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A study of public awareness of speech-language pathology in Amman.

Background: Statistical levels of awareness and knowledge of speech-language pathology and of communication disorders are currently unknown among the public in the Middle East, including Jordan.

Aims: This study reports the results of an investigation of public awareness and knowledge of speech-language pathology in Amman-Jordan. It also determines the level of knowledge of communication disorders that the general public has.

Methods: This study was carried out through a questionnaire. A total of 1203 participants were surveyed about their knowledge of the field of speech-language pathology and of communication disorders in a local shopping mall. Information was collected based on participants' age (ranging from 18-50 years), gender, qualifications and occupation, and whether they have children or not.

Results: Public awareness and knowledge of speech -language pathology in Amman-Jordan appear to be limited .Participants with the most accurate knowledge of speech-language pathology and communication disorders, mostly females with children, had bachelor degree in health- or education-related fields. Moreover, results indicated lack of familiarity with different types of communication disorders except for stuttering.

Key words: awareness, speech-language pathology, communication disorders, speech language pathologist.

Introduction

One of the main significant principles of imperative international organizations, such as the United Nations (U.N) and UNESCO, involve struggling for the rights of children and their family. According to (U.N) principles 'The child shall be entitled to grow and develop in health; to this end, special care and protection shall be provided to both him and to his mother, including adequate pre-natal and post-natal care' (U.N. 1959, Principle 4). Moreover, the UNESCO states 'Early childhood care and education programmes for children aged up to six years ought to be developed and/or reoriented to

promote physical, intellectual and social development and school readiness. These programmes have a major economic value for the individual, the family and the society in preventing the aggravation of disabling conditions' (UNESCO, 1994, [section]53).

The principles of both the U.N and UNESCO, resembles with the aims of the European agency for development in special needs education, as it intends to offer the child and his family the support and service needed, where early intervention is consigned to bring about the necessary action needed to be taken as early as possible during any time in his/her education. Early intervention is essential for children who have impairments that would limit the normal development of the physical, cognitive, emotional, and social and communication aspects in a child's life. Impairments as such are caused by children or adults who happen to have disorders underlying the umbrella of communication disorders. The goal of early intervention, as considered by Blackman, is to preclude or limit the physical, cognitive, emotional, and other restrictions of young children with biological or environmental risk factors. However, the main obstacle that we face in the Middle-East and specifically in Jordan is the lack of awareness of communication disorders and the lack of awareness of the speech-language pathology profession and its services.

Communication is the process that participants use to exchange information and ideas, needs and desires (Justics, 2006). The process is an active one that involves encoding, transmitting, and decoding the intended message (Robert & Owens, 2008). However, regardless of the way that individuals communicate with one another--whether it is speech and hearing, reading and writing, or sign or further manual means--communication occurs through the process of encoding, transmitting, and decoding the intended message, and consequently communication disorders or impairments are present when a person has significant difficulty in one or more of these aspects of communication, taking into account sharing language, dialect and culture with people (Hedge, 2001).

The speech-language pathology is concerned with the study and understanding of human communication and its disorders, assessment and treatment of swallowing, speech-language, and cognitive-communication

disorders that result in communication disabilities (Justics, 2006), Whereas the person/specialist responsible for treating these disorders is called a speech-language pathologist (SLP).

Therefore, several studies have investigated the prevalence of communication disorders with varying results. These studies are vital for effectively raising awareness and educating the general public about speech language pathology, in addition to planning, evaluating service delivery, and future preventions (Law, Boyle, Harris, Hnkrness, & Nye, 2000; Williams, Derbyshire, & Vaghy., 1980).

The National Institution of Health in America (1995) estimated that 42 million Americans or 10% of population have a communication disorder (National Institution of Deafness and other Communication Disorders [NIDCD], 1995; Casby, 1989). According to the Canadian Association of Speech Language Pathologists and Audiologists [CASLPA] 2007), speech and hearing problems affect tens of thousands of individuals. Another study conducted on 14500 primary and secondary school students in Australia across three years revealed that the prevalence of communication disorders was 13.04 % and 12.40% in the first and second years respectively (McLeod & McKinnon 2007). Furthermore, a more specific study in Australia about communication disorders prevalence proposed a range of estimates of the rate of each communication disorder, from 0.12% (voice) to 25.2% (expressive speech and language) (McCormack, J., McLeod, S., Harrison, L., & McAllister, L., 2007). Karbasi, Fallah and Golestan (2011) suggested that the prevalence of total speech disorders which include speech sound disorders, stuttering and voice was 14.8% in primary school students in Iran. Paul & Desl, & Thorbum ( 1992) found that among 5468 Jamaican children studied, the ranking of prevalence of disabilities from highest to lowest was 'cognitive', 'speech', 'visual', 'hearing', 'motor' and 'seizure'.

