This was a cross-sectional study via a web-based survey. Ethics approval for the study was obtained from the authors’ organization’s Human Research Ethics Committee (JEPUKM_JEP-2021-020).

A total of 89 questionnaires were returned and analysed for this study. Approximately 75% (N=67) of SLPs reported providing services via telepractice during the COVID-19 pandemic. Nineteen percent of SLPs, all of whom were providing services via telepractice during the COVID-19 pandemic, had provided services via telepractice prior to the COVID-19 pandemic. The demographic information of SLPs who provided and did not provide services via telepractice during the COVID-19 pandemic are presented in Table 1. The SLPs had working experience of between 1 to 20 years, with the majority (43.3%) of SLPs who had provided services via telepractice having 0 to 5 years of experience and the majority (36.4%) of those who had not having 6 to 10 years of experience. Some respondents reported working in more than one setting. The majority of SLPs from both groups worked at hospitals (52.2%, 50.0%) (Table 1).

The types of cases seen by the two groups of respondents are presented in Figure 1. Almost all SLPs from both groups (95.7%; 100%) stated that their caseload consisted of children with developmental language disorders. This was followed by speech sound disorders for both groups of participants (81.8%; 71.0%).

The 67 SLPs who provided services via telepractice during the COVID-19 pandemic then completed Section B regarding their telepractice and the results are presented in Table 2. In terms of frequency, most participants (50.7%) who provided services via telepractice did so approximately 1 to 5 times a week (Table 2). A large majority (91.0%) of them provided services via telepractice for children aged 3 to 5 years old with less than 20% providing services via telepractice to adults from various age groups (Table 2).

When providing services via telepractice, participants most often (73.1%) used videoconferencing. Almost 90% of SLPs provided treatment via telepractice as compared to 37.3% who used it for assessment. The populations which received services via telepractice are detailed in Table 2, with the most common being children with developmental language disorders followed by speech sound disorders. Slightly more than half of the SLPs (55.2%) felt that services delivered via telepractice were as effective as face-to-face and 34.3% felt that they were less effective (Table 2). The chi-square test of independence indicated no significant association between how often SLPs provided services via telepractice during the COVID-19 pandemic and how effective they felt telepractice was as compared to standard face-to-face service delivery, χ²(9)=14.72, p=.099, phi=.472.

All participants who did not use telepractice (N=22) were aware of telepractice as a form of service delivery in the field of SLP. The main reason they did not use telepractice was the lack of support/knowledge/training (59.1%) and unsuitable patient type (45.5%) (Table 3).

These participants were then asked what they felt they needed to set up effective telepractice (open-ended question) and some of the most common responses were hardware such as microphones/headphones and cameras at their workplace (59.1%), training in conducting sessions via telepractice (31.8%), secure internet connection (22.7%), and knowledge about online clinical materials and software (22.7%).

All participants were asked about the training they had received in telepractice and their response are presented in Figure 2. All SLPs reported having received training in telepractice with most of the SLPs who were providing services via telepractice reporting that they received training through professional development courses (38.8%). There was an equal number of respondents who were not providing services via telepractice reporting that they had received training through professional development course and university education (36.45). The chi-square test of independence indicated no significant association between whether or not SLPs were providing services via telepractice and the type of training they had received, χ²(3)=1.36, p=.715, phi=.124. All participants expressed a desire to obtain more training in telepractice. Some of the areas of training most wanted were clinical aspects such as how to manage clients online (68.5%) and various online software and resources (29.2%).

More than two-thirds of respondents reported providing services via telepractice during the COVID-19 pandemic compared to 19%doing so prior to the pandemic. This finding of a large majority of SLPs providing services via telepractice during the Covid-19 pandemic was similar to that of Tambyraja, Farquharson, and Coleman (2021) and Aggarwal et al. (2020). The increase in services delivered via telepractice during the COVID-19 pandemic compared to before was also documented in several other studies (ASHA, 2020; Sylvan, Goldstein, & Crandall, 2021). These findings suggest that Malaysian SLPs, like SLPs elsewhere, were willing to accept and trial out a different form of service delivery when they were unable to provide services face-to-face. Some of the factors that could have led them to explore and provide services via telepractice were: (a) understanding of the importance of continuous therapy for individuals who need it, (b) parents/clients/caregivers seeking to receive services during the lockdown, and (c) SLPs needing to continue to seek an income (especially private practitioners).

It was evident from this study that albeit only a few, there were some SLPs who were providing services via telepractice prior to the COVID-19 pandemic. In Malaysia, most SLPs practice in big cities (Chu, Khoong, et al., 2019; Chu, Tang, et al., 2019), with some SLPs who are attached to government hospitals in big cities conducting visits to rural areas periodically. It could have been that the SLPs that were providing services via telepractice were those who were providing follow-up services to clients in rural areas. The use of telepractice as a service delivery model for rural areas has been well documented in countries such as Australia (Speech Pathology Australia, 2014).

Fong et al. (2020)’s who conducted a similar study in Hong Kong reported that only 35% of their participants provided clinical services through telepractice. Similarly, only 34% of Turkish SLPs surveyed by Aktürk and Toğram (2021) and 6% of Korean SLPs surveyed by Kim et al. (2020) provided services via telepractice during the COVID-19 pandemic with a large majority choosing not to do so. It could have been that these two studies were conducted much earlier in the pandemic and SLPs were reluctant to start telepractice as they were unaware that the pandemic would span for almost two years.

