JCPSLP Vol 22 No 2 2020

Learning from our clients

Top 10 Privileging client voices Anne Breaks

3 Reach out to clients Find out about groups or forums that your clients already attend. These may include parent support groups, community groups, nurseries, schools and faith groups; ask the group’s leader if you can speak to clients/families about their opinions and experiences. 4 Embrace technology Use technology to help find out about client’s views. Our clients often have busy and complex lives – an online interview or conversation (using Skype, Zoom, Google chat, etc.) may be far easier to schedule (and reschedule) than a face-to-face meeting (Deakin & Wakefield, 2014). 5 Blogs Winkler, Bedford, Northcott, and Hilari (2014) suggest that unsolicited first person narratives in the form of blogs offer a novel and rich source of data which they used to examine how stroke and aphasia affect the carer and their relationship with the person with aphasia. The use of blogs can mitigate against interviewer bias. Blogs can also be used to substantiate concepts identified through interviews (Yen et al., 2013). 6 Facebook groups Social media groups offer a source of information about the lives and views of specific client groups. However, clinicians need to be cognisant that members of these groups are self-selecting and their views may not be reflective of the wider population. Similarly, agenda setting theory (McCombs & Shaw, 1993) suggests that people acquire cues to the relative importance of topics based on the emphasis given to them in the media. If social media amplifies the extensive sharing of inaccurate information or “fake news”, undue prominence may be given to potential harmful ideas. 7 Listen actively Hear what your clients are saying, do not have preconceived ideas. Consider what their behaviours are telling you. Self-regulation theory describes how individuals control what they think, do and say in order to be the person they want to be. The Health Belief Model (Rosenstock, 1974) assumes that people are generally rational in their thoughts and actions, and will take the best health-supporting action if they feel that it is possible to address a negative health issue. Similarly, high levels of concerns and low levels of perceived need are associated with low levels of adherence to medications (Chapman, Horne, Chater, Hukins, & Smithson, 2014).

S ervice users bring new, real life perspectives to the issue of engagement and compliance with health care. Horne (2006) suggests that there is no such thing as a non-compliant patient, but that engagement and adherence to treatment is related to a complex model of beliefs and concerns. If we are to learn from our clients, we need to be willing and able to listen to and empathise with their perspective and to be prepared to change aspects of our clinical practise in order to act upon what we learn from our clients. The top 10 tips below provide useful sources of the “client voice”; suggest frameworks for understanding their views, and some more cautionary issues to consider. Although many of the websites cited are based in the UK, many of the principles and information available have universal application. 1 National and international organisations The following organisations ensure patients are central to and active participants in their health care. • INVOLVE has a wealth of resources to support active public involvement in National Health Service (NHS), public health and social care research https://www.invo. org.uk. • The Expert Patients’ Programme (EPP) from NHS is underpinned by the concept of the ‘expert patient’, suggesting that people can be equal partners in their own care if they have the confidence, knowledge and skills (Department of Health (DH), 2001). 2 James Lind Alliance The James Lind Alliance was established in 2004 to bring together patients, carers and clinicians to identify, agree upon and prioritise key research areas or uncertainties about the effects of treatments (http://www.jla.nihr.ac.uk/). Research that has involved priority-setting partnerships is published in the British Medical Association’s open journal. A wide range of areas are covered across adult and paediatric care, including clients with a range of conditions. https://bmjopen.bmj.com. Anne Breaks is a consultant speech and language therapist working at the Evelina London Children’s Hospital, UK. She has over 30 years’ experience as a clinician, service manager, health service commissioner and researcher. Her PhD research, investigating the reasons parents opt to use a blended diet, was predicated on the belief that as health care professionals we can learn from our clients, and that our clients do not always feel that they are listened to.

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JCPSLP Volume 22, Number 2 2020

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