What works, how and in which contexts when using digital health to support parents/carers to implement intensive speech and language therapy at home for children with speech sound disorder? A realist review

Naomi Leafe; Emma Pagnamenta; Laurence Taggart; Mark Donnelly; Angela Hassiotis; Jill Titterington

doi:10.1371/journal.pone.0321647

What works, how and in which contexts when using digital health to support parents/carers to implement intensive speech and language therapy at home for children with speech sound disorder? A realist review

Naomi Leafe
, Emma Pagnamenta
, Laurence Taggart
, Mark Donnelly
, Angela Hassiotis
, Jill Titterington

Research output: Contribution to journal › Review article › peer-review

5 Citations (Scopus)

76 Downloads (Pure)

Abstract

Purpose
Digital health solutions to support parent-implemented interventions alongside
direct speech and language therapist (SLT) input could help increase intervention
intensity for children with speech sound disorder (SSD) to meet evidence-based
recommendations. This realist review explores the factors which could make intensive parent-implemented digital interventions for children with SSD effective, and how this complex intervention might work in different contexts.

Methods
Realist review methodology was adopted to explore what works, why, how, for which parents/carers, and in what circumstances. Realist methods aimed to understand the active ingredients, contexts, and associated outcomes of this complex intervention. Preliminary theories were developed to describe how and why digital parent implemented interventions work for children with SSD. Data was extracted from 43 papers to test and refine preliminary theories. Behaviour change theories were used to explain how the intervention works in practice.

Results
A set of 20 explanatory theories were developed to depict how and why digital
parent-implemented interventions work in different contexts. Theories covered five areas: child-participation; the child-parent-SLT dynamic; parent-training; partnership and collaboration; intervention intensity. The theories describe mechanisms of the intervention and how these are responded to in different situations. Findings highlight the importance of intensive intervention for children with SSD.

Conclusions
This realist review adds new in-depth insight into how digital parent-implemented interventions work, for whom, and why. This new understanding has potential to support future successful digital parent-implemented interventions and increase intervention intensity for children with SSD globally. Implications for services and the potential of emerging digital health approaches to promote parent-implemented interventions are discussed.

Original language	English
Pages (from-to)	1-31
Number of pages	31
Journal	PLoS ONE
Volume	20
Issue number	5
Early online date	7 May 2025
DOIs	https://doi.org/10.1371/journal.pone.0321647
Publication status	Published online - 7 May 2025

Bibliographical note

Publisher Copyright:
© 2025 Leafe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability Statement

The data supporting the findings reported in this paper are openly available from Ulster University’s Research Portal at https://doi.org/10.21251/2b0e8c5c-f334-4090-a682-56cd71c75ab4

Funding

All the funding for this review has come from a PhD studentship at Ulster University (NL) supported by the Department for the Economy (DfE). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study.

Funders
Department for the Economy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being
SDG 4 Quality Education
SDG 10 Reduced Inequalities

Keywords

Digital health
Children
speech sound disorder
parent-implemented
carer-implemented
direct speech and language therapy
intensive intervention
realist review
effective
intervention
intensity
Stuttering
Humans
Language Therapy
Speech Therapy
Parents
Speech Sound Disorder
Language Development Disorders
Review Literature as Topic
Speech
Apraxias
Child
Caregivers
Language Therapy/methods
Speech Sound Disorder/therapy
Speech Therapy/methods
Digital Health

Access to Document

10.1371/journal.pone.0321647

journal.pone.0321647Final published version, 2.3 MBLicence: CC BY

Fingerprint

Dive into the research topics of 'What works, how and in which contexts when using digital health to support parents/carers to implement intensive speech and language therapy at home for children with speech sound disorder? A realist review'. Together they form a unique fingerprint.

