Environmental factors and their associations with speech-language-hearing diagnostic hypotheses in children and adolescents

Borges, Marina Garcia de Souza; Medeiros, Adriane Mesquita de; Lemos, Stela Maris Aguiar

doi:10.1590/1982-0216/20212356421

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ORIGINAL ARTICLES • Rev. CEFAC 23 (5) • 2021 • https://doi.org/10.1590/1982-0216/20212356421 copy

Environmental factors and their associations with speech-language-hearing diagnostic hypotheses in children and adolescents

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

to analyze the associations between speech-language-hearing diagnostic hypotheses in children and adolescents and the Environmental Factors in the International Classification of Functioning, Disability, and Health.

Methods:

an observational, analytical, cross-sectional study carried out between 2016 and 2019 in an outpatient center with 5- to 16-year-old children and adolescents undergoing speech-language-hearing assessment and their parents/guardians. The Brazilian Economic Classification Criteria was used, and sociodemographic data were collected, along with speech-language-hearing diagnostic hypotheses and information on the presence of categories of the Environmental Factors, qualified as either barriers or facilitators. Descriptive and association analyses were made, using Pearson’s chi-square and Fisher’s Exact tests, with the significance level set at 0.05.

Results:

most participants had changes in oral language acquisition/development, written language, and oral-motor function. The most prevalent facilitators were in the categories of Services, Systems, and Policies; Support and Relationships; and Products and Technology, whereas the barriers were in the categories of Attitudes; Products and Technology; and Services, Systems, and Policies. The diagnostic hypotheses of “Change in cognitive aspects of language”, “Change in speech”, and “Change in voice” had a significant association with the codes present in chapters 3 - Support and Relationships, and 4 - Attitudes.

Conclusion:

this association shows that patients with communication changes need a comprehensive approach encompassing the Contextual Factors.

Keywords:
Speech, Language and Hearing Sciences; International Classification of Functioning, Disability and Health; Child; Adolescent; Social Environment

