A questionnaire-based analysis of parental perspectives on pediatric cochlear implant (CI) re/habilitation services: a pilot study from a developing CI service in India

Factors that influence stress in caregivers of 5-year-old children with hearing loss wearing hearing aids or cochlear implants

OBJECTIVE

Stress levels among caregivers of children with hearing loss could influence caregiver-child interactions and ultimately, children's developmental outcomes. Given the limited understanding of stress levels among caregivers of Australian children with hearing loss, the present study aimed to examine stress in caregivers of 5-year-old children with hearing loss wearing hearing aids or cochlear implants and to identify factors associated with greater stress levels.

METHODS

A total of 99 caregivers of 70 hearing aid users and 29 cochlear implant users participated in the study. Caregivers' stress was measured using the 68-item Pediatric Hearing Impairment Caregiver Experience (PHICE) questionnaire that examines caregivers' context-specific stress levels in relation to caring for a child with hearing loss. Factors contributing to stress were identified in relation to eight domains including communication, education, emotional well-being, equipment, financial, healthcare, social, and support.

RESULTS

Across domains, the three most common predictors of increased stress were the use of cochlear implants over hearing aids, use of sign and oral language (mixed) over oral language as the communication mode at home, and increased behavioural difficulties of the child.

CONCLUSION

Overall, reported stress levels among Australian caregivers were low. Identified factors influencing stress levels can inform service provision improvement.

Towards universal access: A review of global efforts in ear and hearing care

Hearing loss affects 1.6 billion people worldwide and disproportionately affects those in low- and middle-income countries. Despite being largely preventable or treatable, ear and hearing conditions result in significant and lifelong morbidity such as delayed language development, reduced educational attainment, and diminished social well-being. There is a need to augment prevention, early identification, treatment, and rehabilitation for these conditions. Expanded access to hearing screening, growth of the hearing health workforce, and innovations in ear and hearing care delivery systems are among the changes that are needed. To that end, the World Health Organization has prioritized ear and hearing care as a component of Universal Health Coverage, and recent publications have advanced the priority for ear and hearing care. Efforts are underway at the national levels around the world, as evidenced by countries like Zambia and Nigeria that have integrated ear and hearing care within national health strategies. While significant strides have been made in improving access, a critical need remains for additional research, advocacy, and intervention to ensure that no one is left behind in the goal to achieve universal access to ear and hearing care.

Reliability and validity assessment of a survey: Measuring satisfaction with cochlear implant rehabilitation services for children in Jordan

BACKGROUND

Assessing parental satisfaction with healthcare services is crucial, particularly for parents and their children, who are the primary recipients of these services. In the context of Arabic-speaking parents, there is a notable absence of survey instruments tailored to measure their satisfaction. This study seeks to address this gap by validating a survey designed to evaluate parental satisfaction with rehabilitation services (RSs) provided to Jordanian children who have received cochlear implants (CIs).

METHODS

The study included 92 participants and followed a four-step methodology: 1) a literature review and expert input; 2) cognitive interviews, pilot testing, and test-retest reliability testing; 3) data collection; 4) validity and reliability assessments.

RESULTS

The survey's validity was confirmed. Expert input and cognitive interviews improved content validity, and factor analysis established construct validity by revealing six factors explaining 82.33% of the variance in the survey scale. Convergent and discriminant validity were confirmed (composite reliability >0.7 and average variance extracted value >0.5). Cronbach's α exceeded 0.8 for each factor and reached 0.855 for the total scale. Survey results showed reliance on speech therapy and audiology, varied rehabilitation durations, and progress. Parents expressed overall satisfaction, particularly influenced by technical quality and efficacy/outcome dimensions. Parents' recommendations to enhance satisfaction with RSs included financial support, improved service accessibility, enhanced service delivery, specialized education, and increased public awareness.

CONCLUSION

This study validates an Arabic satisfaction survey, emphasizing the significance of multidisciplinary, extended rehabilitation programs, skilled professionals, and positive outcomes. It emphasizes the necessity for improved access to specialized care and collaboration among healthcare, government, and media to shape parental perceptions of RSs. While the findings indicate overall satisfaction, they also reveal challenges faced by parents, highlighting the need for comprehensive support systems. These insights assist healthcare providers and policymakers in enhancing care quality and meeting the needs of CI children's families, thereby improving the RSs experience in Jordan.

Challenges faced by Indian parents in raising a child with a cochlear implant - Impact on communication outcomes

OBJECTIVES

The objectives of the present study were to understand the parental views regarding stress, and its affect language, and auditory outcomes. The study also aims to understand the relationship between parental stress, and child's age.

DESIGN, SETTING AND PARTICIPANTS

A retrospective study was performed at a tertiary medical hospital. 50 parents of cochlear implant recipients were recruited for the study. The parents were interviewed and the children were tested using a test battery. The average age of implantation was 4.29 years, and the average hearing age was 3.23 years.

