Khoza-Shangase Katijah, Maluleke Ntsako P
Department of Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa.
Child Care Health Dev. 2025 May;51(3):e70090. doi: 10.1111/cch.70090.
Early Hearing Detection and Intervention (EHDI) programmes are critical for addressing hearing impairment in children by ensuring timely diagnosis and intervention. However, systemic barriers such as linguistic diversity, financial constraints and geographic accessibility challenges hinder equitable access to EHDI services in South Africa. This study explores caregivers' preferences for key attributes of EHDI services to inform the development of context-specific and family-centred programmes.
A cross-sectional survey utilizing conjoint analysis was conducted with 31 caregivers of children with hearing impairment enrolled in early intervention preschools in Gauteng, South Africa. Participants evaluated five key attributes of EHDI services: language of service provision, location of diagnostic evaluations, mode of early intervention delivery, integration of support services and cost reduction strategies. Data were analysed using the conditional logit model to determine attribute preferences.
Caregivers preferred services provided in their home language, diagnostic evaluations conducted at the nearest healthcare facility, home-based early intervention sessions, regular integration of support services and reductions in the cost of EHDI services. Reluctance to adopt telehealth was also noted, highlighting concerns about technological literacy, internet access and trust in virtual care delivery. These preferences emphasize the need for accessible, linguistically congruent and affordable EHDI services tailored to the South African context.
This study provides valuable insights into caregivers' preferences for EHDI services, offering actionable recommendations to address systemic barriers such as designing EHDI services that address systemic barriers to ensure equity in healthcare access. Policymakers and stakeholders should prioritize linguistically diverse service delivery, improve healthcare facility accessibility, incorporate continuous informational counselling and reduce financial burdens to ensure equitable and family-centred EHDI programmes. Future research should explore preferences among a more geographically and socio-economically diverse population to further refine these recommendations. While grounded in South Africa, the results provide insights applicable to other low- and middle-income countries (LMICs) with similar challenges.
早期听力检测与干预（EHDI）项目对于通过确保及时诊断和干预来解决儿童听力障碍问题至关重要。然而，语言多样性、经济限制和地理可及性挑战等系统性障碍阻碍了南非公平获得EHDI服务。本研究探讨了照顾者对EHDI服务关键属性的偏好，以为制定因地制宜且以家庭为中心的项目提供参考。
对南非豪登省参加早期干预学前班的31名听力障碍儿童的照顾者进行了一项采用联合分析的横断面调查。参与者评估了EHDI服务的五个关键属性：服务提供语言、诊断评估地点、早期干预实施方式、支持服务整合以及成本降低策略。使用条件logit模型分析数据以确定属性偏好。
照顾者更喜欢用他们的母语提供服务、在最近的医疗机构进行诊断评估、居家早期干预课程、定期整合支持服务以及降低EHDI服务成本。还注意到照顾者不愿采用远程医疗，这凸显了他们对技术素养、互联网接入以及对虚拟护理服务信任度的担忧。这些偏好强调了需要提供适合南非国情的可及、语言匹配且负担得起的EHDI服务。
本研究为照顾者对EHDI服务的偏好提供了有价值的见解，提出了可采取行动的建议以应对系统性障碍，例如设计能解决系统性障碍的EHDI服务以确保医疗保健可及性公平。政策制定者和利益相关者应优先考虑提供语言多样化的服务、改善医疗机构的可及性、纳入持续的信息咨询并减轻经济负担，以确保公平且以家庭为中心的EHDI项目。未来研究应探索在地理和社会经济背景更多样化的人群中的偏好，以进一步完善这些建议。虽然本研究以南非为基础，但结果提供了适用于其他面临类似挑战的低收入和中等收入国家（LMICs）的见解。
