This suvery was intenteded to be completed by UG students of ASLP program in India. The study’s purpose and informed consent were included in the online platform before starting with the questionnaire. Those participants who agreed to participate in the study proceeded to fill the questionnaire. Based on the results of the pilot study on 20 participants, 80% power, and 95% confidence interval, the sample size required for the present study was calculated as 350. A total of 380 UG students enrolled in ASLP programs in various institutions across India served as participants. These participants were spread across four years of the program. The mean age of the participants was 20.20 years (SD=1.63). A majority of the participants were females (85.79%). Participants who hailed from an urban background were slightly more (54.21%) than those who came from a rural background (45.79%). Distribution of the participants in each year of the UG program, gender and location background of home (urban/rural) is provided in Table 1.

The final questionnaire used in the study is provided as the supplementary material (S1). Brief description of the questionnaire is provided here. First, demographic details of the participants were collected which included details like, age, gender, location background of home*, educational board in which they studied**, marks obtained in plus 2/pre university***, educational and occupational details of parents etc. The next section had questions regarding the factors that influenced career choice. This involved questions like who introduced the participant to the field of ASLP, whether ASLP was their first choice, the factors that attracted them to join the program, and the most influential factor in their career choice.

Footnotes: *Location background of home refers to whether the participant hails from a rural or an urban background. **Educational board in which the participant studied - in India, generally schools follow the syllabus of one of the three educational boards namely: state syllabus (which is specific to each state of the country), Central Board of Secondary Education (CBSE), and Indian Certificate of Secondary Education (ICSE). These boards monitor the educational policies and programmes. ***Plus 2/pre university refers to 12th Grade/Class 12.

We developed the questionnaire by taking relevant questions from related articles [9,12] and were modified to suit the objectives of the present study. Also, we included the questions that we perceived as contextually relevant to the topic. The questionnaire was given to five experienced ASLP professionals with at least five years of experience for content validation. For each question in the questionnaire, the experts rated the contextual relevance on a 4-point rating scale where 4=relevant, 3=somewhat relevant, 2=somewhat irrelevant, and 1=irrelevant. If the rating provided by all the five experts was 4 or 3, then that question was retained; that is, 100% agreement was sought. This rating was taken for calculating the content validity index (CVI). We calculated both validities of the individual items (itemwise CVI=I-CVI) and the content validity of the overall scale (scalewise CVI=S-CVI) [20]. A scale composed of the items with I-CVIs that meet Lynn’s [20] criteria (I-CVI=1.00 with 3 to 5 experts) and having an S-CVI/Ave of 0.90 or higher is judged as having excellent content validity. Based on the responses received, three questions that had poor rating scores were removed. Thus, the I-CVI and S-CVI of the questionnaire were 1. The questionnaire had 17 questions, and was used for the pilot study.

In the pilot study, 20 ASLP students from different years of the UG program participated. These participants were chosen by convenient sampling and were studying in the same institute as that of the investigators. The questionnaire was incorporated in the Dynamics 365 Customer voice (Microsoft Corporation, 2020) and the link was mailed to the participants. Based on the responses, three questions were added to the original questionnaire. The additional questions added were as follows: one question each on rating the influences of personal, educational, and employment factors on the choice of career was added. This was added to obtain more clarity on the influence of each factor on the career choice in Indian scenario. Thus, the modified questionnaire consisted of 20 questions. This version of the questionnaire was also content validated by the same experts. There was a consensus among them, leading to the item-wise and scale-wise content validity index of the final questionnaire to 1.

The final questionnaire was also incorporated in the Dynamics 365 Customer voice (Microsoft Corporation, 2020). The data collection was carried out by distributing the link to the questionnaire through emails, social media platforms like WhatsApp groups, and Instagram. Many institution wise WhatsApp student groups exist in which the link to the questionnaire was posted. Similarly, the link to the questionnaire was posted in the Instagram page of the investigators. The links were posted only once and once the required sample size was achieved, the data collection was stopped and the data was analyzed.

The percentage of responses for the single most influential factor on the career choice of the participants is provided in Figure 5. From the Figure 5 it is seen that the desire to work in a helping profession was the most influential factor (52.11%). Parents/family member/relative/friend was identified the most influential factor by 32.89% of the participants. Remaining factors like experience wirh a parent of a child with communication disorder/individual with communication disorder, personal experience, teacher/career guidance was chosen as the most influential factor by less than 5% of the participants.

To gain more insight into the influential factors, the influences of various factors were classified under three main headings: personal, educational, and employment influences. The participants were asked to rate the influences of each factor on their career decision on a 5-point rating scale where 0 indicated “not an influence,” and 4 indicated “considerable influence” (rating responses provided in Figure 6, Figure 7, and Figure 8 respectively). Figure 6 shows that among personal influences, the desire to work in a helping profession (57.37%) was considered influential followed by parents (40.78%). Experience with an ASLP was considered not an influential factor in ASLP career choice by 48.9% of the participants. From Figure 7 it can be noticed that among the educational influences, location of the institute received greater percentage of 4-point rating indicating considerable influence (24.21%). Teacher in school received greater percentage of 0-point rating indicating no influence (52.63%). Among the employment influences (Figure 8), scope of practice (46.32%) and chances to be employed by foreign countries (46.1%) were considered as considerable influential factor, while job availability (42.63%) held the next position.

