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Response to: The relevance o f Speech-Language Pathology and Audiology Research and Practice - Challenges f o r the Professions The authors are to be commended for raising pertinent issues relating to the ways in which the professions conduct research and the relevance for accountable practice, especially at this point in our professions’ and nation’s history. Given our past and current realities the challenge is to advance research and professional practice responsibly and responsively. In the new spirit o f redressing previous inequities, and increasing the access o f the majority o f South Africans to professional ser­ vices, there has arisen an urgent need for research that guides ethical service delivery in the context o f cultural and linguistic diversity, poverty, and the ravages o f pandemics such as Tu­ berculosis and HIV/AIDS. Posing solutions to the questions raised by the authors might sug­ gest that there are ready answers which is, manifestly not the case. Hence this treatise considers some o f the issues relating to the production o f knowledge and the challenge of making it respon­ sive to professional practice. How do we produce knowledge? The ways in which knowledge is produced reflects particular worldviews - which have changed over time. Critics (such as Habermas, 1972; and Lincoln & Guba, 1985) o f the modem posi­ tivist approach which espouses that the natural causal laws gov- 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. ) 18 H. K athard, E. N aude, M. P illay and E. Ross eming the real world can best be understood by objectively ana­ lyzing the components using experimental methods, assuming linearity, absolute truth and rationality, suggest that it is no longer useful in knowledge production. A deconstructive post­ modern alternative posits that knowledge is relative as it is sub­ jectively constructed by unique individuals arising out o f their lived experiences within a particular culture and social structure (Usher & Bryant, 1989); while the critical paradigm recognizes the relationship between researchers involved in knowledge- making and the institutionalized political and cultural power that favours the privileged (Calas & Smircich, 1999). Action research, according to Reason and Bradbury (2001), is “concerned with the development o f democratic forms o f knowledge” (p.6) and is conceived o f being possible only “with, for, and by persons and communities, ideally involving all stakeholders both in the questioning and sense-making that in­ forms the research and in the action which is its focus” (p.2), with the ultimate purpose o f research being “human flourish­ ing” (p. 10). The participatory worldview promotes inquiry into what “flourishing” is and incorporates elements o f both positiv­ ism (i.e. “there is a ‘real’ reality”) and deconstructive postmod­ ernism (“any a c co u n t... o f the cosmos ... is culturally framed”), hence facilitating use o f positivist techniques and knowledge (where appropriate) and framing “these within a human con­ text” (p. 7). How do we best take advantage o f these different ways o f knowledge production? The choice o f research method sig­ nals a particular worldview - and also ought to reflect deep con­ sideration of the complexities of the issues facing the profes­ sion. It could be argued that the participative framework has potential for addressing issues o f concern in the practice of our professions, where we draw on the knowledge gained from the positivist research and work with our patients/clients towards improved interventions. What methodologies promote research that is responsive to professional practice? A challenge lies in seeking out methods for research that are acceptable to the communities being researched and which yield data that advances the interests o f their members. Action re­ search would suggest involvement of the community in democ­ ratically making this determination by reviewing and discussing options. Certain research questions may best be answered by one or other approach. Quantitative methodologies for example, may be suited to inquiries relating to: determination o f inci­ dence and prevalence o f disorders; establishment o f develop­ mental norms in a variety o f languages and cultures; and evi­ dence based practice. Other research questions, such as the impact o f hearing loss on the quality o f life, may be more suited to a qualitative approach. Re/habilitation involves prolonged contact with indi­ viduals, their families and even their communities. Failure to consider the context and the participants’ lived experiences may render the research based interventions irrelevant. For example, in recommending home discharge with a fine bore nasogastric tube to decrease discomfort, one could seriously compromise the health and nutrition o f the patient if there is no access to electricity or a food processor, and tea ends up being poured into the tube. Qualitative methodologies may be more reflec­ tive o f the prevailing dynamics and thus ultimately lead to inter­ ventions that are responsive to patients. Further, in the production o f knowledge, one might sug­ gest that mixed methodologies have relevance. Both quantita­ D ie Suid-Afrikaanse Tydskrif vir Kommunikasieajwykings, Vol. 54, 2007 tive and qualitative modes o f research are umbrellas that accom­ modate a range o f research methodologies within their ambit, it could be recommended that judicious selection from among these broad research schools could enhance knowledge produc­ tion as well as practice, e.g. prevalence of children with late identification o f hearing loss, and its impact on their lives. How­ ever, Giddings (2006) cautions against mixed methods being seen as a “quick fix” in the face of economic and social pres­ sures and they must be considered against the need for sophisti­ cated designs that address the complexities challenging Speech- language pathologists and Audiologists nationally and interna­ tionally. The research agenda Determination o f the research agenda is frequently driven by academic researchers’ interests and experiences, in a climate where research and publication are a requirement of the job. Researchers are in a powerful position to determine the issues that will receive