Knowledge and attitudes of early childhood development practitioners towards hearing health in poor communities

Knowledge and attitudes of school principals towards childhood hearing loss and hearing services: A cross-sectional survey to support the implementation of inclusive education in Samoa

Objectives

To assess the knowledge and attitudes among school principals towards childhood hearing loss and hearing services to support the implementation of inclusive education in Samoa. Educators are uniquely positioned to advocate for inclusive education in their classrooms, and may be among the first professionals to suspect hearing loss in their young students. Given the well-known impacts of childhood hearing loss on learning and development, educators therefore play a vital role in referring students for an ear and hearing health assessment.

Methods

A cross-sectional convenience sampling design and bilingual questionnaire were used (English/Samoan). School principals attending the annual conference for educators of Samoa over 4 days in June 2022 were invited to anonymously complete a 23-item questionnaire on childhood hearing loss and hearing services. Participants were required to respond to each statement with either 'yes', 'no' or 'unsure'. The questionnaire investigated general knowledge of healthy hearing and hearing loss, knowledge of causes and risk factors of hearing loss, knowledge of identification and intervention for hearing loss and the attitudes towards students with hearing loss.

Results

95.4% of the 109 participants agreed that healthy hearing is important, and 97.2% felt that childhood hearing loss is an important problem in Samoa. Participants agreed that hearing loss adversely impacts the interaction with peers (95.4%), listening in the classroom (94.5%), speech and language development (93.6%), classroom behaviour (88.1%) and reading skills (85.3%). 97.2% of participants felt that students with hearing loss should have the same opportunities as their normal-hearing counterparts, and 92.7% would include students with hearing loss in their classroom. 94.5% were keen to learn more about childhood hearing loss. There were no significant differences in response proportions between variable subgroups.

Conclusion

Overall, the results displayed high levels of knowledge and very positive attitudes among school principals in Samoa towards their students with hearing loss.

The public healthcare sector of Mauritius: knowledge of and attitudes toward hearing loss among community health workers

Mauritius does not have community health workers trained in identifying risk factors for hearing loss or in referring patients for diagnostic testing. It is crucial to gather information about the knowledge of and attitudes toward hearing loss among community health workers before involving them in the identification and intervention of hearing loss in Mauritius. To describe the knowledge of and attitudes toward hearing loss among community health workers in Mauritius. A descriptive survey design with quantitative analysis was used. Using non-probability purposive sampling, 125 community health workers which included 94 community health officers and 31 community-based rehabilitation officers were recruited from the five catchment areas of the public healthcare sector. Participants filled in a 15-item paper-based questionnaire on the knowledge of and attitudes toward hearing loss. The questionnaire was internally consistent, with Cronbach alpha scores of 0.759 and 0.863. The overall knowledge of community health workers regarding risk factors and the identification of hearing loss was poor (38.3%). 92.6% of community health workers reported positive attitudes toward hearing loss. General knowledge of hearing loss (P=0.015) and knowledge of risk factors and identification of hearing loss (P=0.005) were significant predictors of attitudes toward hearing loss. Knowledge of and attitudes toward hearing loss were significantly associated with working experience and practice setting (P=0.004). There remains a need to educate community health workers about the risk factors and identification of hearing loss to ensure timely diagnosis and management of hearing loss at the community level.

mHealth-Supported Hearing Health Training for Early Childhood Development Practitioners: An Intervention Study