MAIN OUTCOME MEASURES

The parents were interviewed about their child's needs, and experience with the cochlear implant using the Strength, and Difficulty questionnaire in Hindi, Questionnaire on Resources, and Stress-Short Form, and the Family Environment Scale, Closed - format Questionnaire to understand parental views, and experiences. The language outcomes were studied using the Integrated Scales of Development (ISD), Revised Categories of Auditory Performance. Factor analysis, and Chi-square tests were performed to understand potential relationships between parental stress, and child language, and/or auditory outcomes.

RESULTS

The results provide five main factors that accounted for significant variance including financial stress (30.1%), hyperactivity (15.2%), lack of personal rewards (13%), peer problems (10.9%), and emotional problems (9.2%). Acquisition of language was highly influenced by stress and caregiver's 'lack of personal rewards. 'Financial stress', and 'hyperactive behavior' of the child significantly affected the receptive language acquisition of a HI child. The most concerning factors for parents were well-being, and happiness (0.885), followed by social relationships (0.830), communication (0.736), the process of implantation (0.695), and the decision to implant (0.681). The stress regarding finance among parents increased marginally (0.024) as the child's age progressed.

CONCLUSION

Parental stress is ongoing. The impact on the expressive language development of the child is significant. The maximum concern of parents is regarding the financial aspects of a cochlear implant, and the lifespan care of their child. Hence, professionals should provide regular, and context-specific counseling to parents after implantation to understand the parents' concerns, and provide appropriate remediation.

Barriers to access to ear and hearing care services in low- and middle- income countries: A scoping review

People living in low- and middle- income countries (LMICs) meet significant challenges in accessing ear and hearing care (EHC) services. We conducted a scoping review to identify and summarise such barriers, to recognise gaps in the literature, and to identify potential solutions. Reviewers independently screened titles, abstracts and full-text articles and charted data. We undertook thematic analysis of supply and demand side dimensions of access, and summarised findings mapped against the Levesque framework. Of 3048 articles screened, 62 met inclusion criteria for review. Across the five access dimensions, supply-side constraints were more frequently described, the most common being a shortage of EHC workforce or appropriate facilities, despite high demand. We identified a thin geographical spread of literature on barriers to accessing EHC services in LMICs, reflecting low availability of such services. LMICs face a diverse range of demand and supply side challenges including workforce, equipment and resource shortages, and challenges for the majority of the population to pay for such services. There is a need for many LMICs to develop health policy and programmes in EHC, including integration into primary care, scaling up the EHC workforce through increased training and education, and improving EHC literacy through public health measures.

Parent-reported quality of life in children with cochlear implants differs across countries

Pediatric cochlear implantation affects communication skills and quality of life, specifically how children interact with others and feel about themselves. Numerous studies worldwide examine well-being among pediatric cochlear implant users, but none to date compare condition-specific quality of life across countries. This retrospective study compares parent-reported cochlear implant-specific quality of life summary data across 14 published studies spanning 11 countries and 9 languages. Sample size ranged from 7 to 370 participants, and children across studies varied in mean chronologic age (3.1–12.2 years), implantation age (1.5–4.6 years), and cochlear implant experience (1.3–8.2 years). Parents completed the Children with Cochlear Implants: Parental Perspectives (CCIPP) questionnaire, an instrument assessing parent-reported cochlear implant-specific quality of life, in their home language. Analysis of variance tests were run for each CCIPP subscale across studies using summary data to determine significant differences between published manuscripts. Across countries, parents of children with cochlear implants appraise communication, social relations, and self-reliance most positively, and the effects of implantation and supporting the child least positively. Cross-country analyses revealed a significant effect of study (country) on quality of life ratings in each domain, with the largest differences in the communication domain. Limited access to implant-related accommodations, cultural awareness of hearing loss, and varying parent expectations may explain country differences in parental ratings of quality of life. Culturally sensitive psychoeducation for the entire family may foster improved life satisfaction for pediatric cochlear implant users and their families.

Research About Parents of Children with Cochlear Implants: A Scoping Review

Parents of children who are deaf or hard of hearing have long attracted interest from researchers, though, since the 1990s, published research about this population has increasingly gravitated toward issues surrounding pediatric cochlear implantation. This scoping review was undertaken to map the nature, extent, and range of three decades of research about parents of children with cochlear implants, and reports on (1) publication characteristics, (2) sampling characteristics, and (3) study design characteristics within 80 peer-reviewed articles published between 1990 and 2020. The results indicate several gaps and gluts within the field, including a lack of diversity within (and detail about) study samples, a disproportionate focus on evaluating parents' personal characteristics and (presupposed) psycho-emotional problems, and a scarcity of participatory or co-constructed projects. The results may inform future research, ensuring a wider range of perspectives and experiences are recorded and issues of highest priority and relevance to families are investigated.

