Hearing loss and hearing aid stigma in low- and middle-income settings : a scoping review

Abstract

PURPOSE : Stigma has been reported as a key barrier to hearing aid uptake. This scoping review explores evidence of reported stigma associated with hearing loss and hearing aids in low- and middle-income (LMI) settings. METHODS : Four databases were searched to identify studies published up to 6 November 2024. Studies mentioning stigma in relation to hearing loss or hearing aids in LMI countries or LMI settings within high-income countries were included. A narrative synthesis was conducted. RESULTS : Twenty-nine studies were included, with 26 conducted in LMI countries and three in LMI settings within high-income countries. Two main domains were identified: (a) stigma experienced by individuals with hearing loss, ear disease, or hearing aids and (b) experiences of stigma reported by direct communication partners. Four themes emerged from affected individuals, including (a) internalized stigma, (b) social stigma, (c) cultural beliefs, and (d) barriers to help-seeking. Communication partners’ themes included (a) perception of individuals with hearing loss, (b) impact on relationships, and (c) cultural beliefs. Unique theme in LMIs is cultural beliefs that hearing loss is associated with witchcraft and curses. CONCLUSIONS : A limited number of studies were identified but emphasized cultural and religious beliefs as important contributing factors to stigma in LMIs.

IMPLICATIONS FOR REHABILITATION • Stigma related to hearing loss and hearing aids in low- and middle-income (LMI) settings presents a significant barrier to help-seeking and device adoption. • Community-based education and culturally sensitive interventions are essential to addressing stigma and promoting hearing healthcare uptake. • Targeting both individuals with hearing loss and their communication partners can help reduce negative perceptions. • Rehabilitation strategies should incorporate cultural and religious beliefs to effectively address stigma unique to LMI settings, such as associations with witchcraft and curses.