Response: D. Swanepoel 10 D e p a r tm e n t o f C o m m u n ic a tio n P a th o lo g y , U n iv e r s ity o f P r e to r ia , SA . H. K athard, E. N aude, M. Pillay and E R Research-driven: A Scientific Profession Accountable within Contextual Realities Audiology and speech-language pathology are professional qualifications in the sciences of these respective fields. They are sciences because the professions are founded on the princi­ ple of scientific enquiry which employs logical reasoning proc­ esses to describe, solve, understand and explore phenomena and relationships (Maxwell & Satake, 2006). As practitioners o f these respective sciences we owe our professions to the dedicated application o f scientific enquiry over time to the. field o f communication disorders and other basic sciences. Because they are sciences, the practice o f audiology and speech- language pathology are inherently research-orientated. This means that the professions are not only the offspring o f accu­ mulated research but also imply that practising it accountably requires that each clinician, to an extent, also be a researcher. It is this inextricably mutual relationship between research and practice that stimulates the growth and development of our services (Walley et al., 2007). The development and improvement o f our professions should be guided by our scope o f practice and the populations to be served in the unique South African context. It should not therefore be guided by reigning political agendas but the pro­ fessions should rather abide by principles that transcend politi­ cal ideology, which reflect the deepest aspects o f human dig­ nity and respect for all persons. Past political ideologies, which did not abide by this principle, resulted in a legacy of health­ care inequities in South Africa. For example, approximately 80 to 85% o f the South African population relies on the public healthcare sector although the remaining 15 to 20% o f the population that accesses private healthcare services, utilizes 61% o f the country’s total health care expenditure (ANC To­ day, 2005). This figure provides sufficient evidence that as professions we should not subscribe to political philosophies but should rather concern ourselves with upholding the princi­ ple o f respect for all persons within our professional capacity. The professions should therefore be aligned to a basic code of conduct that strives to provide equitable access to ac­ countable audiology and speech-language pathology services for all people within the contextual realities o f the South Afri­ can population. This implies that the professions should be very closely involved with reigning issues of, for example, poverty and the burden o f infectious diseases in South Africa, but within the confines o f our professional scope o f practice and in terms o f the populations which we are mandated to serve. These populations include two categories. Firstly, pre­ vention in the professions encompasses the entire population in efforts to eliminate or minimize risks for, and sequelae of, communication disorders. In this broad category, aspects out­ side the professional scope impact directly on the effectiveness o f prevention, such as poverty which increases risks for com­ munication disorders (Kubba et al., 2004; O ’Connor, 2004). The second population is the sub-set o f individuals with a communication disorder for which intervention is provided. In this population many variables in a client’s environment influences the intervention at an individual level and profes­ sionals need to identify and address these at this level. As pro­ fessionals we are therefore obliged to engage in issues o f social justice and equity only as it relates to our professions at the level o f prevention and intervention. Die Suid-Afrikaanse Tydskrif vir Kommunikasieajwykings, Vol. 54, 2007 In engaging with these issues Kathard et al. acknowl­ edge the crucial role o f research but raise questions regarding the appropriateness o f the empirical approach to research, re­ ferred to as a ‘cultural artifact ’, with respect to accomplishing this task. The current body o f professional knowledge on which our professions stand is presumed to be biased towards the populations from which this knowledge initially originated, i.e. ‘Caucasian, middle-class, monolingual European speakers’. Whilst it is true that the professions have been dominated by positivist empirical scientific enquiry, and in fact were founded on this very approach, it is important to consider their roles both as a vehicles for addressing current issues in the profes­ sions and as probable sources o f biased professional knowledge that may not be applicable to the majority o f South African populations. A positivist empirical research paradigm by definition implies a belief that there is objective truth which can be inves­ tigated and described by employing