5 Citations
1 Article

'To know that you are a link in the chain': A realist evaluation to explore how digital, intensive, parent-implemented interventions work for children with speech sound disorder, why, and for whom
Leafe, N., Pagnamenta, E., Donnelly, M., Taggart, L. & Titterington, J., 30 Jun 2025, In: International Journal of Language and Communication Disorders. 60, 3, p. 1-17 17 p., e70049.
Research output: Contribution to journal › Article › peer-review

Open Access
File
2 Link opens in a new tab Citations (Scopus)

50 Downloads (Pure)

Context-Mechanism-Outcome configurations from a realist evaluation exploring digital interventions for children with speech sound disorder [dataset]
Leafe, N. (Creator), Pagnamenta, E. (Contributor), Taggart, L. (Contributor), Donnelly, M. (Contributor) & Titterington, J. (Contributor), Ulster University, 9 Aug 2025
DOI: 10.21251/5e96b5a3-005b-43d2-b39d-4a4bf8de8760, https://orcid.org/0000-0003-1250-265X
Dataset

File

The Parent-Power Pod: co-production of an intensive, digital parent-implemented intervention for children with speech sound disorder, informed by realist methodology
Leafe, N. (Author), Cousins, W. (Supervisor) & Donnelly, M. (Supervisor), May 2025
Student thesis: Doctoral Thesis

Cite this

Leafe, N., Pagnamenta, E., Taggart, L., Donnelly, M., Hassiotis, A., & Titterington, J. (2025). What works, how and in which contexts when using digital health to support parents/carers to implement intensive speech and language therapy at home for children with speech sound disorder? A realist review. PLoS ONE, 20(5), 1-31. Advance online publication. https://doi.org/10.1371/journal.pone.0321647

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title = "What works, how and in which contexts when using digital health to support parents/carers to implement intensive speech and language therapy at home for children with speech sound disorder? A realist review",

abstract = "Purpose Digital health solutions to support parent-implemented interventions alongside direct speech and language therapist (SLT) input could help increase intervention intensity for children with speech sound disorder (SSD) to meet evidence-based recommendations. This realist review explores the factors which could make intensive parent-implemented digital interventions for children with SSD effective, and how this complex intervention might work in different contexts. Methods Realist review methodology was adopted to explore what works, why, how, for which parents/carers, and in what circumstances. Realist methods aimed to understand the active ingredients, contexts, and associated outcomes of this complex intervention. Preliminary theories were developed to describe how and why digital parent implemented interventions work for children with SSD. Data was extracted from 43 papers to test and refine preliminary theories. Behaviour change theories were used to explain how the intervention works in practice. Results A set of 20 explanatory theories were developed to depict how and why digital parent-implemented interventions work in different contexts. Theories covered five areas: child-participation; the child-parent-SLT dynamic; parent-training; partnership and collaboration; intervention intensity. The theories describe mechanisms of the intervention and how these are responded to in different situations. Findings highlight the importance of intensive intervention for children with SSD. Conclusions This realist review adds new in-depth insight into how digital parent-implemented interventions work, for whom, and why. This new understanding has potential to support future successful digital parent-implemented interventions and increase intervention intensity for children with SSD globally. Implications for services and the potential of emerging digital health approaches to promote parent-implemented interventions are discussed.",

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author = "Naomi Leafe and Emma Pagnamenta and Laurence Taggart and Mark Donnelly and Angela Hassiotis and Jill Titterington",

note = "Publisher Copyright: {\textcopyright} 2025 Leafe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

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Leafe, N, Pagnamenta, E, Taggart, L, Donnelly, M, Hassiotis, A & Titterington, J 2025, 'What works, how and in which contexts when using digital health to support parents/carers to implement intensive speech and language therapy at home for children with speech sound disorder? A realist review', PLoS ONE, vol. 20, no. 5, pp. 1-31. https://doi.org/10.1371/journal.pone.0321647

What works, how and in which contexts when using digital health to support parents/carers to implement intensive speech and language therapy at home for children with speech sound disorder? A realist review. / Leafe, Naomi; Pagnamenta, Emma; Taggart, Laurence et al.
In: PLoS ONE, Vol. 20, No. 5, 07.05.2025, p. 1-31.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - What works, how and in which contexts when using digital health to support parents/carers to implement intensive speech and language therapy at home for children with speech sound disorder? A realist review

