Abstract
BACKGROUND: Makaton, an unaided augmentative and alternative communication (AAC) method, is widely used by speech-language therapists (SLTs) in diverse clinical and educational settings. Despite its applicability across populations with complex communication needs, limited research has explored how South African SLTs perceive, use and experience Makaton. This gap is significant given South Africa's multilingual context, resource disparities and the need for culturally relevant AAC strategies. OBJECTIVES: This study aimed to explore South African SLTs' perceived competencies and use of Makaton. METHOD: This study employed a mixed-methods design. An online survey comprising closed- and open-ended questions was distributed to SLTs across South Africa. A total of 57 participants were included in the study. Quantitative responses were analysed using descriptive and inferential statistics, while qualitative responses were analysed thematically using Braun and Clarke's six-phase framework. RESULTS: While 87.7% of participants viewed Makaton as valuable, only 5.5% reported feeling very confident using it. No statistically significant difference between recommending Makaton to parents and team members (Wilcoxon signed-rank [WSR] = -1.386, p = 0.166). Four themes captured Makaton's perceived value: (1) multimodal communication, (2) accessibility and practicality, (3) support for speech and language development and (4) inclusion and social interaction. Reported challenges included: (1) limited awareness and training, (2) financial and/or resource constraints, (3) poor consistency and carryover, (4) motor and/or cognitive limitations and (5) cultural and regional mismatches. CONCLUSION: While Makaton is positively regarded by SLTs, limited training, confidence and implementation support hinder consistent use.Contribution: Expanding access to training and embedding Makaton in professional education may enhance AAC service delivery in the multilingual South African context.