Cultural Differences in Hearing Aid Use

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Originally posted at HHTM On May 20, 2015. Reprinted with permission.

According to the World Health Organization (WHO) (2015) these are the current facts on deafness and hearing loss around the world:

• 360 million people (328 Million and 32 Million children) worldwide have disabling hearing loss (40 dB or greater for the better ear for adults)(greater than 30 dB in the better ear for children). The majority of people with disabling hearing loss live in low and middle income countries. Approximately one-third of people over 65 years of age are affected by disabling hearing loss.



• Hearing loss may result from genetic causes, complications at birth, certain infectious diseases, chronic ear infections, the use of particular drugs, exposure to excessive noise and ageing.
• Half of all cases of hearing loss are avoidable through primary prevention.
• People with hearing loss can benefit from hearing aids, cochlear implants and other assistive devices; captioning and sign language; and other forms of educational and social support.
• Current production of hearing aids meets less than 10% of global need.

Cultural Issues – “New Research”

Those of us that have traveled to various countries realize that there are many cultural differences that affect how patients, their families, and others react to hearing impairment.  These cultures react quite differently in in how and if they seek hearing rehabilitation.  While the WHO has suggested that 90% of worldwide population with hearing loss could benefit from hearing aids, only a small proportion of them actually seek professional assistance and use hearing aids to reduce the effects of their hearing impairment. This issue prompted a group of researchers, from a number of countries to investigate cultural differences in how patients seek help for their hearing loss and in the adoption hearing aids (Zhao et al (2015). The research group included members from the UK, Sweden, China, and India that discussed health-care systems, audiology services, and how they are used in their respective countries. They considered various theoretical approaches to the understanding of how culture may affect hearing-related behaviors.

Results from the study indicated that different cultural value systems lead to various perceptions and interpretations of situations related to aging, disability, hearing loss, and hearing aid use. Specifically, negative stereotypes about aging and the perception of aging differ widely from one culture to another. The countries studied represented a broad spectrum on the individualism to collectivism scale, with the UK and Sweden being highly individual. India and even more so China, demonstrating collectivist attitudes. These factors are thought to moderate perceptions of health, disability, and disease, implying that cultural differences lead to different ways of perceiving and interpreting situations related to hearing loss and hearing aid use.

Zhao et al’s conclusions are similar to that of other researchers in that disabilities, such as hearing impairment, and their perceived causes must be viewed within a cultural context.  Various cultures  view the causes ofdisabilities and, subsequently, their treatments in various ways. Different disciplines, cultures, and individuals do not agree about what “disabilities” are and how to explain them (Smith, 2014).While western cultures typically believe in a direct, scientific cause-and-effect relationship between a biological problem in a developing baby or an elderly adult, less educated cultures often believe that the causes are fate, bad luck, sins of a parent, the food the mother ate, or evil spirits (Cheng, 1995). These alternative views affect the way a child or an adult with a disability is viewed within the culture and the degree to which a family may be willing to pursue intervention to address the person’s disabilities or special needs, i.e. hearing aids. As Audiologists it is necessary to appreciate these differences as we seek to facilitate aural rehabilitative treatment for these patients, but are there more practical issues?

But is the Worldwide Non-Use of Hearing Aids All Cultural?

According to WHO (2015), current hearing instrument production only meets 10% of the needs of the hearing impaired worldwide. According to Strom (2013), the world market for hearing aids is probably just over 10 million units. His estimates include a fairly even three way split  among the United States and Canada (about 31% of the world hearing aid market by units), Europe (38%), and Asia, the Pacific Rim (22%) as well as the “rest of the world” (9%) accounting for another almost 1/3 of the total market. The growth of the world market for amplification is about 3-4% which is slow by anyone’s estimation according to the extreme need that exists in the “rest of the world”.  While cultural issues are a major component in the worldwide treatment of hearing impairment, there are also many other practical issues that complicate the uptake of amplification in the treatment of  hearing impairment around the world, particularly in third world countries. These other issues relate to costs of the products, availability of professionals for the fitting and follow up, distribution capabilities, battery availability and other general concerns.   As the field of audiology develops worldwide within the various cultures and the practical issues are circumvented, the use of amplification will be come greater and the cultural acceptance of hearing impairment will follow as it has in more developed countries.

References

Smith, D. (2014).  Differing perspective of Disability. Education.com  Retrieved May 20, 2015: http://www.education.com/reference/article/differing-perspectives-disabilities/

Strom, K. (2013).  Staff standpoint: Worldwide hearing aid sales. Hearing Review.  Retrieved May 20, 2015: http://www.hearingreview.com/2013/05/staff-standpoint-worldwide-hearing-aid-sales/

World Health Organization (2015).  Deafness and Hearing Loss. Retrieved May 19, 2015:  http://www.who.int/mediacentre/factsheets/fs300/en/

Zhao F, et al. Exploring the influence of culture on hearing help-seeking and hearing-aid uptake. International Journal of Audiology 2015 Mar 11:1-9.rieved May 19, 2015: http://www.audiology-worldnews.com/news/1336-the-influence-of-culture-on-hearing-help-seeking-and-hearing-aid-uptake