Improving access to the hearing services program for people from culturally and linguistically diverse (CALD) backgrounds

Australia is a culturally diverse country. Almost 30% of Australians were born overseas. More than 20% of Australians speak a language other than English at home. People from culturally and linguistically diverse (CALD) backgrounds are more likely to experience hearing loss; but they are less likely to access hearing services.

Government-funded hearing services program (HSP) is available in Australia. However, people from CALD communities are less likely to access it. The reasons for this are not clear. 

A review of the HSP recommended that the Government identify the challenges for access to HSP for CALD people. In 2022, the University of Queensland received a NHMRC grant for a project to address the recommendations of the HSP review. In the project, researchers worked with people from CALD backgrounds and hearing healthcare providers to:

1. Understand what helps and hinders children and adults from CALD backgrounds access hearing health care.
2. Co-develop and test strategies to help people from CALD communities access hearing health care.

This project helps people from CALD communities to achieve their goals in life without being limited by hearing loss.

What we found? (Publications)

1- What did we already know? A review of the global research

A global review of 25 studies on barriers and supports for CALD communities accessing hearing care.

Researchers reviewed 25 international studies on what is already known about barriers and supports for CALD communities accessing and using hearing healthcare. Personal challenges include limited awareness of hearing health, feelings of embarrassment, or beliefs that discourage help-seeking, such as viewing hearing loss as taboo, a religious matter, or a natural part of ageing. Environmental challenges include language barriers, insufficient cultural training for hearing health professionals, short appointment times, and high costs. Helpful supports include translated information, professional interpreters, cultural training for professionals, community programs, and health workers who connect with different communities. 

2-    Hearing loss in Australian children from diverse communities

CALD children are nearly twice as likely to have hearing loss as other Australian children.

Using data from the Longitudinal Study of Australian Children, researchers found that 38 out of every 100 children from CALD backgrounds had hearing loss, compared to 21 out of every 100 other children. Children whose parents did not speak English very well were more likely to have hearing loss. If the family had lived longer in Australia, the chance of hearing loss was lower. Good hearing is essential for developing communication skills and wellbeing in children. If hearing loss is not treated early, it can affect how well children do in school and how happy they are later in life. That is why it is important for CALD communities to know how common hearing loss is and what causes it. 

3-    Why people from diverse backgrounds do not use hearing services

Interviews with 46 people from 15 language backgrounds reveal the key barriers to accessing hearing care.

Researchers interviewed 46 people with hearing loss and their families from 15 different language backgrounds. The study found five main reasons affecting whether people use hearing services:

1. Cultural beliefs and stigma — some cultures have different beliefs about hearing loss; some people feel shame or worry about what others will think if they wear hearing aids.
2. Communication with health professionals — it can be hard to talk to hearing specialists if you speak a different language, and interpreters are not always available.
3. Trust in healthcare — some people are not sure if they can trust the healthcare system based on past experiences.
4. Knowledge — many people do not know about hearing loss, hearing aids, or where to find hearing services.
5. Support from family, community, and funding — getting help depends on support from family and community, and on having financial support available.

4-    What hearing care professionals say about caring for patients from diverse backgrounds

26 hearing care professionals share what helps and what gets in the way of delivering culturally responsive care.

Researchers interviewed 26 hearing care professionals across Australia, including audiologists, clinic managers, and front-of-house. Five key themes shaped how well professionals could provide culturally responsive care:

1. Understanding each patient's cultural needs and building trust — taking time to recognise different cultural expectations and communication preferences is essential.
2. Overcoming language barriers — professional interpreters can help, but access to professional interpreters is not always easy or consistent.
3. Giving information in a way patients can understand — information needs to be presented in a way that makes sense for the patient's background and health literacy.
4. Including family members in appointments — family members play an important role for patients from diverse communities, both as communication support and as part of decision-making.
5. Having enough time, resource, and support at the clinic — practical factors matter, including clinical resources and longer appointment times. 

5-    What makes hearing care welcoming for everyone

A practical checklist of actions for clinics and professionals to become more culturally responsive.

Researchers interviewed community members and surveyed 45 international experts to identify the most important strategies for culturally responsive hearing care.
Receptionists should: ask if the client needs an interpreter; ask about preference for including a family member in appointments; ask about the client's preference for the gender of their clinician.
Hearing care professionals should: ask clients about their expectations; check that clients understand instructions; encourage clients to speak up when they do not understand; take time to explain the benefits and limitations of treatment options; discuss strategies and devices for managing hearing; inform clients about local community resources; provide information in other languages if needed; and ask if clients have any remaining questions before they leave.