Caregiver Self-Perceived Comfort Level and Training Resource as Predictors of Augmentative and Alternative Communication Use

Using a descriptive quantitative approach, this study examined the role of caregiver self-perceived comfort level (SPCL) in the success of augmentative and alternative communication (AAC) system implementation. The role of SPCL as a mediator variable affecting the relationship between the predictor variable (caregiver training resources) and the outcome variable (AAC use) was investigated. Related factors examined as covariates include caregiver demographics (gender, education level, and setting), the primary disability of the child or youth with complex communication needs, the type of AAC system (low-technology vs high-technology), and caregiver involvement in system selection. To examine the contribution of these variables to AAC use, the innovation decision model was used as a guide to propose a new framework describing how these factors are related as well as how they directly or indirectly impact AAC use. Data from a pre-administered Caregiver Training Survey was analyzed to answer the research question. There were 291 participants who completed the original survey. An inspection of the initial data revealed that 52.86% of the overall data was missing. Following Multiple Imputation using the fully conditional specification method, the data was analyzed including test of model fit, and multiple regression to test the direct and indirect effects of the independent variables on the dependent variable. For low-technology AAC, there was no statistically significant direct or indirect effect observed between the study variables. Thus, SPCL cannot be said to mediate the relationship between training resources and low-technology AAC use. For high-technology AAC, although SPCL cannot be said to mediate the relationship between training resource and AAC use, there were statistically significant direct and total effects of training resource on AAC use. The results suggest that SPCL does not mediate the relationship between caregiver training resources and AAC use for both low-technology and high-technology AAC. However, there were a few limitations that must be considered when interpreting the results. The significant amount of missing data meant that there was a significant inability to detect the studied effects using statistical analysis. This was further compounded with the fact that the survey was pre-administered and causal relationships between the variables in the study could not be established before a mediation analysis was conducted. Conducting a mediation analysis with observational data leaves room for multiple confounding variables. These limitations notwithstanding, the role of training resources in the communicative outcomes of children and youth with complex communication needs was established. The nature of this relationship should be further investigated, including the role of SPCL as a moderator that strengthens or weakens the observed relationship between training resources and AAC use.