Categories and Qualifiers in the Environmental Factors	Speech-Language-Hearing Diagnostic Hypothesis
	Oral Language Acquisition/Development			Written Language
	Yes N (%)	No N (%)	p-value	Yes N (%)	No N (%)	p-value
e110 - Products or Substances for Personal Consumption
Not described	31 (44.3)	4 (33.3)	0.6911	22 (36.1)	13 (61.9)	0.1101
It is a barrier	1 (1.4)	0 (0.0)		1 (1.6)	0 (0.0)
It is a facilitator	38 (54.3)	8 (66.7)		38 (62.3)	13 (61.9)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e125 - Products and Technology for Communication
Not described	62 (88.6)	11 (91.7)	0.9001	53 (86.9)	20 (95.2)	0.5521
It is a barrier	1 (1.4)	0 (0.0)		1 (1.6)	0 (0.0)
It is a facilitator	7 (10.0)	1 (8.3)		7 (11.5)	1 (4.8)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e130 - Products and Technology for Education
Not described	22 (31.4)	5 (41.7)	0.5181	17 (27.9)	10 (47.6)	0.1131
It is a barrier	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
It is a facilitator	48 (68.6)	7 (58.3)		44 (72.1)	11 (52.4)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e140 - Products and Technology for Culture, Recreation, and Sport
Not described	5 (7.1)	1 (8.3)	1.0002	6 (9.8)	0 (0.0)	0.3301
It is a barrier	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
It is a facilitator	65 (92.9)	11 (91.7)		55 (90.2)	21 (100.0)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e165 - Assets
Not described	0 (0.0)	0 (0.0)	0.2712	0 (0.0)	0 (0.0)	0.0672
It is a barrier	5 (7.1)	2 (16.7)		3 (4.9)	4 (19.0)
It is a facilitator	65 (92.9)	10 (83.3)		58 (95.1)	17 (81.0)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e310 - Immediate Family
Not described	0 (0.0)	0 (0.0)	1.0002	0 (0.0)	0 (0.0)	1.0002
It is a barrier	1 (1.4)	0 (0.0)		1 (1.6)	0 (0.0)
It is a facilitator	69 (98.6)	12 (100.0)		60 (98.4)	21 (100.0)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e315 - Extended Family
Not described	26 (37.1)	7 (58.3)	0.1671	21 (34.4)	12 (57.1)	0.0671
It is a barrier	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
It is a facilitator	44 (62.9)	5 (41.7)		40 (65.6)	9 (42.9)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e320 - Friends
Not described	2 (2.9)	2 (16.7)	0.1141	4 (6.6)	0 (0.0)	0.4001
It is a barrier	1 (1.4)	0 (0.0)		1 (1.6)	0 (0.0)
It is a facilitator	67 (95.7)	10 (83.3)		56 (91.8)	21 (100.0)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e325 - Acquaintances, Peers, Colleagues, Neighbors, and Community Members
Not described	12 (17.1)	4 (33.3)	0.4011	9 (14.8)	7 (33.3)	0.1591
It is a barrier	1 (1.4)	0 (0.0)		1 (1.6)	0 (0.0)
It is a facilitator	57 (81.4)	8 (66.7)		51 (83.6)	14 (66.7)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e355 - Health Professionals
Not described	5 (7.1)	2 (16.7)	0.5131	4 (6.6)	3 (14.3)	0.4721
It is a barrier	1 (1.4)	0 (0.0)		1 (1.6)	0 (0.0)
It is a facilitator	64 (91.4)	10 (83.3)		56 (91.8)	18 (85.7)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e360 - Other Professionals
Not described	61 (87.1)	11 (91.7)	0.8671	51 (83.6)	21 (100.0)	0.1411
It is a barrier	1 (1.4)	0 (0.0)		1 (1.6)	0 (0.0)
It is a facilitator	8 (11.4)	1 (8.3)		9 (14.8)	0 (0.0)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e410 - Individual Attitudes of Immediate Family Members
Not described	52 (74.3)	9 (75.0)	0.5841	47 (77.0)	14 (66.7)	0.4731
It is a barrier	5 (7.1)	0 (0.0)		4 (6.6)	1 (4.8)
It is a facilitator	13 (18.6)	3 (25.0)		10 (16.4)	6 (28.5)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e415 - Individual Attitudes of Extended Family Members
Not described	63 (90.0)	10 (83.3)	0.4771	54 (88.6)	19 (90.6)	0.5761
It is a barrier	2 (2.9)	0 (0.0)		1 (1.6)	1 (4.8)
It is a facilitator	5 (7.1)	2 (16.7)		6 (9.8)	1 (4.8)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e420 - Individual Attitudes of Friends
Not described	59 (84.3)	11 (91.7)	0.4101	52 (85.2)	18 (85.7)	0.9991
It is a barrier	8 (11.4)	0 (0.0)		6 (9.8)	2 (9.5)
It is a facilitator	4 (4.3)	8 (8.3)		3 (4.9)	1 (4.8)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e425 - Individual Attitudes of Acquaintances, Peers, Colleagues, Neighbors, and Community Members
Not described	57 (81.4)	11 (91.7)	0.3841	49 (80.3)	19 (90.5)	0.2861
It is a barrier	13 (18.6)	1 (8.3)		12 (19.7)	2 (9.5)
It is a facilitator	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e570 - Social Security Services, Systems, and Policies
Not described	64 (91.4)	10 (83.3)	0.3831	54 (88.5)	20 (95.2)	0.3711
It is a barrier	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
It is a facilitator	6 (8.6)	2 (16.7)		7 (11.5)	1 (4.8)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)
e580 - Health Services, Systems, and Policies
Not described	3 (4.2)	0 (0.0)	0.7641	3 (4.9)	0 (0.0)	0.4311
It is a barrier	6 (8.6)	1 (8.3)		6 (9.8)	1 (4.8)
It is a facilitator	61 (87.1)	11 (91.7)		52 (85.3)	20 (95.2)
Total	70 (100.0)	12 (100.0)		61 (100.0)	21 (100.0)

