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

Abstract

Objectives: Early hearing detection and intervention (EHDI) is guided by the 1-3-6 approach: screening by one month, diagnosis by 3 mo, and early intervention (EI) enrollment by 6 mo. Although screening rates remain high, successful diagnosis and EI-enrollment lag in comparison. The aim of this systematic review is to critically examine and synthesize the barriers to and facilitators of EHDI that exist for families, as they navigate the journey of congenital hearing loss diagnosis and management in the United States. Understanding barriers across each and all stages is necessary for EHDI stakeholders to develop and test novel approaches which will effectively reduce barriers to early hearing healthcare.Design: A systematic literature search was completed in May and August 2021 for empirical articles focusing on screening, diagnosis, and EI of children with hearing loss. Two independent reviewers completed title and abstract screening, full-text review, data extraction, and quality assessments with a third independent reviewer establishing consensus at each stage. Data synthesis was completed using the Framework Analysis approach to categorize articles into EHDI journey timepoints and individual/family-level factors versus system-level factors.Results: Sixty-two studies were included in the narrative synthesis. Results revealed that both individual/family-level (e.g., economic stability, medical status of the infant including middle ear involvement) and system-level barriers (e.g., system-service capacity, provider knowledge, and program quality) hinder timely diagnosis and EI for congenital hearing loss. Specific social determinants of health were noted as barriers to effective EHDI; however, system-level facilitators such as care coordination, colocation of services, and family support programs have been shown to mitigate the negative impact of those sociodemographic factors. Conclusions:Many barriers exist for families to obtain appropriate and timely EHDI for their children, but system-level changes could facilitate the process and contribute to long-term outcomes improvement. Limitations of this study include limited generalizability due to the heterogeneity of EHDI programs and an inability to ascertain factor interactions.

Neonatal Hearing Rescreening in a Second-Level Hospital: Problems and Solutions

“…If an infant becomes lost to follow-up in hearing screening, healthcare professionals should strive to engage with the family and encourage them to arrange a follow-up appointment. In certain cases, outreach programs or community resources can facilitate connecting families with the necessary services [ 25 ].…”

The Association of Race With Decreased Access to Pediatric Hearing Healthcare in the United States

“…Therefore, hearing healthcare professionals must focus on interventions at the system and provider level. Examples of interventions that have proven effective include colocation of services, hearing healthcare navigators, networking providers with pediatricians, educating pediatricians and primary care physicians regarding EHDI, educating parents/caregivers before hospital discharge, increasing regional access through satellite locations and telehealth, providing safety-net clinics that accept all payer types with minimal out-of-pocket expenses, and parent-to-parent networking (Bush et al 2017; Suskind et al 2018; Findlen et al 2022). In addition, professionals must also increase understanding from the family’s point of view.…”

Association of Sociodemographic Factors on the Presentation and Management of Unilateral Vocal Fold Immobility

“…7 It has been shown repeatedly that social determinants of health (SDOH) influences time to presentation for a number of otolaryngologic conditions. [18][19][20][21][22][23][24] SDOH is a complex construct influenced by sociodemographic variables such as sex, race, ethnicity, and socioeconomic status (SES). SDOH affects the burden of symptoms, access to, and effectiveness of medical interventions.…”