Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, Durham, North Carolina, USA.
Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA.
Ear Hear. 2024;45(Suppl 1):53S-61S. doi: 10.1097/AUD.0000000000001539. Epub 2024 Sep 19.
Although hearing devices such as cochlear implants and hearing aids often improve communication, many people who are d/Deaf or hard of hearing (d/DHH) choose not to use them. Hearing device-related stigma, or negative societal beliefs about people who use hearing devices, often drives this decision. Although much research has documented the negative effects of hearing device-related stigma, no widely accepted, validated measure to quantify such stigma across populations currently exists. In this article, we describe the preliminary validation of four distinct but related scales measuring hearing device-related stigma in different populations, including people who use hearing devices and those close to them.
We preliminarily validated four measures for quantifying hearing device-related stigma in different populations that were previously developed and refined through a literature review, Delphi interviews, cognitive interviews, and a pretest. We preliminarily validated these measures through self-administered online surveys in a convenience sample in the United States. Among participants who use a hearing device and who either (a) self-identified as being d/DHH before they developed language (lifelong; n = 78) or (b) those who self-identified as having acquired a d/DHH identity after they developed language (acquired n = 71), we validated an anticipated hearing device-related stigma scale (d/DHHS-LE-HDA). We validated three scales that measure perceived hearing device-related stigma observed by parents of children who are d/DHH and who use a hearing device (n = 79) (d/DHHS-P-HDPO), care partners of adults who are d/DHH and use a hearing device (n = 108) (d/DHHS-CP-HDPO), and health care providers (n = 203) (d/DHHS-HCP-HDSH). Exploratory factor analysis assessed the reliability of each measure.
Each of the four scales loaded onto one factor. Factor loadings for the eight-item scale measuring anticipated hearing device-related stigma among the two populations with lived experience ranged from 0.635 to 0.910, with an ordinal α of 0.93 in the lifelong d/DHH participants and 0.94 among the acquired d/DHH participants. The six-item scale of perceived stigma observed by parents had item loadings from 0.630 to 0.920 (α = 0.91). The nine-item scale of hearing device-related stigma observed by care partners had item loadings from 0.554 to 0.922 (α = 0.95). The eight-item scale of hearing device-related stigma reported by health care providers had item loadings from 0.647 to 0.941 (α = 0.89).
Preliminary validation results show that the four stigma measures perform well in their respective populations. The anticipated stigma scale performed similarly well for both lifelong d/DHH and acquired d/DHH, which suggests that it could perform well in different contexts. Future research should further validate the scales described here as well as measure hearing device-related stigma in different populations-including people who live in different geographic regions and people using different kinds of hearing devices-and evaluate the success of interventions developed to reduce hearing device-related stigma.
尽管耳蜗植入体和助听器等听力设备通常能改善交流，但许多聋人或重听人士并不选择使用这些设备。听力设备相关的污名，即社会对使用听力设备的人的负面看法，往往是导致这一决定的原因。尽管有大量研究记录了听力设备相关污名的负面影响，但目前尚无广泛认可的、经过验证的方法来衡量不同人群中的这种污名。本文描述了四项不同但相关的量表的初步验证，这些量表用于衡量不同人群中的听力设备相关污名，包括使用听力设备的人和他们的亲密接触者。
我们通过文献回顾、德尔菲访谈、认知访谈和预测试，初步验证了四项用于量化不同人群中听力设备相关污名的测量方法。我们通过在美国的便利样本中进行的自我管理在线调查，初步验证了这些方法。在使用听力设备的参与者中，我们验证了一种预期的听力设备相关污名量表（d/DHHS-LE-HDA），其中包括（a）在语言发展之前就已确定为聋人或重听人士的终身聋人（n = 78），或（b）在语言发展之后才确定为聋人或重听人士的后天聋人（n = 71）。我们还验证了三个用于衡量聋人或重听儿童的父母对听力设备相关污名的感知量表（d/DHHS-P-HDPO），以及衡量成年聋人或重听人士照顾者对听力设备相关污名的感知量表（d/DHHS-CP-HDPO）和卫生保健提供者对听力设备相关污名的感知量表（d/DHHS-HCP-HDSH）。探索性因素分析评估了每个量表的可靠性。
四项量表中的每一项都加载到一个因素上。在有生活经验的两个群体中，用于衡量预期听力设备相关污名的八项量表的因子负荷从 0.635 到 0.910，终身聋人参与者的有序α为 0.93，后天聋人参与者的有序α为 0.94。父母感知的六分量表的项目负荷从 0.630 到 0.920（α=0.91）。照顾者感知的九分量表的听力设备相关污名项目负荷从 0.554 到 0.922（α=0.95）。卫生保健提供者报告的八分量表的听力设备相关污名项目负荷从 0.647 到 0.941（α=0.89）。
初步验证结果表明，四项污名量表在各自的人群中表现良好。预期污名量表在终身聋人和后天聋人中表现相似，这表明它在不同的环境中也能表现良好。未来的研究应该进一步验证这里描述的量表，并在不同的人群中测量听力设备相关的污名，包括生活在不同地理区域的人群和使用不同类型的听力设备的人群，并评估为减少听力设备相关污名而开发的干预措施的效果。
