Adolescents' experiences of receiving and living with sequential cochlear implants: an interpretative phenomenological analysis

Patient-centered empirical research on ethically relevant psychosocial and cultural aspects of cochlear, glaucoma and cardiovascular implants - a scoping review

BACKGROUND

The significance of medical implants goes beyond technical functioning and reaches into everyday life, with consequences for individuals as well as society. Ethical aspects associated with the everyday use of implants are relevant for individuals' lifeworlds and need to be considered in implant care and in the course of technical developments.

METHODS

This scoping review aimed to provide a synthesis of the existing evidence regarding ethically relevant psychosocial and cultural aspects in cochlear, glaucoma and cardiovascular implants in patient-centered empirical research. Systematic literature searches were conducted in EBSCOhost, Philpapers, PsycNET, Pubmed, Web of Science and BELIT databases. Eligible studies were articles in German or English language published since 2000 dealing with ethically relevant aspects of cochlear, glaucoma and passive cardiovascular implants based on empirical findings from the perspective of (prospective) implant-wearers and their significant others. Following a descriptive-analytical approach, a data extraction form was developed and relevant data were extracted accordingly. We combined a basic numerical analysis of study characteristics with a thematically organized narrative synthesis of the data.

RESULTS

Sixty-nine studies were included in the present analysis. Fifty were in the field of cochlear implants, sixteen in the field of passive cardiovascular implants and three in the field of glaucoma implants. Implant-related aspects were mainly found in connection with autonomy, freedom, identity, participation and justice, whereas little to no data was found with regards to ethical principles of privacy, safety or sustainability.

CONCLUSIONS

Empirical research on ethical aspects of implant use in everyday life is highly relevant, but marked by ambiguity and unclarity in the operationalization of ethical terms and contextualization. A transparent orientation framework for the exploration and acknowledgment of ethical aspects in "lived experiences" may contribute to the improvement of individual care, healthcare programs and research quality in this area. Ethics-sensitive care requires creating awareness for cultural and identity-related issues, promoting health literacy to strengthen patient autonomy as well as adjusting healthcare programs accordingly. More consideration needs to be given to sustainability issues in implant development and care according to an approach of ethics-by-design.

Health Literacy in the Context of Implant Care-Perspectives of (Prospective) Implant Wearers on Individual and Organisational Factors

The continuous development of medical implants offers various benefits for persons with chronic conditions but also challenges an individual's, and the healthcare system's, ability to deal with technical innovation. Accessing and understanding new information, navigating healthcare, and appraising the role of the implant in body perceptions and everyday life requires health literacy (HL) of those affected as well as an HL-responsive healthcare system. The interconnectedness of these aspects to ethically relevant values such as health, dependence, responsibility and self-determination reinforces the need to address HL in implant care. Following a qualitative approach, we conducted group discussions and a diary study among wearers of a cochlear, glaucoma or cardiovascular implant (or their parents). Data were analysed using the documentary method and grounded theory. The data reveal the perceptions of implant wearers regarding the implant on (1) the ability to handle technical and ambiguous information; (2) dependence and responsibility within the healthcare system; and (3) the ethical aspects of HL. Knowing more about the experiences and values of implant wearers is highly beneficial to develop HL from an ethical perspective. Respective interventions need to initially address ethically relevant values in counselling processes and implant care.

Cochlear Implant Nonuse: Insight from Deaf Adults

Research examining the outcome of pediatric cochlear implantation consists of certain limitations, including the use of assessments that are often restricted to auditory-spoken skills, biased recruitment practices, and lack of consideration for identity development. To better understand the long-term outcome of implantation, it is vital to seek out individuals who decide to stop using their device and elicit feedback related to their decision. Thus, 11 adults, who were past cochlear implant (CI) users, were interviewed to gain insight into factors that had led to their decision regarding cochlear implant nonuse. Results indicated several variables to have played a role, but the most prominent factors were limitations in postimplant auditory perceptual development and development of a d/Deaf identity. Although cochlear implant practices and technology have improved over the past few decades, we need to recognize the continued variability in outcome to ensure the provision of the most accurate information and appropriate services.

Adolescents' experiences of communication following acquired brain injury

BACKGROUND

Paediatric acquired brain injury (ABI) is one of the leading causes of neurodisability in childhood. The long-term effects of ABI on cognition, behaviour and emotions are well documented. Previous research has found that communication is difficult for adolescents with ABI compared with typically developing peers. Quantitative studies have identified deficits in specific domains of speech and language, but no research studies have sought to capture adolescents' lived experiences of communication or explored the multidimensional nature of this.

AIMS

To explore adolescents' everyday experiences of communication following ABI. This research also offered adolescents an opportunity to give their views on an issue that has not previously been explored in relation to paediatric ABI.

METHOD & PROCEDURES

A qualitative study was undertaken using interpretative phenomenological analysis (IPA) for in-depth exploration of the lived experiences of communication following ABI. Participants were recruited from an NHS Trust in England. Six adolescents (aged 11-18 years) participated in semi-structured interviews. Data analysis followed the guides for IPA.

OUTCOMES & RESULTS

The data revealed three main themes: the social world; communication competence; and life in the classroom. Adolescents experienced communication changes and challenges, which affected functioning and participation. Difficulties with communication affected identity, learning, relationships and confidence.

CONCLUSIONS & IMPLICATIONS

These findings provide an insight into how communication is experienced in everyday life from the perspectives of adolescents with ABI. The study revealed that adolescents' individual experiences of communication were dependent on contextual factors. Sensitivity to communication changes was associated with the age when the ABI occurred. Difficulties with communication impacted on identity. Negative communication experiences at school affected a sense of belonging; peer group support helped some adolescents to cope with the communication challenges they faced. Further research is needed to explore how participation in communication is affected by paediatric ABI and what could be done to support this. It is recommended that increased attention should be paid by professionals to the psychological impact of communication changes and difficulties experienced by this population.