In terms of prevalence of communication disorders in Arab countries, only limited studies are available; for example, a study in Egypt suggested that the prevalence of articulation and stuttering in primary school was 5.8% and 3.9 respectively (Fahmi, 1975). A1 Shakhes (1997) reported in a study conducted in primary schools in Saudi Arabia that the prevalence of articulation and speech disorders was 12.9 %. Another study in Syria indicated that the prevalence of speech and articulation disorders in primary school was 8.27% (A1-Attar, 2008). However, with regards to the prevalence of communication disorders in Jordan, the studies were very limited. A preliminary unpublished study found that the prevalence of communication disorders in Jordanian schools was approximately 15% (Amayreh & Natour. 2012). In a statistical study at speech clinic patients in Jordanian Royal medicine services, Khamayseh (1997) suggested that the prevalence of speech and stuttering was 14% and 11%, respectively.

Globally, number of studies was carried out pertaining the level of public awareness and knowledge of speech-language pathology, particularly number of which were measuring the public awareness of speech-language pathology in general, whereas others were measuring the awareness of specific disorders. Recently, American Speech-Hearing Association [ASHA], 2013 according to surveyed speech

language pathologist and audiologist members of ASHA, results indicated that almost half of ASHA members suggested lack of awareness as the most important barrier to early detection of communication disorders (American Speech-Hearing Association, 2013). Moreover, a study that was conducted in the UK about the public awareness of speech-language pathology suggested that the public awareness of speech-language pathology was limited (Breadner, Warr-Leeper,& Husband 1987) and public awareness of stuttering in Brazil (Pereira, Rossi & Borsel, 2008), public awareness of stuttering in China (Xing Ming, Jing, Yi Wen, & Borsel, 2001), public awareness of aphasia in New Zealand (McCann, Tunnicliffe, & Anderson, 2012) was also found to be limited.

To date, little information is available regarding community awareness and knowledge of communication disorders and speech-language pathology, and this lack of knowledge about communication disorders may negatively impact client treatment. The purpose of this study was to investigate the awareness and knowledge of the public about speech-language pathology in Amman at a shopping mall. This investigation was motivated by two key factors; the first is the authors' experience and observations whether inside the Speech and Language Clinic at the University of Jordan or outside this clinic, These experiences have demonstrated that the majority of people have limited knowledge about speech-language pathology, or overlap between speech-language pathologist (SLP) with other professions, such as special education teacher, counsellors and class teacher. The second factor is that most patients do not receive early intervention. However, as U.N and UNESCO implemented, it is agreed that the earlier a child receives intervention services, the more benefit there is for the child (Batshaw, 2002; Warren, 2000). Moreover, according to American Speech-Hearing Association study nearly 60% percent of children's parents are unaware that communication disorders' treatment takes longer and consequently, is more expensive if problems are not detected early. (American Speech- Hearing Association, [ASHA], 2013)

It is understandable, that the cost of not providing services may result in the patient losing social relationships and roles, and in some cases employment and income (Ellis & Mauldin, 2013). Thus, with the forgoing in mind, we conducted a study to investigate public awareness and knowledge of speech-language pathology, and services that can be offered locally.

Methodology

Questionnaire Design

Data were collected based on a questionnaire that was developed in English, by Breadner et al (1987), and translated into Arabic. To ensure the validity of the instrument, a number of minor changes were made to reflect the Arabic rather than the English culture.

A cover letter that explained the purpose of study and encouraged participants to return it completed was enclosed in the questionnaire. The letter ensured confidentiality and expressed appreciation for participating.

The questionnaire consisted of three sections (A and B) (See Appendix A) and participant's demographics information.

Section A elicited information on the participant's knowledge and awareness of the field of speech-language pathology, and the profession of the speech-language pathologist. It also investigated knowledge related to when children should be referred to a speech and language assessment, and whether referrals should come only from the family doctor. Finally, this part investigated public awareness of the vocation (i.e. types of communication disorders within the scope of practice of the speech-language pathologist, (i.e. closed ended questions with five rated answers).

