Analysis of barriers and facilitators to early hearing detection and intervention in KwaZulu-Natal, South Africa

Abstract

Background There is slow progress in early hearing detection and intervention (EHDI) services within South Africa. Audiologists are EHDI gatekeepers and can provide valuable insights into the barriers and facilitators that can progressively move EHDI towards best practice in South Africa. Objectives The study aimed to determine the barriers and facilitators to EHDI in KwaZulu-Natal as reported by audiologists/speech therapists and audiologists (A/STAs). Method A descriptive qualitative approach was used. Telephonic interviews were conducted with 12 A/STAs working in public and private healthcare facilities, using the strengths, weaknesses, opportunities, threats (SWOT) conceptual framework. Data was analysed using thematic analysis in conjunction with NVivo software. Results One of the main barriers perceived by A/STAs, affecting EHDI was the lack of resources in healthcare facilities. The participants indicated that although there was a guideline in place to guide practice, it may be more suited to an urban area versus a rural area. Poor knowledge and awareness of EHDI was also identified as a barrier. Information provided from A/STAs at grassroots level, in the various provinces, may benefit in developing a more contextually relevant and practical guideline. Facilitators included; development of task teams specifically for EHDI programmes, creation of improved communication networks for collaboration and communication, training of healthcare professionals and improving data management systems. Conclusion Strategies such as an increase in resources, further education and training, development of contextually relevant, culturally, and linguistically diverse practices and protocols need to be in place to improve EHDI implementation. Further research, clinical implications and limitations are provided emanating from the study.

Availability of resources for paediatric hearing care in a South African province

“…These findings are similar to those reported in previous studies. 19 , 23 , 24 , 25 A study in KwaZulu-Natal Province 25 where participants argued that uneven distribution of audiologists and speech therapists remains a challenge in the provision of EHDI. 18 , 19 , 20 , 21 , 22 Similarly, a study 25 in the Gauteng province also reported that the insufficient number of audiologists available to provide screening affects the provision of early hearing detection and intervention services.…”

“… 19 , 23 , 24 , 25 A study in KwaZulu-Natal Province 25 where participants argued that uneven distribution of audiologists and speech therapists remains a challenge in the provision of EHDI. 18 , 19 , 20 , 21 , 22 Similarly, a study 25 in the Gauteng province also reported that the insufficient number of audiologists available to provide screening affects the provision of early hearing detection and intervention services. Subsequently, we recommend equitable distribution of health professionals for the provision of early hearing detection and intervention in state hospitals in the EC, especially considering the dawn of the National Health Insurance, where babies should have equitable access to hearing health.…”

Barriers to and Facilitators of Early Hearing Detection and Intervention in the United States: A Systematic Review

“…Although Holte et al (2012) reported that only 32% of infants in their study completed each of the 1-3-6 benchmarks by the targeted timeline, this number shrinks to less than 20% for national-level data (Subbiah et al 2018), indicating continued difficulty with meeting EHDI expectations and suggesting a significant need to address barriers. Many of the barriers identified through this review have been reported by EHDI programs in other developed or developing countries (Lai et al 2014; Ravi et al 2016; Fitzpatrick et al 2017; Naidoo & Khan 2022; Waterworth et al 2022). A common theme across the journey for these US studies was that specific SDOH served as significant barriers, consistent with a recent review by the American-Speech-Language-Hearing Association Special Interest group for EHDI (Kingsbury et al 2022).…”

A call for linguistic and culturally congruent family-centred early hearing detection and intervention programmes in South Africa

“…Early hearing detection and intervention (EHDI) programmes are recognised as the standard of care for newborns and infants presenting with hearing impairment (Health Professions Council of South Africa [HPCSA], 2018 ; Naidoo & Khan, 2022 ). Early hearing detection and intervention encompasses the earliest possible identification, diagnosis and intervention for these children, to ensure that they can communicate effectively and develop to their maximum potential (HPCSA, 2018 ; Kanji & Khoza-Shangase, 2021 ; Maluleke & Khoza-Shangase, 2023 ).…”

“…Despite the high prevalence of infant hearing impairment and global and national healthcare reform initiatives towards equitable access to healthcare, widespread implementation of EHDI programmes is far from being realised in South Africa and faces numerous challenges (Khoza-Shangase, 2019 ; United Nations General Assembly, 2015 ; World Health Organization [WHO], 2021 ). These challenges include an over-burdened public healthcare sector, quadruple burden of disease challenges, social determinants of health challenges, resource limitations, poor knowledge and awareness of EHDI among healthcare professionals (HCPs) and caregivers, and a lack of government mandate for EHDI (Kanji & Khoza-Shangase, 2021 ; Maluleke et al, 2023a ; Naidoo & Khan, 2022 ; Petrocchi-Bartal et al, 2021 ; WHO, 2021 ).…”