Categories and Qualifiers in the Environmental Factors	Speech-Language-Hearing Diagnostic Hypothesis
	Cognitive Aspects of Language			Change in Speech
	Yes N (%)	No N (%)	p-value	Yes N (%)	No N (%)	p-value
e110 - Products or Substances for Personal Consumption
Not described	5 (50.0)	30 (41.7)	0.8361	5 (45.5)	30 (42.3)	0.9121
It is a barrier	0 (0.0)	1 (1.4)		0 (0.0)	1 (1.4)
It is a facilitator	5 (50.0)	41 (56.9)		6 (54.5)	50 (56.3)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e125 - Products and Technology for Communication
Not described	10 (100.0)	63 (87.5)	0.4961	10 (90.9)	63 (88.7)	0.9201
It is a barrier	0 (0.0)	1 (1.4)		0 (0.0)	1 (1.4)
It is a facilitator	0 (0.0)	8 (11.1)		1 (9.1)	7 (9.9)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e130 - Products and Technology for Education
Not described	2 (20.0)	25 (34.7)	0.4851	3 (27.3)	24 (33.8)	0.6681
It is a barrier	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
It is a facilitator	8 (80.0)	47 (65.3)		8 (72.7)	47 (66.2)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e140 - Products and Technology for Culture, Recreation, and Sport
Not described	1 (10.0)	5 (6.9)	0.5542	1 (9.1)	5 (7.0)	0.8082
It is a barrier	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
It is a facilitator	9 (90.0)	67 (93.1)		10 (90.9)	66 (93.0)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e165 - Assets
Not described	0 (0.0)	0 (0.0)	0.3031	11 (100.0)	64 (90.1)	0.2761
It is a barrier	0 (0.0)	7 (9.7)		0 (0.0)	7 (9.9)
It is a facilitator	10 (100.0)	65 (90.3)		0 (0.0)	0 (0.0)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e310 - Immediate Family
Not described	0 (0.0)	0 (0.0)	0.1222	0 (0.0)	0 (0.0)	1.0002
It is a barrier	1 (10.0)	0 (0.0)		0 (0.0)	1 (1.4)
It is a facilitator	9 (90.0)	72 (100.0)		11 (100.0)	70 (98.6)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e315 - Extended Family
Not described	2 (20.0)	31 (43.1)	0.1641	5 (45.5)	28 (39.4)	0.7051
It is a barrier	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
It is a facilitator	8 (80.0)	41 (56.9)		6 (54.5)	43 (60.6)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e320 - Friends
Not described	0 (0.0)	4 (5.6)	0.6911	0 (0.0)	4 (5.6)	0.6621
It is a barrier	0 (0.0)	1 (1.3)		0 (0.0)	1 (1.4)
It is a facilitator	10 (100.0)	67 (93.1)		11 (100.0)	66 (93.0)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e325 - Acquaintances, Peers, Colleagues, Neighbors, and Community Members
Not described	0 (0.0)	16 (22.2)	0.2261	1 (9.1)	15 (21.1)	0.5831
It is a barrier	0 (0.0)	1 (1.4)		0 (0.0)	1 (1.4)
It is a facilitator	10 (100.0)	55 (76.4)		10 (90.9)	55 (77.5)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e355 - Health Professionals
Not described	3 (30.0)	4 (5.6)	0.033*1	2 (18.2)	5 (7.0)	0.4411
It is a barrier	0 (0.0)	1 (1.4)		0 (0.0)	1 (1.5)
It is a facilitator	7 (70.0)	67 (93.0)		9 (81.8)	65 (91.5)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e360 - Other Professionals
Not described	9 (90.0)	63 (87.5)	0.015*1	10 (90.9)	62 (87.3)	0.020*1
It is a barrier	1 (10.0)	0 (0.0)		1 (9.1)	0 (0.0)
It is a facilitator	0 (0.0)	9 (12.5)		0 (0.0)	9 (12.7)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e410 - Individual Attitudes of Immediate Family Members
Not described	8 (80.0)	53 (73.6)	0.6501	10 (90.9)	51 (71.8)	0.2091
It is a barrier	1 (10.0)	4 (5.6)		1 (9.1)	4 (5.6)
It is a facilitator	1 (10.0)	15 (20.8)		0 (0.0)	16 (22.6)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e415 - Individual Attitudes of Extended Family Members
Not described	9 (90.0)	64 (88.9)	0.1621	11 (100.0)	62 (87.3)	0.4571
It is a barrier	1 (10.0)	1 (1.4)		0 (0.0)	2 (2.8)
It is a facilitator	9 (0.0)	7 (9.7)		0 (0.0)	7 (9.9)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e420 - Individual Attitudes of Friends
Not described	8 (80.0)	62 (86.1)	0.7221	10 (90.9)	60 (84.5)	0.7151
It is a barrier	1 (10.0)	7 (9.7)		1 (9.1)	7 (9.9)
It is a facilitator	1 (10.0)	3 (4.2)		0 (0.0)	4 (5.6)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e425 - Individual Attitudes of Acquaintances, Peers, Colleagues, Neighbors, and Community Members
Not described	9 (90.0)	59 (81.9)	0.5261	10 (90.9)	58 (81.7)	0.4501
It is a barrier	1 (10.0)	13 (18.1)		1 (9.1)	13 (18.3)
It is a facilitator	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e570 - Social Security Services, Systems, and Policies
Not described	9 (90.0)	65 (90.3)	0.9781	10 (90.9)	64 (90.1)	0.9361
It is a barrier	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
It is a facilitator	1 (10.0)	7 (9.7)		1 (9.1)	7 (9.9)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)
e580 - Health Services, Systems, and Policies
Not described	1 (10.0)	2 (2.8)	0.5071	1 (9.1)	2 (2.8)	0.2541
It is a barrier	1 (10.0)	6 (8.3)		2 (18.2)	5 (7.0)
It is a facilitator	8 (80.0)	64 (88.9)		8 (72.7)	64 (90.1)
Total	10 (100.0)	72 (100.0)		11 (100.0)	71 (100.0)