Section B required the participants to indicate whether a number of scenarios for diverse types of communication disorders should be evaluated by a SLR A 5 point Likert scale, that comprised of strongly agree, agree, undecided, disagree and strongly disagree responses (Snow, 2012, was used to rate participants' attitude. Finally, Section C asked for biographical information that included (i.e. age, gender, and level of education)

The questionnaire was reviewed by a group of professors from the Department of Speech-Language and Hearing Sciences at the Faculty of Rehabilitation Sciences, the Department of Educational Psychology, and the Faculty of Educational Sciences at the University of Jordan.

Procedures

Procedures of the current study were similar to those of Breadner's et al study (1985). Questionnaires were given out to visitors, in one of the largest shopping malls in Amman. Amman is a city of 2,473,400 habitants. It represents 38.7 % of the total population of Jordan (Department of Statistics, 2012). The questionnaire was reviewed for ambiguities or misunderstanding by professionals and 10 undergraduate students in the field of speech-language pathology. Recommendations, thus, were considered and a number of necessary changes were made.

The study investigators and 12 graduate students in speech-language pathology distributed the questionnaire after obtaining consent from the mall administration. A corner for attracting shoppers, with edible incentives and brochures on communication disorders, was set in the mall to serve the purpose of the study. Those who voluntarily agreed to participate in the study received a copy of the consent form to sign, and the questionnaire. The questionnaire took approximately 15 minutes to complete. Participants did not receive any information or help from the study team during filling the questionnaire. Upon their completion, those who had any questions related to speech-language pathology and/or communication disorder issues were given information and counselled.

Statistical analysis

A coding system was designed based on the questionnaire items and response categories. SPSS statistical analysis software was used in data analysis.

For the purpose of this study, two data analysis procedures were conducted: (1) descriptive statistics were used to examine distribution of responses, and (2) comparisons between groups were undertaken using Chi square analysis to measure association for selected personal information variables which included (gender, level of education, type of occupation, socio economic statues, income level and whether the participants have children or not) and the knowledge of speech-language pathology. Analysis was conducted after testing for the assumption of equal variances. Significance was set at p > 0.05.

Results

1. Characteristics of the participants

Descriptive statistics were computed for individual survey items pertaining to the characteristics of the participants (see Table 1).

A total of 1203 surveys were completed, and about half of the participants were males (49.5%) from 18 to 25 years old. Two third of the participants reported having one or two children; the average age range of children was from 2 to 9 years. Regarding qualifications, half of the participants (49.7%) had a bachelor degree, 15% had a high school certification, 10.6% had a diploma, and 28.2% attended health- or education-related fields.

Around half of the participants were employed; while 36.7% were not. In terms of total annual income, 43.9% of the participants reported an annual income between 5000-10,000 Jordanian dinars. Moreover, regards to socio-economic status, results indicated that 64.8% of Jordanian families have another source of income. Interestingly, around two third of the study sample were interested in learning more about the speech-language pathology and what it takes to work in the field.

2. General knowledge and awareness in the field of speech-language pathology:

2.1 Knowledge about speech language pathologists (SLPs):

Questions 1-4 addressed whether participants ever read, or heard about speech language pathologists (SLPs). Results indicated that 65.6% of the participants had never read anything about SLPs. However, those who had read about SLPs reported that they have obtained their information--ranked from highest to lowest--through the internet, magazines, books and brochures.

Nearly 50% of the participants indicated that they had never heard about SLPs. Among those who had, the most frequently reported sources of information were televisions, the internet, and parents of children with communication problems. Radio, and general education lectures were ranked as the lowest sources of information. About 17.5% of the participants reported that they must have met a speech-language pathologist, while one third of the study sample believed that they knew someone who SLP.

2.2 Knowledge of the speech language pathologist working settings, age of clients, and clinical training:

Questions 5-9 in the questionnaire were related to the SLP employment settings and vocation. Approximately half of the participants thought that the SLP primary employment setting is in private clinics, while settings like kindergartens (23.6 %), schools (23%) and hospitals (22.4%) came next. Furthermore, 11.3% of the sample believed that the speech-language pathologist may be able work in a university setting. Although SLPs do work in all listed settings, just 2.7% of the participants correctly identified the five settings.

Additionally, 812 of the sample (67.3%) indicated that they do not need referral from a physician in order to follow up with a SLP. Over half of the participants (57.1%) thought that the SLP does work with preschool age children. Just 10.4 % believed that a SLP is involved in working with infants and elderly groups. Concerning SLPs training, 39.2% of the participants thought that one year training after graduation is needed. Although 32.4% of the study participants thought that a SLP is given the "Doctor "title, the majority believed that the SLP is called a "Therapist."

