How acceptable is high-intensity speech intervention for children with a cleft palate? A qualitative study

This study investigated the retrospective acceptability of high-intensive (10 1-hr speech intervention sessions divided over 2 weeks) versus low-intensive (10 1-hr speech intervention sessions divided over 10 weeks) speech intervention from the perspective of children with a cleft palate using the theoretical framework of acceptability (TFA).

Eleven children (aged 6 to 12 years) with a cleft palate who either received high-intensive speech intervention (n = 6) or low-intensive intervention (n = 5) were recruited. Child-friendly, participatory-based, semi-structured interviews were conducted to investigate children's experiences with speech intervention dosage. The TFA was used to analyse the data deductively.

Children shared varied experiences of high- versus low-intensive speech intervention. In terms of affective attitude, some children felt happy attending frequent sessions because their speech could "get better faster," while others described feeling tired. Children linked more sessions with quicker progress. Despite the burden of more frequent appointments, several noted they were "less likely to quit" because the total intervention time was shorter. Some children understood why they were doing the exercises, while others did not know about the purpose of speech intervention. Some children felt that frequent practice made intervention feel more important.

Speech intervention planning should consider not only clinical effectiveness but also how acceptable the approach is from the child's perspective. It is important to align intervention intensity with children's emotional responses and daily lives. A flexible approach that balances intensity with individual child preferences may support better adherence and long-term success.