AU - Leafe, Naomi

AU - Pagnamenta, Emma

AU - Taggart, Laurence

AU - Donnelly, Mark

AU - Hassiotis, Angela

AU - Titterington, Jill

N1 - Publisher Copyright: © 2025 Leafe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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N2 - Purpose Digital health solutions to support parent-implemented interventions alongside direct speech and language therapist (SLT) input could help increase intervention intensity for children with speech sound disorder (SSD) to meet evidence-based recommendations. This realist review explores the factors which could make intensive parent-implemented digital interventions for children with SSD effective, and how this complex intervention might work in different contexts. Methods Realist review methodology was adopted to explore what works, why, how, for which parents/carers, and in what circumstances. Realist methods aimed to understand the active ingredients, contexts, and associated outcomes of this complex intervention. Preliminary theories were developed to describe how and why digital parent implemented interventions work for children with SSD. Data was extracted from 43 papers to test and refine preliminary theories. Behaviour change theories were used to explain how the intervention works in practice. Results A set of 20 explanatory theories were developed to depict how and why digital parent-implemented interventions work in different contexts. Theories covered five areas: child-participation; the child-parent-SLT dynamic; parent-training; partnership and collaboration; intervention intensity. The theories describe mechanisms of the intervention and how these are responded to in different situations. Findings highlight the importance of intensive intervention for children with SSD. Conclusions This realist review adds new in-depth insight into how digital parent-implemented interventions work, for whom, and why. This new understanding has potential to support future successful digital parent-implemented interventions and increase intervention intensity for children with SSD globally. Implications for services and the potential of emerging digital health approaches to promote parent-implemented interventions are discussed.

AB - Purpose Digital health solutions to support parent-implemented interventions alongside direct speech and language therapist (SLT) input could help increase intervention intensity for children with speech sound disorder (SSD) to meet evidence-based recommendations. This realist review explores the factors which could make intensive parent-implemented digital interventions for children with SSD effective, and how this complex intervention might work in different contexts. Methods Realist review methodology was adopted to explore what works, why, how, for which parents/carers, and in what circumstances. Realist methods aimed to understand the active ingredients, contexts, and associated outcomes of this complex intervention. Preliminary theories were developed to describe how and why digital parent implemented interventions work for children with SSD. Data was extracted from 43 papers to test and refine preliminary theories. Behaviour change theories were used to explain how the intervention works in practice. Results A set of 20 explanatory theories were developed to depict how and why digital parent-implemented interventions work in different contexts. Theories covered five areas: child-participation; the child-parent-SLT dynamic; parent-training; partnership and collaboration; intervention intensity. The theories describe mechanisms of the intervention and how these are responded to in different situations. Findings highlight the importance of intensive intervention for children with SSD. Conclusions This realist review adds new in-depth insight into how digital parent-implemented interventions work, for whom, and why. This new understanding has potential to support future successful digital parent-implemented interventions and increase intervention intensity for children with SSD globally. Implications for services and the potential of emerging digital health approaches to promote parent-implemented interventions are discussed.

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KW - Language Development Disorders

KW - Review Literature as Topic

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KW - Apraxias

KW - Child

KW - Caregivers

KW - Language Therapy/methods

KW - Speech Sound Disorder/therapy

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What works, how and in which contexts when using digital health to support parents/carers to implement intensive speech and language therapy at home for children with speech sound disorder? A realist review

Abstract

Bibliographical note

Data Availability Statement

Funding

UN SDGs

Keywords

Access to Document

Other files and links

Fingerprint

Research output

'To know that you are a link in the chain': A realist evaluation to explore how digital, intensive, parent-implemented interventions work for children with speech sound disorder, why, and for whom

Datasets

Context-Mechanism-Outcome configurations from a realist evaluation exploring digital interventions for children with speech sound disorder [dataset]

Student theses

The Parent-Power Pod: co-production of an intensive, digital parent-implemented intervention for children with speech sound disorder, informed by realist methodology

Cite this