Public hearing health services in Mauritius : perceptions, barriers and facilitators

Abstract

Hearing loss (HL) is a global public health challenge that affects all age groups. The need for accessing hearing health services across the world remains thus undisputed. There is currently limited published context-specific information regarding HL and hearing health services in the public health sector of Mauritius. The lack of local data on HL and hearing health services in Mauritius motivated the researcher to gather preliminary high-quality data on this topic in the public healthcare sector of Mauritius. Aim The aim of this study was to investigate HL in the public healthcare sector of Mauritius, with particular emphasis on hearing health services. Study 1 described the audiological profile of patients referred to the audiology unit of a public hospital over 3 years in order to provide stakeholders with information on the ear and hearing health services in the public healthcare sector of Mauritius. Study 2 and Study 3 investigated the knowledge of and attitudes toward HL among PCPs and CHWs of the public healthcare sector of Mauritius, respectively. Finally, Study 4 investigated the barriers to and facilitators of implementing an audiology service delivery model in the public healthcare sector of Mauritius. Methods A total of four studies were conducted to achieve the main aim of the study. Study 1 made use of a retrospective design and convenience sampling to review the audiological data of 1474 patients who attended the audiology unit of a public hospital between January 3, 2019 and October 1, 2021. Study 2 employed a quantitative survey research methodology with a crosssectional descriptive design to collect data among 320 PCPs who were selected using nonprobability purposive sampling from the public healthcare sector of Mauritius. PCPs completed a 16-item web-based survey questionnaire constructed using Google Forms about their knowledge of and attitudes toward HL. Study 3, similarly to Study 2, employed a nonexperimental, cross-sectional, descriptive survey design to gather information about the knowledge of and attitudes toward HL among CHWs. Using non-probability purposive sampling, 125 CHWs were selected from the community level of the public healthcare sector of Mauritius and filled in a 15-item paper-based survey adapted from Hussein et al. (2018). 20 Study 4 used an exploratory-descriptive research methodology, with qualitative methods of analysis, to explore the barriers of and facilitators to implementing an audiology service delivery model in the public healthcare sector of Mauritius. Using convenience sampling, four audiologists of the public healthcare sector participated in individual, semi-structured interviews. Results According to Study 1, 189 children (48.9%) presented with conductive HL, with significantly more cases of conductive HL observed in 2020. Due to the national lockdown which occurred as a result of the novel CoronaVirus disease (COVID-19), the traditional in-person nature of appointments in the audiology unit where research took place may have limited the uptake of hearing aids in 2020 in adults. Only 25.3% of children were fitted with hearing aids. Many cases of HL were undetected, which highlighted inequities in the delivery of hearing health services in Mauritius in children, especially in the identification of HL. In Study 2, insufficient knowledge was demonstrated by PCPs in the early identification of and intervention for HL, professionals who are responsible for conducting hearing assessments, and the different hearing tests used to assess hearing sensitivity. PCPs evidenced adequate knowledge regarding whether hearing tests are invasive or not. Additionally, PCPs displayed positive attitudes toward HL. The chi-squared test showed significant associations between knowledge of and attitudes toward HL. Ear, nose, and throat (ENT) specialists and paediatricians showed significantly higher scores than other PCPs for both knowledge of and attitudes toward HL. The third study showed that 62.8% of CHWs demonstrated good experience and general knowledge of HL. However, the overall knowledge regarding the aetiological factors of HL was limited. The majority of CHWs (92.6%) showed overwhelmingly positive attitudes toward HL. Simple regression analysis showed that general knowledge of HL (p = 0.015) and knowledge of risk factors and identification of HL (p = 0.005) significantly predicted attitudes toward HL. The chi-squared test showed that knowledge of HL and attitudes toward HL were significantly associated with working experience and practice setting (p = 0.004). The results of Study 4 showed audiologists’ awareness of the extensive resources pertaining to audiology service delivery in the public healthcare sector of Mauritius, the need for an 21 increased access to hearing health services for the Mauritian population and audiologists’ professional ethics and duty of care. Concerns were highlighted where there is a need to adopt consistent guidelines in audiology practice due to the differences in the norms adopted for screening and diagnostic testing by the audiologists. Conclusion To the researcher’s knowledge, this is the first study that provided comprehensive baseline data regarding local information on hearing health as well as HL in the public healthcare sector of Mauritius. The findings of the study support the need for the implementation of a sustainable program for the early identification of and intervention of HL in the public healthcare sector of Mauritius, both at the secondary (early identification and intervention) and tertiary tiers of prevention (interventions to address HL). It is crucial for the relevant authorities, stakeholders, and decision-makers to invest in educating primarily PCPs and CHWs about the causes, risk factors, and identification of HL, both in children and in adults. This is particularly important to ensure that individuals with HL obtain timely diagnosis and management at an early age. Since the public healthcare sector’s extensive availability of resources is conducive to early hearing detection and intervention, this calls for changes to improve healthcare services to the Mauritian population by introducing a HL program consistent with international norms and guidelines, for both children and adults. A model for an early hearing detection and intervention program in the public healthcare sector is proposed as well as a training program for the interdisciplinary team that will be involved in a successful early hearing detection and intervention program, for both children and adults.