sound methods. It is im­ portant, however, to distinguish the type of research for which this positivist empirical approach is utilized (Newman, 1997). A basic in contrast to an applied type of research is not influ­ enced by the population it is conducted on or by, and in fact will often not even utilize such samples towards its research ends. Since our professions are based on the accumulation of decades o f basic research in the sciences underlying human communication such as anatomy, physiology and acoustics (Maxwell & Satake, 2006), the basic knowledge of our profes­ sions should not be influenced by research conducted by or on ‘mainly male, urban, middle-class, Judeo-Christian, European language speakers'. Applied research, in contrast, is susceptible to bias due to the nature of the study population. This type o f research al­ though not necessarily constituting the basic knowledge o f our professions certainly constitutes the majority o f the research conducted by audiologists and speech-language pathologists and is referred to as professional research. Since these profes­ sions are mainly concerned with addressing the challenges o f clients, the focus o f scientific enquiry is most often on solu­ tions which can be applied immediately (Maxwell & Satake, 2006). However, professional research should also aim to gen­ erate an authentic indigenous theoretical base for the profes­ sions (de Vos, 2002). Unfortunately, due to the past inequali­ ties o f South African healthcare services based on racial dis­ tinctions, the knowledge produced by applied research in healthcare professions such as audiology and speech-language pathology has certainly favoured a white cultural and linguistic minority. It is these inequalities, in terms o f access to services reflecting the cultural linguistic needs o f people in South Af­ rica, which the professions should address by prioritizing ser­ vices and applied research to previously disadvantaged com­ munities. To address these reigning inequalities in research for the professions in the multicultural and multilingual South African context it is true that a positivist research paradigm may not be sufficient to describe the complexities o f the clients we serve as professionals. A holistic or eclectic approach, which combines positivist and phenomenological research paradigms and ap­ plies both quantitative and qualitative methods, may be more R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) Im proving the R elevance o f Speech-L anguage Pathology and A udiology R esearch and P ractice 11 appropriate for the task. A phenomenological, in contrast to a positivist, research paradigm assumes that the world is socially construed and therefore all truth is subjective and relative (Newman, 1997). Combining research along the continuum o f the positivist and phenomenological extremes, investigating both abstract and concrete concepts to describe, solve, understand and explore professional practice and client profiles is therefore war­ ranted. This holistic or eclectic approach can provide a richer body o f professional knowledge that produces scientific fact within an understanding o f the subjective realities of the socio­ cultural populations which we serve. It is therefore not a matter o f abandoning old methods but rather o f embracing new ones alongside traditional research methods. To an increasing extent, this has been a trend in recent studies conducted by the profes­ sions in South Africa (Louw & Avenant, 2002; van Dijk, 2003; Swanepoel et al., 2005). Whilst it is necessary and useful to critically consider the research paradigms to be employed by the professions o f audiol­ ogy and speech-language pathology, on a more practical level it is essential that whatever the research being pursued, it must ultimately be published. Research conducted by our professions in South Africa unfortunately, remains unpublished in the over­ whelming majority o f cases. A marginal number o f publications, and especially international publications, have emerged from the respective fields o f audiology and speech-language pathology since the establishment o f the professions in South Africa over five decades ago (Swanepoel, 2006). Credence and advocacy for our services rely in large part on the recognition o f the research we conduct. This is especially true in an era where evidence- based practice has become a core principle o f professional prac­ tice. It is therefore o f great importance that we not only ensure the use of an holistic paradigm in our research but that we dem­ onstrate the worth o f our efforts by bringing them to fruition in the form o f internationally recognized peer-reviewed publica­ tions. The collective responsibility for establishing world-class research outputs that are locally relevant rests on the profession as a whole, and in particular on the academics and postgraduate students