A program to respond to otitis media in remote Australian Aboriginal communities: a qualitative investigation of parent perspectives

Abstract

BackgroundIndigenous infants and children in Australia, especially in remote communities, experience early and chronic otitis media (OM) which is difficult to treat and has lifelong impacts in health and education. The LiTTLe Program (Learning to Talk, Talking to Learn) aimed to increase infants’ access to spoken language input, teach parents to manage health and hearing problems, and support children’s school readiness. This paper aimed to explore caregivers’ views about this inclusive, parent-implemented early childhood program for 0–3 years in an Aboriginal community health context.MethodsData from in-depth, semi-structured interviews with 9 caregivers of 12 children who had participated in the program from one remote Aboriginal community in the Northern Territory are presented. Data were analysed thematically. Caregivers provided overall views on the program. In addition, three key areas of focus in the program are also presented here: speech and language, hearing health, and school readiness.ResultsCaregivers were positive about the interactive speech and language strategies in the program, except for some strategies which some parents found alien or difficult: such as talking slowly, following along with the child’s topic, using parallel talk, or baby talk. Children’s hearing was considered by caregivers to be important for understanding people, enjoying music, and detecting environmental sounds including signs of danger. Caregivers provided perspectives on the utility of sign language and its benefits for communicating with infants and young children with hearing loss, and the difficulty of getting young community children to wear a conventional hearing aid. Caregivers were strongly of the opinion that the program had helped prepare children for school through familiarising their child with early literacy activities and resources, as well as school routines. But caregivers differed as to whether they thought the program should have been located at the school itself.ConclusionsThe caregivers generally reported positive views about the LiTTLe Program, and also drew attention to areas for improvement. The perspectives gathered may serve to guide other cross-sector collaborations across health and education to respond to OM among children at risk for OM-related disability in speech and language development.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1081-3) contains supplementary material, which is available to authorized users.

Ear and hearing care programs for First Nations children: a scoping review

“…The two most commonly identified barriers to accessing existing (mainstream) services were geographical [ 18 , 20 , 21 , 42 , 56 , 58 , 60 , 62 – 64 , 69 – 73 ] and low levels of awareness of how to prevent the impacts of ear disease and hearing loss in young children as well as strategies to mitigate impacts [ 18 , 20 , 21 , 56 , 58 , 63 , 65 , 66 , 68 , 70 – 73 , 75 , 76 ]. These barriers were either specifically reported in publications relating to the program or inferred through specific program strategies (e.g.…”

“…it was assumed that implementation of telehealth in regional and remote areas indicated a geographical barrier to services). Additional barriers identified included extensive ENT waitlist times [ 18 , 58 , 64 , 65 , 70 , 75 , 76 ], lack of service coordination [ 18 , 58 ], system fragmentation [ 67 ], workforce shortages [ 58 ], implementation difficulties [ 74 ], and cost [ 18 , 20 , 21 , 64 ]. Further, coordinating access to tertiary care was identified as challenging due to systemic barriers [ 18 ].…”

“…One study utilised outputs regarding clinic attendance differences between groups in a randomised-control trial [ 68 ]. Seven studies included qualitative measures such as perspectives of perceived program impact [ 18 , 55 , 61 , 65 , 66 , 75 , 76 ]. One article reported outcome measures regarding surgical and hearing outcomes at post-surgical review [ 64 ].…”

“…Most of the studies identified that programs relied on government funding mechanisms which could either ensure sustainability or lead to program discontinuation [ 18 , 54 , 55 , 57 – 60 , 63 , 65 ]. For example, while the Healthy Ears, Better Hearing, Better Listening (HEBHBL) program depended on Australian Government funding, annual funding timing created logistical problems in the continuity of the service [ 18 , 55 ].…”

“…The HEALS program was not able to be continued as an ongoing and sustainable service due to tight funding deadlines and lack of recurrent funding [ 75 , 76 ]. The LiTTLe Program received funding from the Honda Foundation, Ian Thorpe Fountain for Youth, and the Federal Government’s Communities for Children Program, however, the program was discontinued due to a government funding reduction [ 65 ].…”