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Finding the best fit: examining the decision-making of augmentative and alternative communication professionals in the UK using a discrete choice experiment
  1. Edward J D Webb1,2,
  2. Yvonne Lynch3,
  3. David Meads1,2,
  4. Simon Judge3,4,
  5. Nicola Randall3,4,
  6. Juliet Goldbart3,
  7. Stuart Meredith3,
  8. Liz Moulam3,
  9. Stephane Hess2,5,
  10. Janice Murray3
  1. 1Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  2. 2Choice Modelling Centre, University of Leeds, Leeds, UK
  3. 3Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, Greater Manchester, UK
  4. 4Barnsley Assistive Technology Team, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK
  5. 5Institute of Transport Studies, University of Leeds, Leeds, UK
  1. Correspondence to Dr Edward J D Webb; e.j.d.webb{at}


Objectives Many children with varied disabilities, for example, cerebral palsy, autism, can benefit from augmentative and alternative communication (AAC) systems. However, little is known about professionals’ decision-making when recommending symbol based AAC systems for children. This study examines AAC professionals’ preferences for attributes of AAC systems and how they interact with child characteristics.

Design AAC professionals answered a discrete choice experiment survey with AAC system and child-related attributes, where participants chose an AAC system for a child vignette.

Setting The survey was administered online in the UK.

Participants 155 UK-based AAC professionals were recruited between 20 October 2017 and 4 March 2018.

Outcomes The study outcomes were the preferences of AAC professionals’ as quantified using a mixed logit model, with model selection performed using a step-wise procedure and the Bayesian Information Criterion.

Results Significant differences were observed in preferences for AAC system attributes, and large interactions were seen between child attributes included in the child vignettes, for example, participants made more ambitious choices for children who were motivated to communicate using AAC, and predicted to progress in skills and abilities. These characteristics were perceived as relatively more important than language ability and previous AAC experience.

Conclusions AAC professionals make trade-offs between attributes of AAC systems, and these trade-offs change depending on the characteristics of the child for whom the system is being provided.

  • discrete choice experiment
  • augmentative and alternative communication
  • clinical decision making

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  • Contributors All authors conceived the study and defined the study aims. EW, DM, YL, NR, SJ, JG, SM, LM and JM developed attributes and levels. EW, DM and SH constructed the survey statistical design. EW and DM collected data. EW conducted statistical analysis. EW, YL, NR, SJ, JG, SM, LM and JM interpreted findings. EW wrote the manuscript first draft. All authors contributed to and approved the final manuscript.

  • Funding This independent research was funded by the National Institute for Health Research, UK (Health Services & Delivery Research Project: 14/70/153 - Identifying appropriate symbol communication aids for children who are non-speaking: enhancing clinical decision-making). The views expressed in this article are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. Stephane Hess acknowledges additional support by the European Research Council through the consolidator grant 615596-DECISIONS.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was received for the study from an NHS Research Ethics Committee (REC reference 6/NW/0165) and informed consent was obtained from participants at the start of the survey.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.