3. Knowledge and awareness of communication disorders

This questionnaire section dealt with types of communication disorders that speech language pathologists usually assess. Participants were asked to make judgements on five different communication disorder scenarios: articulation disorders, language developmental delay, voice disorders, fluency disorders, and dyslexia. Dyslexia is characterized by difficulties in the development of literacy and language related skills (Davis, 2010). The five communication disorder scenarios were as follows:

1. Shadi, age 5, can't say the "s." sound properly, and used the "th." sound instead. For example he says. "hpoon."-for "spoon." Should Shadi be tested by a speech language pathologist?

2. Salma, age 3, uses about 50 different words and is starting to put words together, like "want cookie." She understands simple questions and can point at pictures and parts of her body when named. Should Salma be tested by a speech language pathologist?

3. Ali, age 8, has a husky voice. His mother says he's always yelling. Should Ali be tested by a speech language pathologist?

4. Ahmad, age 5, sometimes repeats sounds or words when he's excited, but never seems to notice it. For example, he might say "LLL--look at me, mommy!."hmad's parents are not concerned about his speech. Should Ahmad be tested by a speech language pathologist?

5. Sara, age 8, has lots of trouble reading and writing at the time that she does not have problems talking to her friends and family members. The school plans to give her a number of tests to find the cause of the problem. Should Sara be tested by a speech language pathologist?

Approximately one third of the study participants believed that patients in the five scenarios should be referred to the SLP for assessment. Furthermore, there was general agreement on the significant role of the SLPs in the assessment of fluency disorders and articulation disorders. In contrast, language developmental delay, voice disorders, and dyslexia were the areas that participants were most undecided about. This indicates the need for further public education of the SLPs vocation and the various types of communication disorders.

Question 15 included a set of case scenarios. Some of which SLPs are typically involved in their treatment, and some that they are typically not. Results are summarised in Table 2.

Interestingly, participants did not differentiate between situations that do not require a speech language pathologist--such as in "people with pneumonia', "people with leukemia." ."adults who lose their eyesight." and in." people with tonsillitis."--and situations that require one (i.e. SLP). Additionally, results from Table 2 indicate good knowledge of disfluency disorders "e.g. adults who stutter." compared to other communication disorders. Most participants thought that "people who have memory deficits "were the most difficult communication disorders to make a judgement about.

4. Effect of personal characteristics on level of awareness

Relationship between participants' personal traits and characteristics was investigated in relation to knowledge about SLP and communication disorders.

Demographic background of gender, income level, socio-economic status, education level, type of occupation, and whether there are children or not was analysed. Results indicated no significant differences in terms of income or socio-economic status. In contrast, significant differences were found in the remaining variables.

Females were more likely to have information about SLP from readings [chi-square (1d.f.) =; p = 0.001], from hearing or watching a programme [chi-square (ld.f.) =11.82; p = 0.001], or from meeting an SLP [chi-square (1d.f.) = 7.07; p = 0.29]. Females were more capable of correctly identifying settings that SLPs work in [chi-square (4d.f.) =12.82; p = 0.000],

Participants with children were more likely to acquire information through hearing or watching a programme [chi-square (1d.f.) = 7.51; p = 0.006], meeting SLPs [chi-square (1d.f.) = 6.30; p = 0.012], or knowing someone who knew an SLP [chi-square (1d.f.) = 14.10; p = 0.029].

In terms of education, participants with a bachelor degree were more likely to have information from hearing or watching a programme about SLPs [with a significant difference of chi-square (4d.f.) = 12.40; p = 0.015]; from meeting SLPs [chi-square (4d.f.) = 8.9; p = 0.021]; or from knowing someone who knew SLPs [chi-square (4d.f.) = 9.66; p = 0.014]. Also, they were able to accurately identify setting that SLPs work in [chi-square (16d.f.) = 30.90; p = 0.014].

More interesting results come from looking at occupation. Results revealed that respondent's occupation had the most significant impact on knowledge of the field of speech-language pathology. Participants working in the fields of health, or education were more likely to have some information about the field of speech-language pathology from readings [chi-square (1d.f.) = 4.36; p = 0.037]; meeting a speech-language pathologist [chi-square (1d.f.) = 20.00; p = 0.000]; or knowing someone who knew a speech-language pathologist [chi-square (1d.f.) = 8.68; p = 0.003]. They were also able to accurately identify settings of SLPs employment [chi-square (4d.f.) = 8.8; p = 0.023]. Moreover, they were more likely to know about the different age groups that are typically treated by the SLP [chi-square (5d.f.) = 8.51; p = 0.037].

