Parents' views about factors facilitating their involvement in the oral early intervention services provided for their children with hearing loss in Kuwait

Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services

BACKGROUND

Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion.

METHODS

We conducted a scoping review following the methodological framework proposed by Arksey and O'Malley, Int J Soc Res Methodol 8:19-32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article.

RESULTS

Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities.

CONCLUSION

Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations' needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.

What Are Parents' Experiences With Their Child's Hearing Aid Use in the First 5 Years?

OBJECTIVES

Parents are required to make informed choices for their children regarding the use of hearing amplification after hearing loss has been diagnosed. If parents choose a listening and spoken language approach for their child where the development of age appropriate spoken language is the parents' goal, then the early fitting and frequent use of hearing aids is crucial. Within the framework of family centered care, parents have the ultimate responsibility for supporting their child's hearing aid use. However, few studies have focused on parents' insights regarding the aspects that shape hearing aid use in the early years. Thus the aim of this study was to explore parents' firsthand experiences with their child's hearing aid use in the first 5 years. Understanding parents' insights will help improve service provision to optimize outcomes for children with hearing loss.

DESIGN

The study utilized a prospective qualitative design to explore parents' firsthand experiences with their child's hearing aid use. Purposive sampling was used to recruit 12 parents who participated in semi-structured interviews. Parents' responses were analyzed using thematic analysis.

RESULTS

Three overarching themes were conceptualized, namely: (a) towards hearing aids - journey into the wilderness; (b) adjusting to hearing aids - it's the journey, not the destination; and (c) support for my child's hearing aid use - it's not where you are going, it's who you have beside you. Each theme was further divided into categories and subcategories.

CONCLUSIONS

This study identified that parents have much to contribute to service providers' understanding regarding the aspects that shape consistent hearing aid use in young children. Parents shared many insights such as the emotionally daunting nature of the first few months post hearing loss confirmation, the influence of family support, and the importance of building connections and understanding about hearing loss and hearing aid use within their social networks. Based on these insights, the authors provide recommendations for clinical best practice that draw upon key principles of family centered care. They consist of practical suggestions including strategic support to overcome less optimal hearing aid use and ways to facilitate parent support within their familial and communal networks.

Family-Centered Early Intervention (FCEI) Involving Fathers and Mothers of Children Who Are Deaf or Hard of Hearing: Parental Involvement and Self-Efficacy

(1) Background: Studies related to family-centered early intervention (FCEI) for children who are deaf or hard of hearing (DHH) have largely focused on mothers, at the exclusion of fathers. Yet, understanding fathers’ experiences with FCEI is also important and may inform service delivery. The present study explores self-efficacy and involvement with FCEI in both fathers and mothers. (2) Methods: Dutch fathers and mothers completed questionnaires about their parental self-efficacy, involvement in FCEI, perceived support from their primary EI provider, and the impact of raising a child who is DHH on parenting. (3) Results: Both fathers and mothers reported relatively high levels of self-efficacy. Mothers reported higher levels than fathers on some domains of self-efficacy and tended to be more involved in their child’s FCEI than fathers. In fathers, but not mothers, higher levels of self-efficacy were related to higher levels of involvement and higher levels of perceived support. (4) Conclusions: Similarities and differences were found between fathers and mothers in their perspectives on self-efficacy and involvement. This points to potential differences related to their FCEI needs. EI providers need to address both the needs of fathers and mothers to promote optimal development among child who are DHH.

Mothers view about oral health status, oral hygiene behaviors, and dental services utilization of their children with hearing impairment attending special schools

AIM

Parents are the principal decision-makers regarding their child's health. Awareness of mothers' view about their children's health, particularly with special health care needs (SHCN) (include hearing impaired children), is essential for health care providers. Therefore, the present study aimed to assess the mothers view about oral health status, oral hygiene practices, and dental services utilization of their children with hearing impairment attending special schools.

METHODS

A cross-sectional study was conducted between May and September 2020 among mothers of students with hearing impairment attending special schools. Also, the telephone structured interview was used to gathering mothers view.

RESULTS

57.4% of the mothers rated their children's oral health status as excellent or good, 27.9% as moderate, and 14.7% as poor. About half of the mothers (49.2%) stated that their children used toothbrushes once daily, and 15% use dental floss. Also, 54% of the children visited the dentist before this survey's conduct.

CONCLUSION

The findings of the present study suggest that children with hearing impairment can also have good oral health status and behaviors. These results may be attributed to the fact that the study sample was taken from two special schools. Also, only the mothers' perception assessment of students' oral health status was done. Further studies are required to increase the strength of evidence.

A new training package (3Cs: Connect, Communicate and Collaborate) for improving family responsive service delivery in early intervention for children with hearing loss: A proof of concept study

BACKGROUND

An objective of early intervention for children with hearing loss is to enhance family engagement in therapy to maximise a child's speech and language potential. However, requiring a service provider to work collaboratively with a child's family can create problems in developing and underdeveloped countries, where skilled service providers and services for children with hearing loss are lacking and where an expert model of intervention prevails.

OBJECTIVES

To determine the preliminary effectiveness of a new training package Connect, Communicate and Collaborate (3Cs), in improving the knowledge and confidence of service providers in the delivery of family responsive services in an early intervention program for children with hearing loss.

METHODS

Five learning modules were developed based on service provider experience working with children with hearing loss, and parents of children with hearing loss. Six participants completed the training package comprising five training modules and an introductory session over a 6-week period. Participants' confidence and knowledge in providing family responsive practice was measured pre and post training using visual analogue scales, and participants were also invited to provide their reflections on the program.

RESULTS

Pre- and post-training confidence ratings revealed significant improvements in the perceptions of participants in the implementation of responsive family practice across four of five of programme learning modules (p < 0.002). Participant reflection statements indicate they became more considerated in their family responsive practice. Despite positive experiences working with parents, participants stated they had ongoing difficulties guiding families through the decision-making processes of habilitation. The reflection process assisted learning and improved practice by supporting participants to build on their strengths.

CONCLUSION

The 3Cs package improved the confidence in and knowledge of delivery of responsive family services for six participants in Kuwait. It also improved the participant's self-evaluation skills. The 3Cs provides professional development that meets the needs of service providers working with children with hearing loss to improve inclusion of families in the therapy process.