(1) Hearing health training and promotion is a priority for early childhood development (ECD) practitioners, but training opportunities are limited, especially in low- and middle-income countries (LMIC). mHealth (mobile health) has the potential to deliver scalable ear and hearing training to ECD practitioners. (2) This study investigated the effect of an mHealth training intervention program for ECD practitioners to improve knowledge and perceptions of hearing health in young children. An experimental one-group, pre-post-test study included ECD practitioners working with children between birth and 6 years old across 31 neighbouring communities in the Western Cape Province, South Africa. Hearing health training was provided using WhatsApp messages that encompassed infographics and voice notes. Knowledge and perceptions regarding hearing and hearing-related problems in children were surveyed pre-training, directly post training, and 6 months post training. (3) ECD practitioners (N = 1012) between 17 and 71 years of age received the mHealth training program and completed both the pre-and post-training surveys. Overall, knowledge scores indicated a significant improvement from pre- to post training (Z = -22.49; p < 0.001). Six-month post-training knowledge scores were sustained. Content analysis of ECD practitioners' application of the training information 6 months post training indicated improved awareness, practical application, better assistance for hearing problems, and widespread advocacy. (4) The mHealth training program supports improved knowledge and perceptions of ECD practitioners regarding hearing health for young children. With improved knowledge scores maintained 6 months post training, mHealth hearing health training is an effective intervention. An mHealth training program for ECD practitioners provides a scalable, low-cost intervention for primary and secondary prevention in childhood hearing loss, especially in LMICs.

Knowledge and attitudes of schoolteachers in the Pacific Islands to childhood hearing loss and hearing services: A national survey protocol for Samoa

Objectives:

The Pacific Island region is estimated to have among the highest rates of childhood ear disease and hearing loss in the world. The adverse effects of childhood hearing loss include delayed speech/language development, learning difficulties, and reduced social-emotional well-being. Schoolteachers and early childhood educators are among the first professionals who may suspect hearing loss in their young students, and they are well-placed to initiate referrals to appropriate health services. Given the current efforts to implement Inclusive Education in the Pacific Islands, teachers are also uniquely positioned to positively influence, support, and advocate for a child with hearing loss in their classroom. There are no previous studies on this topic from the Pacific Island region.

Methods:

The study will use a national survey and convenience sampling design. Teachers attending the Annual Teachers Conference in Samoa will be invited to independently and anonymously completed a 23-item questionnaire on childhood hearing loss and hearing services. Questions are in English, with a Samoan translation provided. The participating teachers will be required to respond with “yes,” “no,” or “unsure,” and to mark their response on the questionnaire. The questions assess knowledge of biomedical etiology of hearing impairment, knowledge of the adverse impacts of hearing loss on childhood development, knowledge of hearing loss identification and intervention, and attitudes toward children with a hearing impairment.

Results:

Not applicable for a study protocol.

Conclusion:

We publish these protocols to facilitate similar studies in other low- and middle-income countries, and especially among our Pacific Island neighbors.

The role of health promotion in the development of ear and hearing health services in the Pacific Islands : A literature review

The Pacific Islands have among the highest rates of ear disease and hearing loss in the world. Ear and hearing health services are limited in this region; however, a significant proportion of avoidable hearing loss and disability may be addressed through public health promotion activities. In order to develop appropriate hearing health education campaigns and promotion initiatives, knowledge and attitude studies among target population groups are vital. This review aimed to summarize the research literature on knowledge and attitude to ear disease and hearing loss in the Pacific Islands in order to develop appropriate health promotion campaigns for our context in Samoa. PubMed and ScienceDirect databases were searched for relevant journal articles. Key search terms were ‘Pacific Islands’, ‘ear disease’, ‘hearing loss’, ‘knowledge’, ‘attitudes’, and their relevant synonyms. There was no limit on the date of publication. Only one journal article met the review criteria. Parental knowledge and attitude to childhood hearing loss and hearing services in the Solomon Islands was overwhelmingly positive (96%–99.3%). There was high parental awareness of ear disease as a cause of hearing loss among children (94%) and high parental awareness of public health initiatives aimed at reducing ear disease and hearing loss such as routine childhood immunizations (84%) and breastfeeding (76%). Knowledge and attitude studies among key stakeholders are needed to develop appropriate health promotion activities to reduce the preventable causes of hearing loss in the Pacific Islands. Health promotion activities should prioritize major public health issues of ear disease and noise-induced hearing loss.