Results from this study reveal that females who attained a bachelor degree in health- or education- related fields and have children, regardless of their number, have the highest level of accurate information and knowledge about the field of speech-language pathology and about communication disorders.

Discussion

Characteristics of participants

The aim of this study was to determine the awareness and knowledge of the public regarding speech-language pathology. To carry out this research the data were collected in a large shopping mall between 20 and 21 March 2013. These two days were selected because March 21 was Mother's Day and fortunately, these two days also fell at weekend. In other words, we found that the shopping mall was very busy due to people who came to buy gifts, who needed to shop or who were interested in shopping, which reflected the representative sample. Those shoppers might consist of younger persons, particularly between the ages of 18 and 30 as the sample reflected. The numbers of female and male participants were 44.3% and 49.5%, respectively. A critical analysis of the data shows that although some females were with their children they were still interested in filling out most of the survey questions, mainly in the knowledge and awareness section compared with males who left some questions blank.

The results further shown that among shoppers, certain subgroups were more likely to be concerned to answer a questionnaire about speech-language pathology than others. These would be individuals with more formal education, especially those in health- and education-related fields. On the other hand, these professionals such as doctors, dentists, and teachers are more likely to be in contact with speech language pathologist, since they may meet, observe, and refer the persons and families with communication disorders to speech-language pathologists. Furthermore, persons not from health- and educated-related fields might be less knowledgeable and have lower awareness than their peers with more appropriate education and therefore less equipped to fill out a survey.

In terms of respondents with children, parents' participants might be more involved in speech-language pathology than non-parents, while mothers who take greater care of their children than fathers might be more interested in the topic than the fathers. In addition, mothers are often good observer regarding the normal language and speech development with their children through daily and direct contact, which leads them to seek and search for problem solution. Therefore, it could be inferred that this group of shoppers, who decided to complete the survey, would be more knowledgeable about speech-language pathology than other subgroups.

Finally, although the results on the subject of socio-economic income and annual returns suggest no statistical differences in knowledge about speech-language pathology, it is important when promoting public awareness to focus on all segments of society particularly those with an annual income of 10,000 Jordanian dinars or less which represents the largest number of sample participants with 43.3%

General knowledge and awareness of speech-language pathology:

The major findings of this study are that public awareness and knowledge of speech-language pathology as a profession is less than would be desirable. This finding is consistent with those of Breadner et al., 1987) and American speech language association ASFIA survey, 2013). This shows clearly with respect to information about SLPs that individuals are exposed. Moreover, the results suggest that about 70% of the participants reported they had never read about SLPs, and they believed that internet and magazines were the first sources of information. There are several reasons why this may be able the case. Firstly, the technology via the internet has brought new information and knowledge faster than the traditional research in the library. Secondly, many people particularly the youth would be more attracted to buy and read magazines because they always cover a wide range of subjects such as beauty, fashion and makeup and men's and women's needs. Finally, many individuals feel that it is very hard to find specialised books or brochures in diverse subject.

It appears that books and brochures could be put to greater use to educate the public. It is expected to find that televisions and the internet were also the top reported sources where people had ever seen or heard about SLPs. As a consequence of the previous results, it is not surprising to find that the majority of the study sample had never met a SLP.

It is encouraging to note that most participants believed that a referral from a physician was not necessary to meet a SLP, which is considered a good thing due to the fact that not all physicians have ideal knowledge about symptoms, assessment and treatment of communication disorders. Moreover, not all families in Jordan have a family doctor to ask for referral. Finally, some parents who have children with communicative disorders believed that these disorders are not a medical issue but are an educational matter, although approximately 20% of participants believed a physician's referral is required. A SLP should play an important role in educating physicians about communicative disorder signs and the important role of the SLP. Another finding relating to places that employed SLPs showed that half of the participants thought that the private clinic was the initial position that employed SLPs while the knowledge and awareness of other places was limited. It is probably reasonable to assume that individuals who had experience with communicative disorders, regardless of their ages, worked in these private clinics. On the other hand, clinics usually provide adults and children in the community with comprehensive and progressive speech and language services, in addition to adopting a collaborative approach with parents, teacher and other professionals, while speech language clinics in kindergartens and schools serve preschool and school-aged children.

