Aboriginal and Torres Strait Islander preferences for healthcare settings: effective use of design images in survey research.

Objective The aim of this study was to develop an effective digital survey instrument incorporating images to investigate Aboriginal and Torres Strait Islander preferences for health clinics and hospitals, design of healthcare settings and the differences between inner regional and remote locations. Methods Design-related constructs developed from qualitative interviews informed the construction of healthcare setting images. These images were embedded in an online survey instrument to elicit data on design preferences and an area-based recruitment strategy ensured participation by Indigenous Australians from three Queensland locations. Logistic regression analyses were used to estimate the odds of preference for a healthcare setting design by location. Results Statistical analysis of data from 602 participants showed a preference for health care at an Aboriginal and Torres Strait Islander clinic. The odds of preference for an in-patient room with a two- versus single-bed design was greater for participants with less education, and lower for participants with a long-term health problem. Conclusions The multidisciplinary approach to developing an online survey instrument with images and the willingness of Indigenous people of all ages to engage with the images demonstrated the effectiveness of this method in providing robust evidence for the design of culturally appropriate healthcare spaces for Indigenous users. What is known about the topic? Evidence-based research influences the design of healthcare buildings, yet the field currently provides negligible evidence on cross-cultural perceptions or experiences of conventional modern hospitals and clinics. Although recent healthcare buildings show signs of acknowledging Indigenous users, general principles in the Australian Health Facility Guidelines give limited specific information about how cultural requirements may translate into architectural design. What does this paper add? The multidisciplinary approach to research design has enabled the development of healthcare design-related constructs from consultation with Indigenous people, the presentation of these constructs as images and the inclusion of these images for comparison and selection in a digital survey instrument. Combined with a culturally appropriate recruitment strategy, this survey provides evidence from a large sample of the Indigenous population. Selected results from analyses of survey responses show the capacity of the methodological approach to address broader questions about Indigenous preferences for healthcare settings by location, age and sex. What are the implications for practitioners? A focus on individual preferences related to healthcare clinics and the combined significance of design and setting can give practitioners a better understanding of Aboriginal and Torres Strait Islander people's preferences and suggest ways to reduce the incidence of poor engagement with healthcare services.

Teaching VOCA use as a communicative repair strategy.

Students with developmental disabilities often rely on prelinguistic behavior (e.g., reaching, leading) to communicate. When listeners fail to attend to prelinguistic behaviors, students may benefit from responding with an alternative form of communication to repair the breakdown. In the present study, we taught two students with developmental disabilities to repair communicative breakdowns by using a voice-output communication aid (VOCA). Intervention occurred at morning snack time when the students had the opportunity to access preferred items through prelinguistic behavior (e.g., reaching, guiding). Breakdowns occurred when the listener failed to attend to the student's initial request. Effects of the intervention were evaluated in a multiple-baseline design across subjects. Both students learned to use the VOCA to repair communicative breakdowns. As VOCA use was acquired as a repair strategy, the students also began to use the device to initiate requests when there had been no breakdown in communication. The intervention appeared to be an effective approach for supplementing prelinguistic behaviors with an additional option for communicating a request.

Teaching students with developmental disabilities to locate their AAC device.

Students with autism and related developmental disabilities who do not speak are often taught to use some type of augmentative and alternative communication (AAC) system, such as a voice output communication aid (VOCA). One problem with such devices is that the person may be unable to communicate when the device is not readily accessible. We first taught three nonverbal students with autism to use a VOCA to request access to preferred items. Following this initial acquisition phase, however, none of the students would locate their VOCA when it was not within reach. A least-to-most prompting procedure was implemented to teach the students to locate their AAC device. The effectiveness of this procedure for teaching VOCA location skills was evaluated in a delayed multiple-baseline across subjects design. The results showed that the intervention was effective in teaching the students to locate their AAC device when they needed it to request access to preferred objects. Teaching VOCA location skills may be a useful and necessary component in AAC interventions for some people with developmental disabilities.