The responses of the participants regarding whether they or their family members were diagnosed with communication disorder before joining the program and how the diagnosis of communication disorder had influenced their decision to become an ASLP are provided in Table 3. It was observed that 21.84% of the participants indicated that a diagnosis of communication disorder was made in themselves or in family member/relative/friend before they joined the ASLP program. When these participants were asked how the diagnosis of communication disorder influenced their decision to become an ASLP, 32.53% of the participants reported that it made them feel empathetic for others with a communication disorder. Some (20.48%) also felt that they have overcome their communication difficulties and wanted to help others do the same.

Several demographic variables and responses to many questions in the questionnaire were identified as possible influential factors in career choice. All the demographic variables that were considered as potential influential factors were: gender (male/female), location background of home (urban/rural), education board which the participant studied (state/CBSE/ICSE), marks scored in plus 2/grade 12 (distinction/first class/second class/third class), educational qualification of parents (professional/post graduates/graduates/grade 12 or diploma/grade 10 or less), occupation of parents (legislators/professionals/technicians/clerks/agricultural workers/self employed/unemployed). Among the responses to questions, the factors that were considered important and influential in making ASLP career decision in previous studies [9,11–18] were considered for the analysis: awareness about various factors related to the program before joining the ASLP program; whether the participant applied to other programs; the most influential factor; influence of various personal, educational and employment factors; diagnosis of communication disorder in self or family/relatives/friends. Association between career choice (whether ASLP was the first choice or not) and the possible influential factors were assessed using the Pearson Chi-square test. The associations were considered significant if the p-values were less than 0.05. When the association was tested for 2X2 cross-tabulations, the effect size was reported using Phi, and for larger tables, Cramer’s V was reported. Complete statistical results of all the cross-tabulation and Chi-square tests between several variables in the questionnaire are provided as supplementary material (S2–S9). Only Chi-square test values of all the associations tested are reported here.

None of the demographic variables of the participants (gender, location background of home, educational board; marks scored in plus 2/grade 12, education, and occupation of father and mother) were significantly associated with ASLP as the first choice of career (Table 4). Neither the awareness about various aspects of the ASLP program was significantly associated with the ASLP as the first career choice (Table 5). However, from Table 6 it can be seen that the proportion of participants choosing ASLP as the first choice was more when they did not apply to other programs than otherwise. Association between the first choice and the variable the most influential factor on the career choice was significant. Pair-wise Chi-square association between ASLP as the first choice and different influential factors was done by applying Bonferroni’s correction for multiple comparisons. Hence, a p-value less than 0.003 was considered significant (0.05/15=0.003) (S7). Results of pairwise comparison indicated that a greater number of participants who reported that the desire to work in helping profession was the most influential factor on their choice of career had ASLP as the first career choice. On the other hand, participants who reported parents were the most influential factor in their career choice had lesser number of participants with ASLP as the first choice. Association between diagnosis of communication disorder in self and diagnosis of communication disorder in the family with ASLP as the first choice of career were not significant (Table 6).

For statistical analysis, the 5-point rating responses to the influence of personal, educational, and employment factors were converted into a dichotomous response. Ratings 0, 1, and 2 were considered “no influence,” and ratings 3 and 4 were considered “considerable influence.” Chi-square association between these variables and ASLP as the first choice of career was investigated (Table 7). Under the personal influences, participants having considerable influence from desire to work in a helping profession, and experience with a parent of a child with communication disorder/individual with communication disorder had more chances of having ASLP as the first career choice. Under the educational influences, the participants who had considerable influence from the academic curriculum had significantly higher chances of choosing ASLP as the first choice of career. None of the factors under the employment influences were significantly associated with ASLP as the first choice.

Summarizing the association between the factors affecting ASLP as the first choice of career, it can be said that the demographic variables considered in this study, awareness about various aspects of ASLP program before applying for the program were not significantly associated with the first choice of career. The important associations with the first choice of career were: the desire to work in helping profession, experience with an individual with communication disorder, academic curriculum, and not applying to any other program. It can be underscored that personal influences were more significant than educational and employment influences on the first choice of career of the participants.

To our knowledge, this is the first study in India which investigated the factors that might have influenced the choice of career among current ASLP UG students. The present study showed that most of the participants learnt about the ASLP field from parents/family member/relative/friend. Earlier investigations also reported that their participants learnt about ASLP program from family/friends [9,21,22]. However, it is to be noted that parents/family/relatives/friends have a more significant role in introducing the ASLP program to students in India than in other countries. Donai [21] and Guigen et al. [9] who reported school and booklets on a career as the second primary source of information about ASLP program respectively. These differences across studies could be related to the timeline when these studies were conducted, the availability of the internet then, and the differences in information sources that introduce the students to ASLP across various countries.