Further support for lack of awareness comes from the fact that a few of the participants do not believe that the SLP work with infants and elderly groups. However, high proportion of participants considered that they work mostly with preschool and school-aged children. This may be due to the fact that they make up the bulk of the speech-language caseloads. Additionally, the majority of those who suffer from communication disorders are located among preschool and grade school children. SLPs may wish to make it known that they are qualified to deal with infants, and elderly people with communication disorder by highlighting some common disorders in infants such as swallowing problems and delayed language development due to hearing loss, aphasia and dysarthria in elderly people.

With regard to SLP training, the participants in this study reported that one to two years of training is required to be certified, which indicated that speech-language pathology as a profession requiring specialised training. According to the Licenses for Practicing Various Medical Professions Unit in the Ministry of Health in Jordan (Ministry of Health, 2013), a SLP who held a Master's degree in speech pathology needs to complete two years training after graduation to become certified, while there is no need of further training for a speech therapist who held a Bachelor's degree in this field because he should work under a supervising certified SLP.

It is interesting to note that the majority of participants thought that a SLP could be called a "Therapist." whereas over 30% of the study sample believed that they may be termed "Doctor." Nevertheless, job titles were a source of confusion to the participants. It is suspected that many in the responding sample were unable to differentiate between "speech pathologist "or "speech therapist "or "doctor." The first two titles are generally used to describe the individual who works in the field of speech pathology while 'doctor' is a medical title. However, regardless of the job title--whether pathologist or therapist--specialists in the SLP area should continue their efforts to educate the general public about the importance of carefully seeking SLPs to be certain they hold the qualifications required. Furthermore, it is important to seek this information to avoid overlap between SLPs and other professions like doctors, language resource teachers, special education specialists and classroom teachers in addition to any person who has only attended brief courses or workshops in speech therapy.

Knowledge and awareness of communication disorders

In subsequent questions, participants were asked to indicate if behavioural profiles are needed for SLPs for evaluation or not; In other words, whether these are needed to determine if the participants can distinguish between normal and abnormal symptoms. Although the results revealed that approximately one third of the participants thought that all five profiles should be referred to SLPs, two thirds of the sample were undecided or disagreed, which strongly indicated that many participants would have difficulty discriminating between normal and abnormal symptoms of speech and language development.

It is interesting to note that the most common behavioural profile with communicative disorders that participants were able to make correct judgment on were articulation and fluency disorders,, while language delay, voice disorders and dyslexia were the most difficult to distinguish. Once again, there is still a need to provide the general public with additional information in order to improve the individual's knowledge by providing the public with an open invitation to contact them and to increase understanding of normal and abnormal language and speech development. It is important to take into consideration encouraging parents, teachers and everyone who deals with children to undertake speech language screening to ensure that all language and speech milestones are within normal limits.

The result from the survey concerning the disorders that SLP could deal with provides variable data. Even though some disorders like stuttering, hearing loss and voice were recognised by the majority of participants, still others were not. This could be an important finding because it has increased the possibility that other communicative disorders such as stroke or cleft lip and palate may still remain unrecognised and thus untreated.

It is interesting to note the participants' comments at the end of survey relate to the possibility to specialise and work in the speech-language pathology field. Two thirds of the participants answered that they are willing to know more about this profession and work in it; However, some of the participants wrote that professionals in this career required good personal characteristics such as excellent communication and interpersonal skills, sensitivity to client needs, ability to set priorities and deal with multiple demands, and of course scientific aptitude and patience.

Conclusion

This study has investigated public awareness and knowledge of speech-language pathology in Amman, Jordan. To that purpose a sample of 1203 participants completed the questionnaires. Overall, it seems that public awareness of speech-language pathology as well as of communicative disorders is limited. However, this research has revealed the least informed target population which includes males, with or without children, with different kind of education degree such as graduate degree and lower than Bachelor's level, and finally in professions other than health- or education-related fields.

Overall, according to the limited knowledge about a number of important subjects, general public awareness of speech-language pathology should focus on the following topics: * Simple identification regarding speech-language pathology as a career, places that employ them, and how to obtain services.

* Increasing people's understanding of disorders that are assessed and treated by SLPs, particularly disorders that are less familiar such as those with associated cleft lip and palate, strokes, dementia and language delay.

* Age groups that speech-language pathologists' work with, particularly infants and elderly people. If the patients are unaware of SLP services, these patients may not receive beneficial attention.