Personality Traits, Self-Efficacy, and Cochlear Implant Use Among Deaf Young Adults

A variety of studies have examined ways in which cognitive and social-emotional factors may be linked to and affected by hearing loss, use of cochlear implants (CIs), and sign language. A related domain that largely has been overlooked, however, is personality. This paper reports a study of personality traits and self-efficacy among deaf and hard-of-hearing (DHH; n = 223) college students, with and without CIs, as compared to hearing peers (n = 106). All participants completed (HEXACO) personality trait and self-efficacy inventories; DHH participants also completed a communication questionnaire. Hearing participants scored higher on the personality trait Conscientiousness than both DHH CI users and non-CI users, as well as higher on Openness to Experience compared to DHH CI users. Hearing participants also scored higher on self-efficacy compared to DHH non-CI users. Among DHH non-CI users, greater self-rated sign language skills were associated with higher Extraversion and Agreeableness scores. Among the DHH CI users, earlier sign language acquisition was associated with higher Openness to Experience scores, and earlier cochlear implantation was associated with greater Emotionality scores. Self-efficacy was associated with both better self-rated spoken language skills and a stronger preference for spoken language over sign language use among DHH CI users.

Cultural Identity of Young Deaf Adults with Cochlear Implants in Comparison to Deaf without Cochlear Implants and Hard-of-Hearing Young Adults

This study examined the relationships between cultural identity, severity of hearing loss (HL), and the use of a cochlear implant (CI). One hundred and forty-one adolescents and young adults divided into three groups (deaf with CI, deaf without CI, and hard-of-hearing (HH)) and 134 parents participated. Adolescents and young adults completed questionnaires on cultural identity (hearing, Deaf, marginal, bicultural-hearing, and bicultural-deaf) and communication proficiencies (hearing, spoken language, and sign language). Parents completed a speech quality questionnaire. Deaf participants without CI and those with CI differed in all identities except marginal identity. CI users and HH participants had similar identities except for a stronger bicultural-deaf identity among CI users. Three clusters of participants evolved: participants with a dominant bicultural-deaf identity, participants with a dominant bicultural-hearing identity and participants without a formed cultural identity. Adolescents and young adults who were proficient in one of the modes of communication developed well-established bicultural identities. Adolescents and young adults who were not proficient in one of the modes of communication did not develop a distinguished cultural identity. These results suggest that communication proficiencies are crucial for developing defined identities.

Language and Psychosocial Functioning among Deaf Learners with and without Cochlear Implants

Various studies have examined psychosocial functioning and language abilities among deaf children with and without cochlear implants (CIs). Few, however, have explored how relations among those abilities might change with age and setting. Most relevant studies also have failed to consider that psychosocial functioning among both CI users and nonusers might be influenced by having language abilities in both signed and spoken language. The present investigation explored how these variables might influence each other, including the possibility that deaf individuals' psychosocial functioning might be influenced differentially by perceived and actual signed and spoken language abilities. Changes in acculturation and quality of life were examined over their first year in college, together with changes in perceived and assessed language abilities. Students with and without CIs differed significantly in some aspects of psychosocial functioning and language ability, but not entirely in the directions expected based on studies involving school-aged deaf students. Participants' cultural affiliations were related as much or more to perceived language abilities as to the reality of those abilities as indicated by formal assessments. These results emphasize the need to consider the heterogeneity of deaf learners if they are to receive the support services needed for personal and academic growth.

Social Maturity and Executive Function Among Deaf Learners

Two experiments examined relations among social maturity, executive function, language, and cochlear implant (CI) use among deaf high school and college students. Experiment 1 revealed no differences between deaf CI users, deaf nonusers, and hearing college students in measures of social maturity. However, deaf students (both CI users and nonusers) reported significantly greater executive function (EF) difficulties in several domains, and EF was related to social maturity. Experiment 2 found that deaf CI users and nonusers in high school did not differ from each other in social maturity or EF, but individuals who relied on sign language reported significantly more immature behaviors than deaf peers who used spoken language. EF difficulties again were associated with social maturity. The present results indicate that EF and social maturity are interrelated, but those relations vary in different deaf subpopulations. As with academic achievement, CI use appears to have little long-term impact on EF or social maturity. Results are discussed in terms of their convergence with findings related to incidental learning and functioning in several domains.

Exploring the experiences of teenagers with cochlear implants

OBJECTIVES

Teenage cochlear implant users' perceptions of deafness, surgery, fitting of the device and life as a cochlear implant wearer were explored in order to gain a more comprehensive understanding of teenagers' experiences of living with the device.

METHODS

Semi-structured in-depth interviews were undertaken and analysed using thematic analysis. Ten teenagers aged 14-16 years with at least one cochlear implant were interviewed.

RESULTS

Seven teenagers experienced great pre-operative anxiety and two reported significant post-operative pain. Four of the teenagers described a mismatch between their expectations and the disappointing reality of adjusting to the device. However, all the teenagers reported an enhanced sense of well-being as a result of being able to interact more easily with their world around them. The teenagers differed in the extent to which they identified with the hearing and deaf world.

DISCUSSION

Despite the early challenges, over time the teenagers experienced many functional and psychosocial benefits. Most felt their lives were now easier as a result of the cochlear implant(s). They described complex, flexible identities.

CONCLUSIONS

By giving prominence to the teenagers' voices this study has added new knowledge concerning their experience of surgery. The findings also more fully revealed the challenges of adjusting to the device and the impact of having a cochlear implant on the teenagers' identities. Clinical recommendations are made to address the gaps in service highlighted by these findings.