Employing the COM-B model to understand parents’ perceptions of barriers and facilitators to accessing services: experiences across 10 countries

Parents can play an important role in supporting change in their children’s speech and language development. However, to do that they need to be able to access and engage with therapy and the therapists. The COM-B model is extensively used in behaviour change interventions, recognising that behaviour is part of an interacting system. This model provides a systematic way to determine how parents view accessing speech and language services and provide these services with an understanding from the service user perspective.
This paper describes a secondary analysis exploring parental identification of the barriers and facilitators to accessing services for their language impaired children.
Parents from ten countries and with a child who had received services for speech and/or language disorder participated in semi-structured qualitative interviews. We used framework analysis using the COM-B and TDF domains implementation model to interpret the data.
The barriers reported across the interviews included lack of ‘knowledge’ about both their child’s conditions, their rights to access services and even which service they needed to engage. ‘Beliefs about consequences’ is present in the interviews with some parents reporting struggling to accept the truth or reality of their child’s diagnosis. ‘Social Influences’ linked to relationships between therapists and parents was discussed in light of staff turn-over, and each therapist needing to get to know their child.
COM-B and TDF are used to design and implement services, in this work parent have identified factors that facilitate or inhibit their access to services. As such this work could inform service amendments to improve parents’ ability to engage with services to enable a more rapid and effective therapy for their child.