, 2006) Culturally, it is the female members of this group who tend to provide the day to day care of children There is no specific information about SLT service awareness in this group, but it is thought that attitudes towards disability in Asian families (Beresford et al. 1996) causes lower service uptake in this minority ethnic group (Bywaters, 2003)

Target population 90%Punjab province in Pakistan (Pakistan Society of Edinburgh) 1/3 housewives completed questionnaire in Urdu Language spoken most often with family: ▫36% Urdu ▫34% English ▫30% Punjabi Other languages: ▫40% Urdu ▫17% Punjabi ▫35% English ▫2% Pahari/Mirpuri ▫6% none

Aim To investigate awareness of childhood communication difficulties and the SLT service provision in Pakistani females in Edinburgh To investigate attitudes towards disability in this ethnic minority group, which may affect their willingness to seek professional input Establishing levels of awareness and attitudes towards disability would inform attempts to empower this particular group to access SLT services

Methodology Questionnaires and interviews with 110 Pakistani females, aged 16 and over Participants contacted through visiting weekly social gatherings within the Pakistani community, such as Nari Kallyan Shagho (NKS) Four main areas investigated:  Participant descriptors (occupation, age, whether or not they have children)  Awareness of child speech and language development and communication difficulties  Awareness of Speech and Language Therapy  Attitudes towards communication impairment

Results Majority (52%) of women would expect a child to start talking by age 1 More so in women with children Child talking at age 1? Child not talking at age 2 is… Majority (66%) considers a child not talking by age of two as having a difficulty More so in women with children

Most awareness of hearing impairment, followed by ▫learning difficulties ▫dysfluency ▫Down’s syndrome ▫dyslexia ▫autism Housewives were generally least aware (except hearing impairment) Communication difficulties

Awareness of SLT service

Perceived role of SLT

Attitudes towards seeking professional advice In answer to the question Would you seek professional advice if a difficulty is suspected? the majority (90%) of respondents said yes A total of 13% would not seek professional advice, they were all in the age group 46+ “...the health visitor is professional advice, but motherly advice is advice given with experience so it’s comforting...both are important”.

Attitude towards seeking professional advice

Feelings of shame All interviewees showed an understanding of why people feel ashamed with comments such as: ▫“...culturally in Pakistan if there’s a problem they try sort it out internally...it is taboo, but prayer alone can’t solve everything” ▫“...my daughter just had mumps...everyone would stare making me feel uncomfortable and feeling the need to explain it was just mumps all the time...no one wants their child to be stared at like that”.

Summary of results Large no. of women aware of the SLT service, but lower awareness of exact role of SLT Lower awareness of speech & language development and causes of communication difficulties Significant number would be ashamed to seek help Particularly older women & housewives Most would seek professional advice, but a significant number would turn to a family member instead. Results from the questionnaires & interviews complement each other.

Conclusion Overall good level of awareness – 70% Confusion around exact role and communication difficulties. Established foundation level of awareness of SLT service and communication difficulties, and attitudes towards disability. Further research on how to increase awareness & involvement Identify groups at risk Research on most appropriate means of gaining new information to increase awareness & involvement