The primary sources where the participants searched for more information regarding the program to make an informed decision about applying to the program were parents/family member/relative/friend and internet/social media. These significant sources contrast with Byrne [13], who reported that most participants obtained information about the SLP program from the internet and university admissions center book. However, there were only 16 participants in that study where the authors conducted in-depth interviews. The differences could also reflect the access to the internet and the popularity of social media at different times and countries. Overall, it appears that in the present day, parents/family member/relative/friend and internet/social media plays a significant role in introducing the students to the program of ASLP in India.

Various studies have shown that most of the students were unfamiliar with the profession of audiology [21,23–25]. Donai et al. [26] pointed that the awareness of audiology as a potential career path is low compared to other professions such as optometry and podiatry. Guigen et al. [9] stated that a majority of the participants were not satisfied with the amount of details collected regarding various aspects of ASLP before getting into the college, mainly related to the work settings of ASLP. Few participants in their study also preferred to know about the academic curriculum and minimum financial remuneration allowed by law. In concurrence to this, present study showed that work settings, academic curriculum, and financial remuneration were the apects of ASLP program which were less known when applying to the program. Thus, it can be concluded that students entering the field of ASLP do not have all the information regarding the program. This indicates the need to promote awarenss regarding various aspects about the ASLP field among students who are about to make their career decision.

The current research shows that slightly more than half of the participants had ASLP as their first choice when applying for higher education. These findings were similar to that of Guigen et al. [9]. Doyle and Freeman [27] reported that 92% of the students seriously considered another occupation before they decided to pursue audiology. The percentage of students applying for other careers (degree/majors) at college was also high in Guigen et al. [9] study. In contrast, a higher percentage of the current study participants did not apply to any other program other than ASLP. Thus, it appears that the Indian ASLP students were more focused on their choice of career than students from other countries.

Among the participants for whom ASLP was not the first choice, most of them had medicine as their first choice. This is in contrast to the observations of Guigen et al. [9], who found that many of the students for whom ASLP was not the first choice, physiotherapy was their first choice. Thus, the present study’s findings and Guigen et al. [9] are different, especially when ASLP was not the first choice. In India, very frequently, when students aspiring to pursue career in medicine do not succeed in securing a seat in medical college, they consider allied health programs like ASLP or physiotherapy as their alternative career choice. Hence, creating awareness about ASLP program among students in general and students aspiring to pursue career in medicine in particular, might attract more students to ASLP program when they do not succeed to pursue their first career choice.

Participants of the present study were asked to select a single most influential factor in career choice. Desire to work in a helping profession turned out to be the most frequently chosen influential factor, followed by parents/family member/relative/friend. Statistically, among the three groups of probable influential factors, personal factors had a substantial influence than educational and employment factors. Among personal factors, the impact of desire to work in a helping profession and experience with an individual with communication disorder was greater to choose ASLP as the first career choice. These findings were similar to the results of previous studies [9,12,15,17].

For a majority of the participants of the present study who were diagnosed with a communication disorder in self/family/friends before joining the program, the diagnosis had some influence on their career choice. This agrees with previous investigations [11,14,16]. It can be summarized that the experience with a communication disorder in any form can positively influence one’s choice of selecting ASLP as a career. However, Byrne [14] alerts that exposure alone is an insufficient reason to want to enter the SLP program for some people. Also, for some participants, exposure to SLP may have been a factor that discouraged them from entering the profession. In the present study, for a smaller percentage of the participants, the diagnosis of communication disorder in self/family did not influence their career choice.

Among educational influences, only academic curriculum affected the ASLP as a career choice. There was no influence of employment factors on the choice of career as ASLP. On one hand it can be argued that for students making a career choice, employment factors are secondary to personal and educational influences. On the other side, this finding can also be related to the fact that financial remuneration, which is an employment factor was the least known aspect about ASLP among the present participants when they applied to the ASLP program. This fact is supported by the literature findings. For example, Guigen et al. [9] stated that 77% of their participants were dissatisfied with the details collected before getting into the college and mainly related to the work settings of ASLP. A few participants in their study also preferred to know about the academic curriculum and minimum financial remuneration allowed by law. Furthermore, there is insufficient awareness among college entering students about audiologists and the ASLP [21,23,25,28]. Thus, it is possible that, due to lack of awareness about the ASLP program, educational and employment factors were not influential on their career choice. Combining the findings of previous studies and present investigation, we emphasize the need to provide more detailed information regarding the ASLP program which can attract more admissions.

Students who had not applied to any other program more likely had ASLP as the first choice than if they had applied to any other program. No relevant literature regarding this fact was identified. However, it is possible that the students who applied only to the ASLP program were more informed about the program and were more satisfied with their choice of career. It is also possible that they were determined to enter the ASLP career and were confident in getting through the program such that they did not apply to any other program. In addition, it is to be noted that all the participants who had ASLP as the first choice had not applied to other programs. This is the novel finding of the study.

This study has certain limitations. Since the questionnaire was distributed on social media platforms, the participants were unevenly distributed across the institutions in India. More responses were available from ASLP students studying in South India. The factors influencing the career choice could be different in other parts of India, which could be explored in future studies.