Barriers and Facilitators to Cultural Competence in Early Hearing Loss Services

Abstract

Background: Cultural competence in early hearing loss interventions, such as Spoken Language Therapy, is required to support language development amongst Canada’s diverse population. Every year an estimated 2000 infants are diagnosed with permanent hearing loss in Canada. Hearing loss has detrimental impacts on language development, a vital health determinant for communication, academic performance and employability. Additionally, it also impacts family life, including stressful treatment decision-making, expensive treatment costs, and family-child communication struggles. International consensus therefore emphasizes the importance of early intervention to diminish these negative impacts. However, with the latest Census revealing that 20% of Canadians identify themselves as a minority or foreign born, there is an important need to explore whether Western-influenced interventions are appropriate and effective for minority culture populations. This investigation is of particular importance as the core focus of early intervention is language development and inclusion into mainstream society and cultural competence may help facilitate optimal language outcomes. In order to facilitate change in these early interventions, knowledge on how cultural differences may affect health care services is required. However, research in this field is limited and often dated, anecdotal, and reflects stereotypical views. This highlights the need for empirical research to inform strategies for increasing culturally competent interventions. The purpose of this research project was therefore to gain a deeper understanding of the impact of cultural diversity in a setting that is typically tailored to meet the needs of the majority culture.

Objectives: 1) to review and assess the state of knowledge with respect to barriers and facilitators of cultural competence in rehabilitation services; 2) to explore practitioners’ experiences with providing services to minority culture families who have children with hearing loss; and 3) to explore the experiences of minority culture families receiving services for their child’s hearing loss.

Methodology: This study employed a mixed methodology. In order to address the first objective, a scoping review was performed in the rehabilitation services literature as the number of studies solely in childhood hearing loss was limited. The second objective was addressed in two stages: Stage 1 involved individual semi-structured interviews with 19 practitioners working in hearing loss and 10 caregivers of minority culture backgrounds whose children were receiving services for hearing loss. Recruitment occurred at the Children’s Hospital of Eastern Ontario in Ottawa, which services a diverse population. In Stage 2, results from the interviews were used to inform the development of a survey tailored to practitioners working in hearing loss. A total of 109 practitioners’ responded from across Canada.

Results: Cultural barriers occurred at each stage of service delivery, from diagnostic testing to the provision of interventions. Language barriers, stigma, and the lack of culturally appropriate materials (e.g., assessments, therapy materials) were consistently shown to be key challenges experienced both by practitioners and families. A wide range of facilitators were also reported. The promotion of the preservation of home languages, the provision of culturally appropriate materials (e.g., translated documents, tailored assessments and intervention sessions), the use of communication strategies (e.g., simple language, pictures or videos), explanations of how disability is perceived in Canada, and explanations of the health care system were all viewed as key to providing culturally competent care.

Conclusion: The findings from this dissertation are the first to capture barriers and facilitators experienced by families of minority culture backgrounds receiving early hearing loss services and by practitioners who provided those services. The results of this program of research can be used to inform practitioners seeking to provide culturally competent care. In addition, this dissertation provides empirical research needed to help initialize a knowledge-to-action intervention seeking to capture and improve cultural competence in hearing loss services in Canada.