Community-Based Hearing and Vision Screening in Schools in Low-Income Communities Using Mobile Health Technologies

Introduction Globally, more than 50 million children have hearing or vision loss. Most of these sensory losses are identified late due to a lack of systematic screening, making treatment and rehabilitation less effective. Mobile health (mHealth), which is the use of smartphones or wireless devices in health care, can improve access to screening services. mHealth technologies allow lay health workers (LHWs) to provide hearing and vision screening in communities. Purpose The aim of the study was to evaluate a hearing and vision school screening program facilitated by LHWs using smartphone applications in a low-income community in South Africa. Method Three LHWs were trained to provide dual sensory screening using smartphone-based applications. The hearScreen app with calibrated headphones was used to conduct screening audiometry, and the Peek Acuity app was used for visual acuity screening. Schools were selected from low-income communities (Gauteng, South Africa), and children aged between 4 and 9 years received hearing and vision screening. Screening outcomes, associated variables, and program costs were evaluated. Results A total of 4,888 and 4,933 participants received hearing and vision screening, respectively. Overall, 1.6% of participants failed the hearing screening, and 3.6% failed visual acuity screening. Logistic regression showed that female participants were more likely to pass hearing screening (OR = 1.61, 95% CI [1.11, 2.54]), while older children were less likely to pass visual acuity screening (OR = 0.87, 95% CI [0.79, 0.96]). A third (32.5%) of referred cases followed up for air-conduction threshold audiometry, and one in four (25.1%) followed up for diagnostic vision testing. A high proportion of these cases were confirmed to have hearing (73.1%, 19/26) or vision loss (57.8%, 26/45). Conclusions mHealth technologies can enable LHWs to identify school-age children with hearing and/or vision loss in low-income communities. This approach allows for low-cost, scalable models for early detection of sensory losses that can affect academic performance.

Hearing and vision screening for preschool children using mobile technology, South Africa

Objective

To implement and evaluate a community-based hearing and vision screening programme for preschool children in the Western Cape, South Africa, supported by mobile health technology (mHealth) and delivered by community health workers (CHWs).

Methods

We trained four CHWs to provide dual sensory screening in preschool centres of Khayelitsha and Mitchells Plain during September 2017–December 2018. CHWs screened children aged 4–7 years using mHealth software applications on smartphones. We used logistic regression analysis to evaluate the association between screening results and age, sex and test duration, and, for hearing, excessive background noise levels.

Results

CHWs screened 94.4% (8023/10 362) of eligible children at 271 centres at a cost of 5.63 United States dollars per child. The number of children who failed an initial hearing and visual test was 435 (5.4%) and 170 (2.1%), respectively. Hearing test failure was associated with longer test times (odds ratio, OR: 1.022; 95% confidence interval, CI: 1.021–1.024) and excessive background noise levels at 1 kilohertz (kHz) (e.g. OR for left ear: 1.688; 95% CI: 1.198–2.377). Visual screening failure was associated with longer test duration (OR: 1.003; 95% CI: 1.002–1.005) and younger age (OR: 0.629; 95% CI: 0.520–0.761). Of the total screened, 111 (1.4%) children were diagnosed with a hearing and/or visual impairment.

Conclusion

mHealth-supported CHW-delivered hearing and vision screening in preschool centres provided a low-cost, acceptable and accessible service, contributing to lower referral numbers to resource-constrained public health institutions.

Hearing loss in preschool children from a low income South African community

OBJECTIVE

This study aimed to determine and describe hearing loss among preschool children in a South African community representative of typical low- and middle income countries (LMIC).

METHOD

Children between the ages of 3-6 years received a hearing screening at their early childhood development (ECD) center. If a child failed the hearing screening, he/she was seen for a follow-up rescreen and diagnostic assessment if necessary at their ECD center or closest referral clinic. Diagnostic testing consisted of otoscopy, tympanommetry and pure-tone diagnostic audiometry.

RESULTS

A total of 6424 children were screened at ECD centers with a referral rate of 24.9%. Follow-up assessments were conducted on 45.3% (725) of these children. Diagnostic testing revealed that 9.3% of children presented with impacted cerumen and 18.7% presented with a hearing loss (56.5% binaural). Binary logistic regression revealed no gender or age effects (p > 0.05). Conductive hearing loss (65.2%) was the most common type of hearing loss found in children.

CONCLUSIONS

Most preschool children who failed the hearing screening and received a diagnostic assessment were in need of intervention services for conductive hearing losses, followed by sensorineural and mixed losses.