Categories and Qualifiers in the Environmental Factors	Speech-Language-Hearing Diagnostic Hypothesis
	Change in Oral-Motor Function			Change in Voice
	Yes N (%)	No N (%)	p-value	Yes N (%)	No N (%)	p-value
e110 - Products or Substances for Personal Consumption
Not described	22 (42.3)	13 (43.3)	0.7471	17 (48.6)	18 (38.3)	0.4781
It is a barrier	1 (1.9)	0 (0.0)		0 (0.0)	1 (2.1)
It is a facilitator	29 (55.8)	17 (56.7)		18 (51.4)	28 (59.6)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e125 - Products and Technology for Communication
Not described	48 (92.3)	25 (83.3)	0.2831	31 (88.6)	42 (89.4)	0.4891
It is a barrier	0 (0.0)	1 (3.3)		1 (2.9)	0 (0.0)
It is a facilitator	4 (7.7)	4 (13.4)		3 (8.6)	5 (10.6)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e130 - Products and Technology for Education
Not described	16 (30.8)	11 (36.7)	0.5841	11 (31.4)	16 (34.0)	0.8031
It is a barrier	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
It is a facilitator	36 (69.2)	19 (63.3)		24 (68.6)	31 (66.0)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e140 - Products and Technology for Culture, Recreation, and Sport
Not described	4 (7.7)	2 (6.7)	1.0002	1 (2.9)	5 (10.6)	0.2322
It is a barrier	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
It is a facilitator	48 (92.3)	28 (93.3)		34 (97.1)	42 (89.4)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e165 - Assets
Not described	0 (0.0)	0 (0.0)	1.0002	0 (0.0)	0 (0.0)	0.2762
It is a barrier	5 (9.6)	2 (6.7)		2 (5.7)	5 (10.6)
It is a facilitator	47 (90.4)	28 (93.3)		33 (94.3)	42 (89.4)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e310 - Immediate Family
Not described	0 (0.0)	0 (0.0)	1.0002	0 (0.0)	0 (0.0)	1.0002
It is a barrier	1 (1.9)	0 (0.0)		0 (0.0)	1 (2.1)
It is a facilitator	51 (98.1)	30 (100.0)		35 (100.0)	46 (97.6)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e315 - Extended Family
Not described	18 (34.6)	15 (50.0)	0.1711	6 (17.1)	27 (57.4)	0.001*1
It is a barrier	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
It is a facilitator	34 (65.4)	15 (50.0)		29 (82.9)	20 (42.6)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e320 - Friends
Not described	2 (3.8)	2 (6.7)	0.3461	2 (5.7)	2 (4.3)	0.6591
It is a barrier	0 (0.0)	1 (3.3)		0 (0.0)	1 (2.1)
It is a facilitator	50 (96.2)	27 (90.0)		33 (94.3)	44 (93.6)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e325 - Acquaintances, Peers, Colleagues, Neighbors, and Community Members