Although most SLPs were providing services via telepractice during the COVID-19 pandemic, Most of the SLPs providing services via telepractice during the COVID-19 pandemic did so only 1-5 times a week Most of the SLPs in this study were practicing in the hospital and it could have been that they were able to continue to provide services face-to-face during the pandemic. Almost all participants reported providing services via telepractice to children aged 3 to 5 years. This was followed by children aged 7-months to 2-years old and 6 to 17-years old. Participants who responded to this survey indicated that their caseload, in general, consist mostly of children, and thus, children were the group that most often received services via telepractice. Children make up the main caseload of SLP in Malaysia, with there being fewer SLPs serving adult populations (Chu, Khoong et al., 2019; Chu, Tang et al., 2019). Studies conducted elsewhere around the world also indicated that preschool and school-aged children were often the focus of telepractice (Aggarwal et al., 2020; Aktürk & Toğram, 2021; Fong et al., 2020). As suggested by Fong et al. (2020), this group was probably the least resistant when it came to receiving rehabilitation through technology.

Given that most SLPs were providing services via telepractice to children, it was no surprise that children with developmental language disorders and speech sound disorders were those most frequently served. Over the years, there has been strong evidence supporting the effectiveness of telepractice for children with speech and language disorder (Wales, Skinner, & Hayman, 2017) which perhaps also made participants more confident when providing services to these groups as participants in this study did report reviewing literature to gain more knowledge about telepractice.

Approximately three quarters of participants used video conferencing when providing services via telepractice. Various online videoconferencing platforms gained popularity during the COVID-19 pandemic, for example, Zoom (Chawla, 2020). In this study, given that children were most often the target of therapy, videoconferencing was a more appropriate modality over audio-only modalities, as it has many options of interactive activities that help keep the children engaged (Walters, Bernis, Delvin-Brown, & Hirsch, 2021).

Almost 90% of SLPs who provided services via telepractice used it for treatment whereas only about one-third used it for assessment. This finding of SLPs not using telepractice for the purpose of assessment frequently is similar to that of Fong et al. (2020). Fong et al. (2020) suggested that perhaps SLPs choose to provide service via telepractice to patients with who they were familiar rather than new patients.

The majority of SLPs felt that telepractice was as effective as face-to-face service delivery, a finding similar to that of Kollia and Tsiamtsiouris (2021). There has been evidence suggesting that clients make similar progress when receiving services via the two modalities (Grogan-Johnson, Alvares, Rowan, & Creaghead, 2010) and SLPs themselves might have seen this progress thus leading them to feel more confident about providing services via telepractice. SLPs perception of the effectiveness of telepractice as compared to face-to-face service delivery, however, was not associated with the frequency of services delivered via telepractice. This findings suggest that although SLPs felt that telepractice was effective, other factors such as the work setting and number of patients could have affected the frequency of services delivered via telepractice although this was not explored further in this study.

All the SLPs who did not provide services via telepractice knew about telepractice as a form of services delivery in the field of speech-language pathology, thus suggesting that perhaps they were unprepared to deliver services via telepractice. According to Hines et al. (2015), at times, although SLPs know about telepractice and its potential, they remain unsure about its effectiveness and uncertain about how to conduct it as it is entirely different from their previous clinical experience.

The most common reason for not using telepractice was a lack of support, knowledge/training, a finding similar to that of May and Erickson (2014) and Hines et al. (2015). The lack of knowledge, support, and training often lead SLP to have doubts about the effectiveness of telepractice, thus affecting attitudes and believes (May & Erickson, 2014). SLPs also cited unsuitable client types as one of the main reasons for not providing services via telepractice. Research has indicated that telepractice is a form of service delivery that is suitable for all client types, regardless of disability type and age (ASHA, 2019). It could be that SLPs who were not providing services via telepractice were unaware of this research evidence. It could also have been that clients were deemed were unsuitable because they opted not to receive telepractice or did not have the technological necessities needed. Technological barriers were also frequently cited as a reason for not using telepractice. As reported by May and Erickson (2014), the lack of access to technology often leads SLPs to view telepractice negatively. Like the SLPs in Korea surveyed by Kim et al. (2020), Malaysian SLPs who were not using telepractice felt the need mostly for equipment (hardware and software) as well as training that provided specific content about telepractice to be able to set up effective telepractice.

SLPs in this study received training in telepractice mostly via professional development courses and university education. The COVID-19 pandemic that resulted in a global shift in service delivery methods led many professional bodies and organizations to conduct various webinars and online training sessions in telepractice to help SLPs transition smoothly to the provision of online services. In Malaysia, telepractice has been added to university coursework in recent years and a majority of participants in this study had been working for less than 10 years, thus it could be that they continued to rely on some of the information they obtained at the university. Although all SLPs had received some training in telepractice, there was no association between whether or not they used telepractice and the type of training they had received. The amount of training received rather than the type might have affected the provision of services via telepractice given that most of those who did not provided service via telepractice cited the lack of knowledge and training as a reason for not using it.

Findings from this study indicated that SLPs in Malaysia, a developing country, demonstrated great commitment to learning about and resilience in using technology for telepractice, suggesting their dedication in ensuring that clients received the services they needed despite the raging pandemic. Their practices were similar to that of SLPs in developing countries, in terms of the populations served and platforms used for telepractice. The COVID-19 pandemic is likely to have led telepractice to have a permanent place in speech-language pathology service delivery throughout the globe, including Malaysia. SLPs will likely continue to have more positives attitudes toward effectiveness of telepractice with increased familiarity, use and training.