Stress among Parents of Children with Hearing Loss and How They Deal with It: A Systematic Review

Introduction  Parenting a child with hearing loss may be accompanied by high stress levels and several challenges. Objectives  The present systematic review was performed to compile the existing literature pertaining to parental stress in parents of children with hearing loss and coping strategies. Data synthesis  The databases searched include PubMed/Medline, Scopus, Cochrane Library and Cumulative Index to Nursing, and Allied Health Literature. The systematic review was designed and performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guidelines. The screening for studies was performed independently by two researchers. Methodological quality appraisal was done using the Mixed methods appraisal tool. Twenty-eight studies were identified and included in the present review, which discussed the stress factors and coping mechanism associated with having child with hearing loss reported by parents. The factors leading to stress were thematically classified into parent/family-related factors, child-related factors, and professionals/service-related factors. The coping strategies were thematically classified into improved support systems and better professional resources. Conclusion  The present systematic review was an attempt at exploring the various stress causing factors among parents of children with hearing loss. The various coping strategies would help in better planning services for these parents and helping to lessen the stress.

A comparison of the quality of life of parents of children using hearing aids and those using cochlear implants

Objective

The goal of this study was to evaluate the quality of life of parents of children who use hearing aids (HA) with those who use cochlear implants (CI) in the Indian context and document any differences found.

Methods

The Kannada version of the AQoL-4D was administered in a modified fashion to 131 parents (87 HA and 44 CI). Sociodemographic details were collected for supplemental information on the intervention strategy used.

Results

A total of 49 parents (29 HA and 20 CI) responded to the questionnaire sent. The mean total scores for both the groups were similar (HA group = 17.9 (SD = 5.5), CI group = 17.2 (SD = 3.4)), as was the score for the first subscale (HA group = 8.6 (SD = 2.9); CI group = 8.5 (SD = 2.6)) of the AQoL-4D. No significant differences were found between the two groups on either scores [Total Score: U (N_HA = 29, N_CI = 20) = 280.5, z = −0.194, p > 0.05; Subscale 1 Score: U (N_HA = 29, N_CI = 20) = 281.5, z = −0.176, p > 0.05]. The degree of hearing loss in the hearing aid group was equivalent to that of the cochlear implant group but this did not appear to influence parental quality of life.

Conclusion

Parents of children with hearing aids and cochlear implants appear to be similar on several psychosocial factors in the realms of functional, social, and psychological well-being. In terms of parental quality of life, hearing aids and cochlear implants appear to be equally effective intervention techniques.

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Effect of Hearing impairment of children on their parents.

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Differences in the quality of life across different amplification strategy used.

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Correlation among quality of life, age of child, age of intervention, duration of hearing loss.

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Emotional consequences in Parents having hearing impaired children.

Comparison of Clinician Versus Parental Perspectives of Outcomes in Cochlear Implantees: A South Indian Experience

Outcomes of cochlear implantation (CI) are generically assessed using standard validated measures like CAP, SIR, MAIS and MUSS scales. Although this reflects the improvement in auditory verbal skills among the implantees with habilitation over one year, the overall perception of their skill development may vary between the parents of these children and the clinicians who provide the habilitation. This study aimed to compare the CAP and SIR scores sequentially over habilitation and further analyzes the correlation between clinician assessment (with CAP/SIR scores) and parental perspective (with MAIS/MUSS scores), at the end of one year of habilitation. 388 children aged 1-6 years who underwent unilateral CI were included in the study. Their baseline CAP and SIR scores were recorded post implantation. All children received 1 year of intensive auditory verbal therapy and their 12 month CAP, SIR, MAIS and MUSS scores were then recorded. The baseline CAP/SIR scores were compared with 12 month CAP/SIR scores and then their 12 month CAP/SIR scores were correlated with 12 month MAIS/MUSS scores respectively. There was significant difference between baseline and the 12 month CAP/SIR scores (p < 0.001). There was strong positive correlation between CAP and SIR scores after 12 months of habilitation (r = 0.7), while there was moderate positive correlation between CAP and MAIS scores (r = 0.59) and between SIR and MUSS scores (r = 0.49) respectively. Though the parents note significant improvement in child's communication abilities, the parental perspective of final outcomes does not always match with the clinician's assessments at the end of habilitation, as highlighted by the moderate correlations. A more precise method of holistic assessment is lacking currently and stands warranted.