attention as well as the scope and nature o f the research. However, researcher interests may not match the re­ search needs o f the community in which the research will be conducted. Further, the definitions and values espoused in such enquiries may reflect researcher perspectives rather than those of the participants. Without consideration o f the communities and research participants’ context, realities and needs, the respon­ siveness o f the research to the germane issues may be chal­ lenged, and the consequent relevance for practice may be ques­ tionable. So the question that arises is: is it possible to conduct research without engaging communities in a participatory man­ ner? Organizations such as the World Health Organization and the United Nations typically have global perspectives on health research needs, and research funding agencies such as the Na­ tional Research Foundation and the Medical Research Council may be more responsive to the broader needs o f the country and attempt to guide research by determining research directions and providing funding to conduct research within these parameters. Some o f the health research trends tend to derive from national burden o f disease data which are based on mortality statistics. However professions such as Speech-language pathology and Audiology are concerned primarily with re/habilitation, and re­ search directions may be better informed by information on dis­ ability in general and communication disability in particular, of which there is a paucity nationally. Where research is funded by international agencies, the benefits to the local communities (and indeed to researchers) need to be addressed. Is there and should there be room for collaboration across these spheres o f interests? Over-researched communities In communities with a high prevalence o f a particular health phenomenon o f interest, there may be many research projects within the community with the same individuals being asked to participate in several studies. A consideration that arises is one of distributive justice whereby these individuals have to bear more o f the burdens relative to the fruits o f research. Research­ ers may want to consider establishing community advisory pan­ els to negotiate entry into the community, determine research needs, and explore options for methodologies that are acceptable to the community, as well as yielding data that is meaningful- Criteria for selecting members o f the advisory panels warrant consideration to enhance representation of the community. Fur­ ther, their independence of the researchers, and empowerment of the advisory panels are important to ensure their credibility. 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 Practice 19 The nature of the knowledge to be produced Should research endeavours be ultimately geared to promoting human flourishing? From a participatory research perspective, all research should be for the betterment o f mankind. What are the ethical considerations when a limited resource, such as na­ tional researchers in our profession, is expended on research that adds to our knowledge and understanding o f the basic sci­ ences but may not have immediate or apparent application for practice? What is the impact of constraining academic freedom by eschewing research based on anything other than national needs? Will potential innovations be lost by prescribing the nature o f knowledge to be produced? Who are the researchers? The current demographic profile o f the profession and its re­ searchers are predominantly o f White and Indian descent with relatively fewer indigenous African and Coloured researchers - reflecting the historical legacy o f inequitable access to tertiary education in the country. Such a situation results in a cultural and linguistic mis-match between the majority o f the research­ ers and the populations to be researched. There continues to be an imperative to redress the inequities in access to training in these professions. However, given the urgent need for profes­ sion specific research in South Africa, it may not be as impor­ tant to match the culture and language o f the researcher and participant, as it is for the researcher to demonstrate awareness o f and sensitivity towards the pertinent characteristics o f par­ ticipants and their communities. In other professions, such as medicine, clinicians are frequently researchers, but this is not necessarily reflective of our professions. The question that arises is: should cohorts o f clinicians be prompted to be researchers as well? Why should this be a consideration and what would clinicians gain? N a­ tionally, research in our professions has been conducted by academics, and post- and under-graduate students at universi­ ties, who constitute a limited pool o f researchers. Further, it is the clinician who faces the challenge o f providing meaningful professional services to the diversity that constitutes the South African public. Clinician researchers are the “bridgers” be­ tween the research and practice communities, and are best suited to develop clinically relevant research, (Yanos & Zie- donis, 2006), to develop innovations for therapy (Charlton, 1997), and to disseminate the research findings into clinical practice (Yanos & Ziedonis, 2006). What is the feasibility of developing a culture of clinicians as researchers? Perhaps re­ search partnerships could be established between academics and clinicians which could result in research being responsive as well as clinically relevant? In conclusion, it should be noted that a particularly im­ portant issue in our professions is who speaks for those who cannot? Should empowerment o f all vulnerable groups be a goal o f research and o f practice? It could be argued that re­ search in our professions should ensure that we hear our clients and that we create opportunities for them to develop their own voices in order to be heard. Charlton, B.G . (1997). N atu ral kinds, n atural history and the clinician- researcher. QJM, 90(11), 707-709. H aberm as, J. (1972). K n o w led g e a n d hum an interests; Theory a n d p ra c tic e; C om m unication a n d th e evolution o f so c iety (J.J. Shapiro, T rans.). London: H einem ann. G iddings, L.S. (2006). 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