Not described	9 (17.3)	7 (23.3)	0.3171	6 (17.1)	10 (21.3)	0.4671
It is a barrier	0 (0.0)	1 (3.3)		1 (2.9)	0 (0.0)
It is a facilitator	43 (82.7)	22 (73.4)		28 (80.0)	37 (78.7)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e355 - Health Professionals
Not described	6 (11.5)	1 (3.3)	0.3181	4 (11.4)	3 (6.4)	0.5061
It is a barrier	1 (1.9)	0 (0.0)		0 (0.0)	1 (2.1)
It is a facilitator	45 (86.6)	29 (96.7)		31 (88.6)	43 (91.5)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e360 - Other Professionals
Not described	46 (88.5)	26 (86.7)	0.6621	32 (91.4)	40 (85.1)	0.5611
It is a barrier	1 (1.9)	0 (0.0)		0 (0.0)	1 (2.1)
It is a facilitator	5 (9.6)	4 (13.3)		3 (8.6)	6 (12.8)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e410 - Individual Attitudes of Immediate Family Members
Not described	37 (71.2)	24 (80.0)	0.6101	21 (60.0)	40 (85.1)	0.034*1
It is a barrier	4 (7.7)	1 (3.3)		3 (8.6)	2 (4.3)
It is a facilitator	11 (22.1)	5 (16.7)		11 (31.4)	5 (10.6)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e415 - Individual Attitudes of Extended Family Members
Not described	45 (86.5)	28 (93.4)	0.4161	28 (80.0)	45 (95.7)	0.003*1
It is a barrier	1 (1.9)	1 (3.3)		0 (0.0)	2 (4.3)
It is a facilitator	6 (11.6)	1 (3.3)		7 (20.0)	0 (0.0)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e420 - Individual Attitudes of Friends
Not described	43 (82.7)	27 (90.0)	0.2971	29 (82.8)	41 (87.3)	0.3981
It is a barrier	5 (9.6)	3 (10.0)		3 (8.6)	5 (10.6)
It is a facilitator	4 (7.7)	0 (0.0)		3 (8.6)	1 (2.1)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e425 - Individual Attitudes of Acquaintances, Peers, Colleagues, Neighbors, and Community Members
Not described	43 (82.7)	25 (83.3)	0.9411	28 (80.0)	40 (85.1)	0.5431
It is a barrier	9 (17.3)	5 (16.7)		7 (20.0)	7 (14.9)
It is a facilitator	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e570 - Social Security Services, Systems, and Policies
Not described	46 (88.5)	28 (93.3)	0.4741	31 (88.6)	43 (91.5)	0.7182
It is a barrier	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)
It is a facilitator	6 (11.5)	2 (6.7)		4 (11.4)	4 (8.5)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)
e580 - Health Services, Systems, and Policies
Not described	3 (5.8)	0 (0.0)	0.3921	2 (5.7)	1 (2.1)	0.6921
It is a barrier	4 (7.7)	3 (10.0)		3 (8.6)	4 (8.5)
It is a facilitator	45 (86.5)	27 (90.0)		30 (85.7)	42 (89.4)
Total	52 (100.0)	30 (100.0)		35 (100.0)	47 (100.0)