In order to maximise the opportunities for effective knowledge to reach as many people as possible, a range of options are advised. These include educating and counselling the public in community venues through visual and auditory educating material such as via the television, posters, open invitations, special lecture presentations and radio interviews.

Additionally, we suggest that SLPs conduct effective screening programmes in kindergartens, schools, centres or institutions which would contribute to raising the awareness of communicative disorders and the methods available to deal with them. Furthermore, workshops and training programmes should be emphasised more to parents, teachers and professionals who come into contact with persons needing referral for speech-language pathology. Regardless of job title--whether pathologist or therapist--professionals must have obtained the required qualifications to ensure appropriate service delivery.

APPENDIX

Questionnaire

Speech language pathology: a study of public awareness

A speech language pathologist is concerned with improving their services to the public. Therefore, we would like to begin with a few questions about what the term "speech language pathologist." means to you.

Q.1 Have you ever read anything about speech language pathologists?

a, No

b. Yes please continue with the question below.

Where have read anything about speech language pathology?

a. Magazine

b. Book

c. Brochure

d. Internet

e. Others--

Q.2 Have you ever seen or heard a programme about speech language pathology?

a. No

b. Yes

Where have you seen or heard a programme about speech language pathology?

a. Television

b. Radio

c. Lecture

d. Child's parent

e. Internet

f. Others--

Q.3 have you ever met a speech-language pathologist?

a. No

b. Yes

Q.4 do you know anyone who knows a speech-language pathologist?

a. No

b. Yes

Q.5 Where do speech language pathologists work?

a. Kindergarten

b. School

c. University

e. Hospital

f. Private clinic

Q.6 Do you need referral from your family doctor to see a speech language pathologist?

a. No

b. Yes

Q.7 Speech language pathologists work with ...

a. Infants

b. Pre-school children

c. Grade school children

d. Teenagers

e. Adults

f. Elderly people

Q.8 How much training would you expect a speech-language pathologist to have beyond graduation?

a. None

b. At least one year

c. At least two years

d. At least three to four years

e. At least four to five years

f. More than five years

Q.9 Are these statements true or false?

a. A speech language pathologist may also be called a doctor.

1. True 2. False

b. A speech language pathologist may also be called a therapist.

1. True 2. False

B. Do you think the following children should be tested by a speech language pathologist?

Q.10. Shadi, age 5, can't say the "s" sound properly, and used the "th" sound instead. For example he says "hpoon" for "spoon." Should Shadi be tested by a speech language pathologist? 1. Strongly agree 2. Agree 3. Undecided 4. Disagree 5. Strongly Disagree

Q.11 Salma, age 3, uses about 50 different words and is starting to put words together, like "want cookie." She understands simple questions and can point to pictures and parts of her body when you name them. Should Salma be tested by a speech language pathologist?

1. Strongly agree 2. Agree 3. Undecided 4. Disagree 5. Strongly Disagree

Q. 12 Ali, age 8, has a husky voice. His mother says he's always yelling. Should Ali be tested by a speech language pathologist? 1. Strongly agree 2. Agree 3. Undecided 4. Disagree 5. Strongly Disagree

Q.13 Ahmad, age 5, sometimes repeats sounds or words when he's excited, but never seems to notice it. for example, he might say "LLL--look at me, mommy!. "hmad's parents are not concerned about his speech. Should Ahmad be tested by a speech language pathologist? 1. Strongly agree 2. Agree 3. Undecided 4. Disagree 5. Strongly Disagree

Q.14 Sara, age 8, has a lot of trouble with reading and writing. Sara does fine talking with his friends and family. The school plans to give her a group of tests to find the cause of the problem. Should Sara's testing include testing by a speech language pathologist?

1. Strongly agree 2. Agree 3. Undecided 4. Disagree 5. Strongly Disagree

Q.15 we would like to ask you which of these groups you might expect a speech language pathologist to work with. Circle the number of your answers

* People with diseases or injuries of the brain

* People with hearing loss

* Adults who stutter

* Autistic children

* People with pneumonia

* Mentally retarded people

* People who have their voice box or vocal folds removed

* People who have had strokes

* Adults who lose their eyesight

* People with cleft lip or palate

* People with strained voices

* People with leukaemia

* People with dementia or memory deficit

* People with muscle diseases

* People with tonsillitis

C. We would like to ask some questions about you to help us interpret the results

Q.16 Gender:

a. male

b. female

Q.17 Nationality:

a. Jordanian

b. other--

Q. 18 What is your age?

a. 18-25 years

b. 26-30 years

c. 31-35 years

d. 36-40 years

e. 41-45 years

f. 46-50 years

g. 51 years or over

Q.19 Do you have any children?

