Underrepresented Voices: Experiences of Asian American Speech-Language Pathologists in Graduate Training and Clinical Practice

Abstract

Purpose: Currently, speech-language pathology lacks diversity in its membership. Asian Americans are especially underrepresented among speech-language pathologists (SLPs) compared to other health professions. This phenomenon suggests that there may be unique factors that Asian Americans face in this discipline. The purpose of this study was to investigate the experiences of Asian American SLPs as trainees and as clinicians, and to explore whether these experiences vary based on their cultural affinity to Asian and American identities.Methods: The study is a qualitative study drawing on the phenomenological tradition. Twenty-six Asian American SLPs who work with adults participated in one-on-one semi-structured interviews. The interviews included open-ended questions about participants’ paths to the profession, their experiences as trainees and clinicians in speech-language pathology that related to their Asian identities, and the influence of their Asian identity on clinical interactions with clients. Participants also completed the Suinn-Lew Asian Self-Identity Acculturation (SL-ASIA) scale and other demographic questions regarding their ethnicity, language, education and work history. Thematic analysis was conducted with a team approach to develop themes and subthemes from codes derived from the interview transcripts. Descriptive measures were used to identify trends between qualitative and quantitative data. Results: Two sets of themes emerged from the interviews. The first set of themes focused on Asian American SLPs’ experiences as trainees during graduate school and clinical fellowship. Participants described how personal factors, including their personal motivation, family influence, and existing perceptions of SLPs played roles in their decisions to pursue graduate study. Once participants entered these graduate programs, they felt constrained by the existing norms within the program. The social environment within their programs that both positively and negatively influenced their experiences included program diversity, peer support, cultural adjustments, and feelings of isolation. The second set of themes explored their experiences in clinical practice. Participants described that their minority background and cross-cultural experiences served as assets for building strong relationships with Asian and other culturally and linguistically diverse (CLD) clients. They were also aware of the positive and negative impact of their language skills on clinical practice. They also faced challenges related to questioning their belonging in the profession from clients, peers, and themselves. Comparing qualitative findings with SL-ASIA responses data showed that experiences varied among participants based on their generational status and their language familiarity with English and Asian languages. While most participants identified as bicultural and comfortable navigating between cultures, they still faced racial stereotypes and discrimination that affected their sense of belonging. Conclusions: Previous research in speech-language pathology and other health professions demonstrates that underrepresented minority members experience sociocultural barriers to career entry, a limited sense of belonging, cultural dissonance in their professional identity, and perceived cross-cultural differences in clinical encounters. While minority SLPs may face many challenges similar to those of other professions, there are two findings highlighted in this study pertaining to Asian American SLPs’ experiences. SLPs coming from CLD backgrounds bring clinical strengths for working with CLD clients, but they also face discrimination from their clients and peers because of these differences. The significant role that speech and language plays in the profession, and existing racial stereotyping of Asians may also point to why Asian Americans are uniquely underrepresented in speech-language pathology compared to other healthcare disciplines. More research that centers on the experiences of minority SLPs is needed to address professional ideologies that hinder diversity and inclusion in the field.