at tertiary institutions for audiology and speech- language pathology. > ‘‘Sociopolitical changes j have come and gone, but the challenge fo r the profession has remained the same - to provide accountable services to the entire population based on quality training and contextual research efforts” (Swanepoel, 2006, p.266). Improving the relevance o f the research and practice of the professions o f audiology and speech-language pathology in South Africa, as argued in response to the issues raised by Response: ErnaAlant Kathard et al., therefore relies on 1) the clear recognition o f the professions as sciences reliant on research development; 2) the adherence to basic principles of human dignity and respect for all persons instead of political ideologies; 3) the engagement of social justice and equity in our professional capacity only as these principles relate to scope of practice and the populations which we serve; 4) the utilization o f holistic research paradigms by embracing phenomenological methods alongside existing positivist methods; 5) the culmination o f research efforts being acknowledged in internationally recognized publications which serve an advocacy function in respect o f the professions and the respective services they render to the broader South African population. A N C T oday (2005). R esponding b etter to the health care n eeds o f com m unities. A N C T oday, 5(4 3 ). h ttp ://w w w .a n c .o rg .z a /a n c d o c s /a n c to d a y /2 0 0 5 / a t4 3 .h tm # artl de V os, A. (2002). Scientific theory and pro fessio n al research. In A.S. de V os (Ed.), R esea rch a t Grass R oots. (2nd ed.) P retoria: V an Schaik. 28-48. K ubba, H., M acA ndie, C., R itchie, K. & M acF arlane, M. (2004). Is deafness a disease o f p overty? T he association betw een socio-econom ic deprivation and congenital hearing im pairm ent. In tern a tio n a l Jo u r n a l o f A u diology, 43, 123-125. L ouw , B. & A venant, C. (2002). C ulture as co n tex t for intervention: developing a cu ltu rally co n g ru en t early intervention program . International P ediatrics, 17(3), 145-150. M axw ell, D.L. & Satake, E. (2006). R eseach a n d sta tistic a l m ethods in co m m u ­ nication sc ien ces a n d disorders. C lifton Park: T hom son D elm ar L earning. N eum an, W .L. (1997). So cia l R esearch M ethods: Q ualitative a n d Q uantitative A p p ro a ch es (3rd ed.), A llyn and B acon, Boston. O ’C onnor, A. (2004). T he persistence in poverty. In D. Potes & T. Bow yer- B ow er (E ds.) E a stern a n d Southern A frica. D e ve lo p m en t challenges in a volatile region. E ssex: Pearson E ducation L im ited.(pp. 89-117). S w anepoel, D. (2006). A udiology in South A frica. In tern a tio n a l J o u rn a l o f A u d io lo g y, 45, 262-266. S w anepoel, D ., H ugo, R. & Louw, B. (2005). Im plem enting infant hearing screening at m aternal and child health clinics: context and interactional processes. H ea lth SA G esondheid, 10(4), 3-15. V an D ijk, C.A . (2003). A n educational a u d io lo g y se rvice d elivery m odel: needs o f teachers o f children w ith hearing loss. U npublished D .Phil. C om m unica­ tion P athology degree. U niversity o f Pretoria. W alley, J., K han, M .A ., Shah, S.K ., W itter, S. & W e, X. (2007). H ow to get research into practice: first g et p ractice into research. B ulletin o f th e W orld H ea lth O rganization, 85(6), 424-425. Director: Centre for Alternative and Augmentative Communication, University o f Pretoria, SA. A bou t being relevant: a com m ent on Kathard, Naude, Pillay & Ross (2007). I accepted the invitation to respond to this paper with pleasure, not only because I welcomed the critical thinking reflected in the paper, but also because I think the issues raised are vital to the long-term sustainability o f the professions of SLP/Audiology in this country. Like others, I also have been deeply concerned about the profession and its future within the African continent. This concern is not based on a belief that the profession is irrele­ vant or peripheral to local development, but rather on the com­ plexities of the issues facing the field o f Speech-Language Pa­ thology and Audiology as well as other rehabilitation profes­ sions within poverty contexts. Kathard et al. (2007) raises important issues upon which I would like to comment and include: • the issue o f relevance and different types o f research, • the role o f evidence-based practice and finally, • intervention in poverty contexts. For a long time, the western world has dominated the profession of Speech-Language Pathology and Audiology for good reasons. However, as the developing countries come into their own, the realization dawns that we can not translate strategies used in The South African Journal o f Communication Disorders, Vol. 54, 2007 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) http://www.anc.org.za/ancdocs/anctoday/2005/