a. No

b. Yes

Q.20. If yes, please indicates the number of children you have in each age group.

a. Under 2 years of age

b. 2-5 years

c. 5-9 years

d. 10-13 years

e. 14-17 years

f. 18-20 years

Q.21 Which is the highest level of education you have completed?

a. Under high school certification

b. High school certification

c. Diploma

d. Bachelor's degree/specify

major--

e. Graduate degree/ specify major--

Q.22 Are there any members of the family work and income owners?

a. No

b. Yes

Q.23 Which of the following categories best describe your total annual family income?

a. 5,000 Jordanian dinars or less

b. 5,000-10,000 Jordanian dinars

c. 10,001-20,000 Jordanian dinars

d. 20.001-30,000 Jordanian dinars

e. 30,001-40,000 Jordanian dinars

f. 40,001 or over

Q.24 Do you live within Amman city limits?

a. No

b. Yes

Q.25 Would you like to specialise or work in this field if you have a chance?

a. No why--

b. Yes why--

References

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Amayreh, M., & Natour, Y. (2012). Introduction to Communication Disorders (1st ed). Jordan: Daralfiker.

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Ellis, C., & Mauldin, P.D. (2013). The Real Cost of Communication Disorders. The ASHA Leader. Retrieved from: http://www.asha.Org/leader

Fahmi, M. (1975). Speech pathology. Cairo: Egypt Library.

Flynn, l., Cumberland, A., & Marshall, J. (2009). Public knowledge about aphasia: A survey with comparative data. Aphasiology, 23, 393-401.

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Karbasi, S. Fallah, R., & Golestan, M. (2011). The prevalence of speech disorders in primary school students in Yazd- Iran. Acta Medica Iranica, 49 (1), 33-37

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HANA MAHMOUD, M.A.-SLP

The University of Jordan

AYA ALJAZI, M.A.-SLP

The University of Jordan

DR. RANA ALKHAMRA, PHD, CCC-SLP

The University of Jordan
Table 1. Participants' characteristics by
percentage

Variable          Category             Frequency     %

Gender            males                   595      49.5
                  females                 533      44.3
                  NA                      75        6.2

Age               18-25                   626      52.0
                  26-30                   218      18.1
                  31-35                   115       9.6
                  36-40                   57        4.7
                  41-45                   44        3.7
                  46-50                   29        2.4
                  Above 50                29        2.4
                  NA                      85        7.1

Have children     No                      827      68.7
                  Yes                     251      20.9
                  NA                      125      10.4

Number of         1                       65        5.4
children          2                       54        4.5
                  3                       41        3.4
                  4                       37        3.1
                  5                       23        1.9
                  6                        7        0.6
                  7                        6        0.5
                  NA                      970      80.6

Qualification     less than High          57        4.7
                  School Certificate
                  High School             181      15.0
                  Certificate
                  Diploma degree          128      10.6
                  Bachelor's degree       598      49.7
                  Graduate degree         101       8.4
                  NA                      138      11.5

Occupational      health-education        339      28.2
field             others                  552      45.9
                  NA                      312      25.9

Socio-            other member works      811      67.4
economic          NO                      198      16.5
income            NA                      194      16.1

Total             Less 5000               190      15.8
family            5000-10,                528      43.9
income            10, -20                 82        6.8
                  20, -30                 55        4.6
                  30, -40                 35        2.9
                  40, -50                 65        5.4

* NA (no answer)

Table 2. Participants' responses by
percentage regarding diversity of
disorders treated by speech language
pathologists.

Types of disorders                Frequency     %

People with diseases or              375      32.1
injuries of the brain
People with hearing loss             455      37.8
Adult who stutter                    830      69.0
Autistic children                    376      31.3
People with pneumonia                43        3.6
Mentally retarded people             357      29.7
People who have their voice          369      30.7
box or vocal folds removed
People who have had strokes          244      20.3
Adults who lose their eyesight       76        6.3
People with cleft palate or lip      267      22.2
People with strained voices          455      37.8
People with leukemia                 32        2.7
People who have memory deficit       94        7.8
People with muscles diseases         103       8.6
People with tonsillitis              73        6.1
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Author:Mahmoud, Hana; Aljazi, Aya; Alkhamra, Rana
Publication:College Student Journal
Article Type:Report
Geographic Code:7JORD
Date:Sep 1, 2014
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