Categories and Qualifiers in the Environmental Factors	Speech-Language-Hearing Diagnostic Hypothesis
	Change in Auditory Processing
	Yes N (%)	No N (%)	p-value
e110 - Products or Substances for Personal Consumption
Not described	11 (36.7)	24 (46.2)	0.4921
It is a barrier	0 (0.0)	1 (1.9)
It is a facilitator	19 (63.3)	27 (51.9)
Total	30 (100.0)	52 (100.0)
e125 - Products and Technology for Communication
Not described	26 (86.7)	47 (90.4)	0.4141
It is a barrier	1 (3.3)	0 (0.0)
It is a facilitator	3 (10.0)	5 (9.6)
Total	30 (100.0)	52 (100.0)
e130 - Products and Technology for Education
Not described	9 (30.0)	18 (34.6)	0.6681
It is a barrier	0 (0.0)	0 (0.0)
It is a facilitator	21 (70.0)	34 (65.4)
Total	30 (100.0)	52 (100.0)
e140 - Products and Technology for Culture, Recreation, and Sport
Not described	2 (6.7)	4 (7.7)	1.0002
It is a barrier	0 (0.0)	0 (0.0)
It is a facilitator	28 (93.3)	48 (92.3)
Total	30 (100.0)	52 (100.0)
e165 - Assets
Not described	0 (0.0)	0 (0.0)	1.0002
It is a barrier	2 (6.7)	5 (9.6)
It is a facilitator	28 (93.3)	47 (90.4)
Total	30 (100.0)	52 (100.0)
e310 - Immediate Family
Not described	0 (0.0)	0 (0.0)	0.3662
It is a barrier	1 (3.3)	0 (0.0)
It is a facilitator	29 (96.7)	52 (100.0)
Total	30 (100.0)	52 (100.0)
e315 - Extended Family
Not described	10 (33.3)	23 (44.2)	0.3601
It is a barrier	0 (0.0)	0 (0.0)
It is a facilitator	20 (66.7)	29 (55.8)
Total	30 (100.0)	52 (100.0)
e320 - Friends
Not described	0 (0.0)	4 (7.7)	0.2151
It is a barrier	0 (0.0)	1 (1.9)
It is a facilitator	30 (100.0)	47 (90.4)
Total	30 (100.0)	52 (100.0)
e325 - Acquaintances, Peers, Colleagues, Neighbors, and Community Members
Not described	3 (10.0)	13 (25.0)	0.1771
It is a barrier	0 (0.0)	1 (1.9)
It is a facilitator	27 (90.0)	38 (73.1)
Total	30 (100.0)	52 (100.0)
e355 - Health Professionals
Not described	3 (10.0)	4 (7.7)	0.7061
It is a barrier	0 (0.0)	1 (1.9)
It is a facilitator	27 (90.0)	47 (90.4)
Total	30 (100.0)	52 (100.0)
e360 - Other Professionals
Not described	25 (83.3)	47 (90.4)	0.3531
It is a barrier	1 (3.3)	0 (0.0)
It is a facilitator	4 (13.4)	5 (9.6)
Total	30 (100.0)	52 (100.0)
e410 - Individual Attitudes of Immediate Family Members
Not described	24 (80.0)	37 (71.2)	0.6101
It is a barrier	1 (3.3)	4 (7.7)
It is a facilitator	5 (16.7)	11 (22.1)
Total	30 (100.0)	52 (100.0)
e415 - Individual Attitudes of Extended Family Members
Not described	27 (90.0)	46 (88.5)	0.8381
It is a barrier	1 (3.3)	1 (1.9)
It is a facilitator	2 (6.7)	5 (9.6)
Total	30 (100.0)	52 (100.0)
e420 - Individual Attitudes of Friends
Not described	25 (83.3)	45 (86.5)	0.8451
It is a barrier	3 (10.0)	5 (9.7)
It is a facilitator	2 (6.7)	2 (3.8)
Total	30 (100.0)	52 (100.0)
e425 - Individual Attitudes of Acquaintances, Peers, Colleagues, Neighbors, and Community Members
Not described	24 (80.0)	44 (84.6)	0.7621
It is a barrier	6 (20.0)	8 (15.4)
It is a facilitator	0 (0.0)	0 (0.0)
Total	30 (100.0)	52 (100.0)
e570 - Social Security Services, Systems, and Policies
Not described	26 (86.7)	48 (92.3)	0.4552
It is a barrier	0 (0.0)	0 (0.0)
It is a facilitator	4 (13.3)	4 (7.7)
Total	30 (100.0)	52 (100.0)
e580 - Health Services, Systems, and Policies
Not described	0 (0.0)	3 (5.8)	0.3921
It is a barrier	3 (10.0)	4 (7.7)
It is a facilitator	27 (90.0)	45 (86.5)
Total	30 (100.0)	52 (100.0)

ABRAMO Associação Brasileira de Motricidade Orofacial Rua Uruguaiana, 516, Cep 13026-001 Campinas SP Brasil, Tel.: +55 19 3254-0342 - São Paulo - SP - Brazil
E-mail: revistacefac@cefac.br

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[1] Corresponding address: Marina Garcia de Souza Borges, Avenida Alfredo Balena, 190, sala 249, CEP: 30130-100 - Belo Horizonte, Minas Gerais, Brasil, E-mail: ninaborgesvh@htomail.com