Quality of life assessment in paediatric cochlear implant recipients in South India: Parental assessment and correlation with rehabilitation scores using a bilingual quality of life assessment questionnaire

Objectives: To assess the quality of life (QoL) of prelingually deaf paediatric population after Cochlear implantation (CI), using a bilingual questionnaire and to correlate with rehabilitation scores; to validate the questionnaire and recommend its use in future studies.Methods: This was a questionnaire based cross-sectional study. Parents of 151 paediatric prelingual CI recipients filled the questionnaire using a 5-point rating scale, with a score of 1-5. These scores were correlated with the CAP and SIR scores.Results and discussion: There was a positive correlation of QoL score with rehabilitation outcomes (r = 0.4638 and P ≤ 0.00001 for CAP; r = 0.3563 and P ≤ 0.00001 for SIR scores). The maximum scores (≥4.0) were given by parents for integration into educational system (4.86), response to environmental sounds (4.12) and overall parental satisfaction about child's performance (4.09). Minimum scores were given for ability to speak in sentences (2.9) and response to verbal sounds at a distance (3.23).Conclusion: The QoL of these children as assessed by the institutional questionnaire have correlated with the rehabilitation outcomes. These QoL results have a positive impact in counselling for early CI as well as for rehabilitation.

Parent reported barriers and facilitators towards cochlear implantation - A systematic review

CONTEXT

Early identification and intervention of hearing loss at a young age leads to long term benefits from language, communication, social, educational and financial aspects. Cochlear implantation is a widely recommended rehabilitation option for hearing loss. The process of cochlear implantation is a long one and the role played by parents is crucial.

OBJECTIVE

The present systematic review was carried out with the aim of identifying the different parent reported barriers towards cochlear implantation.

DATA SOURCES

PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Cochrane Library.

STUDY SELECTION

Studies in parent reported barriers towards cochlear implantation screened and identified using 3 stages by 2 reviewers. Mixed Methods Appraisal Tool was used to carry out the quality appraisal of included studies.

DATA EXTRACTION

Outcome measures related to barriers and facilitators.

RESULTS

Nineteen studies were identified and included in the present review which discussed the parent reported barriers based on themes such as service delivery, social issues, time related, device/surgery, financial, child related and others. The different factors that facilitated the process included availability of resources, finances, child related and parental.

CONCLUSION

The present review was a novel attempt at exploring the different parent reported barriers towards cochlear implantation. The facilitators, which can be used to overcome these barriers, will be useful for making the process smoother.

Parent-perceived challenges related to the pediatric cochlear implantation process and support services received in South Africa

OBJECTIVE

To determine and describe parent-perceived challenges related to the pediatric cochlear implantation process and support services received.

METHOD

A multicenter survey study across six cochlear implant (CI) programs in South Africa (SA) was conducted. The study sample included 82 parents of pediatric (≤18 years) CI recipients with at least 12 months CI experience. A self-administered questionnaire was developed for the purpose of this study, exploring parental challenges regarding the CI process, education of their implanted children and the support services received.

RESULTS

The financial implications of cochlear implantation, including CI device maintenance, were identified by parents as the most prominent challenge. Financing issues were the highest scoring reason that attributed to the delay between diagnosis of hearing loss and cochlear implantation, as well as the greatest barrier to bilateral implantation. Parent-perceived educational challenges included finding adequate educational settings specific to the individual needs of their child and a shortage of trained teachers equipped to support children with CIs. The presence of one/more additional developmental conditions and grade repetition were associated with more pronounced parent-perceived educational challenges. Parents considered speech-language therapy as the most critical support service for their implanted children to achieve optimal outcomes, while parent guidance was indicated to be the most critical support service required for parents of pediatric CI recipients.

CONCLUSION

A greater understanding of parent-perceived challenges will guide CI professionals to promote optimal outcomes, evidence-based service delivery and on-going support to pediatric CI recipients and their families. Study results imply a call for action regarding financial and educational support for pediatric CI recipients in SA.

Assessment of quality of life outcomes with the Glasgow Children's Benefit Inventory following cochlear implantation in children

Background

This study investigated health-related quality of life outcomes for children with cochlear implants in India using the Glasgow Children's Benefit Inventory questionnaire. Cochlear implantation is associated with improved language outcomes. Some studies show this gives higher quality of life after implantation. Previous research demonstrates that India presents unique circumstances that impact perspectives regarding cochlear implantation.

Method

Children (aged under 18 years) who had undergone cochlear implantation were recruited from Vani Pradan Kendra, an organisation for individuals with hearing loss based in Bangalore, India. Demographic data including age, sex, duration of hearing loss and age at implant were collected, and the children's parents or caregivers completed the Glasgow Children's Benefit Inventory questionnaire.

Results

Sixty-nine children (mean age: 8.0 ± 3.89 years) were recruited, and all reported improved quality of life after cochlear implantation. There was no effect of age, gender or education on reported benefits. However, a younger age at implant and longer experience with an implant were associated with greater quality of life improvements.

Conclusion

Cochlear implantation leads to improved quality of life, with greater improvements associated with earlier implantation. This supports early intervention in children with profound hearing loss.