Understanding Barriers to Timely Diagnosis and Intervention Among Immigrant Children With Hearing Loss

Abstract

AbstractObjectiveIdentify the age at diagnosis and intervention of immigrant and/or non‐English‐speaking children with hearing loss (HL) and risk factors associated with delays. Identify barriers for non‐English‐speaking caregivers of deaf/hard‐of‐hearing children.Study DesignSequential mixed methods.SettingTertiary care center in an urban city.MethodsThe analysis includes descriptive statistics, and 1‐way and 2‐way analysis of variance of the retrospective chart review. The quantitative study demonstrated foreign‐born experienced disparities, so we conducted semistructured interviews on a subset of non‐English‐speaking families in the cohort that was then thematically analyzed using a human‐centered design strategy.ResultsWe divided 532 children into 3 groups: US‐born with English as the preferred language (N = 294), US‐born and non‐English language preferred (N = 173), and foreign‐born (N = 67). The laterality of HL and pure‐tone averages were similar among the groups (p = .972 and .071, respectively). Age at diagnosis and time to the intervention were significantly different (39.7, 31.5, 75.8 months, p < .001 and 24.6, 29.2, 48.9 months, p = .001, respectively). Ages at diagnosis and intervention were associated with birthplace (p = .005, p = .0005, respectively) but not preferred language (p = .667, p = .343, respectively). Included in the qualitative interviews were Mandarin‐ (n = 5), Arabic‐ (n = 4), and Spanish‐speaking families (n = 3). Insights revealed participants' quest for anticipatory guidance and social support, the consequences of cultural stigma, and the complexity of caring for a child with HL in an immigrant family.ConclusionForeign‐born children with HL have significant delays in diagnosis and intervention compared to US‐born children. For non‐English‐speaking parents, the diagnosis of HL presents challenges beyond that of the immigrant experience.