Providing instructional support for AAC service delivery in low- and middle-income (LAMI) countries (summary)



Many people with disabilities live in poverty. Providing augmentative and alternative communication (AAC) services for people with complex communication needs (CCN) who live in low and middle income (LAMI) countries can be challenging. Many individuals in LAMI countries do not receive communication rehabilitation services. There are numerous reasons for this; in low-resource conditions rehabilitation services can be difficult to obtain and are not viewed as high priority by governments and there are only a small number of speech and language pathologists in many LAMI countries. The multi-lingual nature of many LAMI countries is an additional complicating factor, as is the limited awareness of the potential of AAC to benefit people who have CCN even with very basic provision and intervention.

In recent years there has been increasing recognition of the need to provide AAC support and training to the communication partners of people in LAMI countries who have CCN, but this has challenges. The training needs to be appropriate to the needs of adult learners, based on adult learning theory. It must be delivered in a manner that is responsive to local needs, culturally sensitive and sustainable. There are rarely enough AAC experts in local areas to offer this and therefore AAC professionals from other countries are sometimes invited to provide training and support.

Some issues common to people with disabilities throughout the world may be more extreme in LAMI countries, these include negative attitudes towards people with disability, too few professionals trained in AAC, the expense of AAC technologies and challenges in providing AAC supports that are culturally and linguistically appropriate.

This study aimed to investigate the experiences of experienced AAC professionals who have offered training and support to professionals, family members and people with CCN from LAMI countries and to consider these within recommendations for AAC training.


What did they do?

Eight experienced AAC professionals from seven countries, including both developed and LAMI countries were recruited to take part in an on-line focus group. Participants had an average of 28 years’ experience in providing training/instruction in AAC in 29 countries, including 17 different LAMI countries.

The focus group took place over a six week period with five different questions posted and participants responding to these and to other people’s responses.


What did they find?

Four main themes emerged in the final results:-

Investigate learner needs – It is important to find out as much as possible about the learners and their needs, either formally or informally. This includes knowing the local context to provide information that is culturally acceptable, affordable and useful. Videos and video-conferencing were often used to gather information.

It is also vital to know about the individuals and families that the learners work with including, where possible, observing their day to day lives to gain a better understanding of their community and how they participate in it.

Provide contextually relevant instructional content – It was said to be important to share basic knowledge about AAC and to help learners to fully understand the ‘power of communication’ to support the development of friendships, developing independence, getting an education, opening up employment opportunities etc.

Topics covered typically included; populations that would benefit from AAC, AAC assessments and functions of communication, types of AAC, creation of AAC systems, including selecting vocabulary and graphic systems. The emphasis of training was influenced strongly by the needs of the audience.

Training also focussed on promoting everyday use of AAC, incorporating it into existing and new activities and using a variety of communication functions. The importance of translating materials and making it culturally relevant whilst not making assumptions about prior levels of knowledge or availability/lack of technology.

Using real life stories of users made easier to focus on broader participation.

Use engaging instructional activities – This included using a learner focussed approach to training, acknowledging the learners experience and contribution to the training and encouraging informal discussions, working collaboratively and through discussion.

The use of interaction, role play, discussions and consideration of a child the learners know well is important.

Videos of people the learners are working with make the training more relevant. Creating resources and role playing the use of these was also found to be helpful.

Involving people who use AAC (PWUAAC) in delivery of the training, either being present or via video was very important in addressing both content and attitudes and supported the credibility of the person offering the training. It was also considered vital that the trainers were knowledgeable and experienced enough to be trusted and able to answer all questions.

Assess the impact of instructional activities – Trainers involved in the focus group used a range of methods to evaluate changes in the trainee’s knowledge and skills. These included observation of role plays and considering resources created during training. Evaluation forms were also used. Seeing that training resources were shared with other professionals when the trainees returned to their work places was also considered a positive benefit.

Longer term impacts were not easy to measure and tended to take the form of looking at how services improved.

Some participants used the internet to watch videos of PWUAAC and discuss how to move forward.

It was recognised that it is important to promote sustainability and continued use of AAC following training e.g. encouraging trainees to identify one thing they would try to implement and ensuring AAC interventions had an impact that was valued by the community.

It was felt that it was important to develop teams of AAC workers rather than individuals and to develop support networks and an ‘AAC community’.

The importance of ongoing interaction with learners following the initial training was recognised, though it could be difficult. Possible ways to maintain these links were identified.



Training local professionals and communication partners to provide AAC support in LAMI countries is very important. Careful planning of the training in terms of adult learning theory is relevant in both LAMI and developed countries.



The small number of group participants and limited number of questions asked mean that only a small element of the needs of LAMI countries was considered. The diversity of cultures in these countries mean that individual needs must always be considered.

Other experienced AAC workers might have provided different experiences.

Things you may want to look into:

Life-skill and employment training for young adults with mental disabilities

Teachers’ perceptions of implementation of aided AAC to support expressive communication in South African special schools: a pilot investigation

Eina! Ouch! Eish! Professionals’ Perceptions of How Children with Cerebral Palsy Communicate About Pain in South African School Settings: Implications for the use of AAC

Caregiver Perceptions of Children who have Complex Communication Needs Following a Home-based Intervention Using Augmentative and Alternative Communication in Rural Kenya: An Intervention Note


Added to site February 17