Conceptual Model of Hearing Health Inequalities (HHI Model): A Critical Interpretive Synthesis

Abstract

Hearing loss is a major health challenge that can have severe physical, social, cognitive, economic, and emotional consequences on people’s quality of life. Currently, the modifiable factors linked to socioeconomic inequalities in hearing health are poorly understood. Therefore, an online database search (PubMed, Scopus, and Psych) was conducted to identify literature that relates hearing loss to health inequalities as a determinant or health outcome. A total of 53 studies were selected to thematically summarize the existing literature, using a critical interpretive synthesis method, where the subjectivity of the researcher is intimately involved in providing new insights with explanatory power. The evidence provided by the literature can be summarized under four key themes: (a) There might be a vicious cycle between hearing loss and socioeconomic inequalities and lifestyle factors, (b) socioeconomic position may interact with less healthy lifestyles, which are harmful to hearing ability, (c) increasing health literacy could improve the diagnosis and prognosis of hearing loss and prevent the adverse consequences of hearing loss on people’s health, and (d) people with hearing loss might be vulnerable to receiving low-quality and less safe health care. This study uses elements from theoretical models of health inequalities to formulate a highly interpretive conceptual model for examining hearing health inequalities. This model depicts the specific mechanisms of hearing health and their evolution over time. There are many modifiable determinants of hearing loss, in several stages across an individual’s life span; tackling socioeconomic inequalities throughout the life-course could improve the population’s health, maximizing the opportunity for healthy aging.

The dynamic relationship between hearing loss, quality of life, socioeconomic position and depression and the impact of hearing aids: answers from the English Longitudinal Study of Ageing (ELSA)

“…It is worth mentioning that only the two studies that adjusted for a variety of SEP measures in their analyses [40,41] did not find an association of HL with depression in older adults. Thus, our study adds to the literature by focusing primarily on the role of SEP, which we suggest may satisfactorily explain the causal, temporal and graded relationship between HL and depression over time, which differs according to people's rank in the social hierarchy [14] Similarly, the socioeconomic pattern we first identify to the benefit from hearing aids on psychosocial wellbeing among those with HL may also explain why no effect of hearing aids use was found in the recent meta-analysis by Lawrence et al: [9] no previous study examined the role of hearing aids under a socioeconomic perspective, so as to be able to identify their effect heterogeneity according to SEP and to firmly conclude, therefore, about whether the use of hearing aids has any effect in alleviating the depressive symptoms among those with HL, and whether hearing aids played a more significant role in alleviating the negative impact of HL among those in the lower social strata. One possible explanation for the above finding might be that hearing aids probably acted as a support measure and aided the most vulnerable people who already lacked life opportunities compared to the most affluent, so they were able to take more control back and keep participating in society.…”

“…It is worth mentioning that only the two studies that adjusted for a variety of SEP measures in their analyses [ 40 , 41 ] did not find an association of HL with depression in older adults. Thus, our study adds to the literature by focusing primarily on the role of SEP, which we suggest may satisfactorily explain the causal, temporal and graded relationship between HL and depression over time, which differs according to people’s rank in the social hierarchy [ 14 ]…”

“…To date firm evidence about the psychosocial mechanisms implicated in the relationship between HL and depression is lacking [10], especially in a longitudinal context. In addition, despite the fact that studies consistently show that HL has a tremendous impact on quality of life [11][12][13], little is understood about the specific mechanisms involved in the relationship between HL and the multidimensional concept of quality of life [11,[13][14][15].…”

Editorial: Ear and Hearing’s Commitment to Promoting Inclusion, Diversity, Equity, and Accessibility in Research on Hearing and Hearing Healthcare

“…CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities (Wallerstein & Duran 2006) Hearing loss Hearing loss is a general term for the complete or partial loss of hearing in one or both ears -The World Health Organization defines disabling hearing loss as greater than 40 dB in the better hearing ear in adults (15 years or older) and greater than 30 dB in the better hearing ear in children (0-14 years) (https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss). Most of the hard of hearing persons with mild, moderate, severe, and profound hearing loss fit under this definition -A sociocultural approach to definition recognizes individual choice in identification and determination to which group a person belongs to irrespective of their audiological status -New conceptualizations could recognize that "hearing loss" is far more than a sensory disorder, as it is associated with negative physical, social, cognitive, economic, and emotional consequences (Tsimpida et al 2021). It may be useful to specify "audiometric hearing loss" when hearing loss is defined by pure-tone thresholds and to acknowledge that even those with little or no audiometric hearing loss may experience problems functioning in everyday life because of "auditory processing disorders" affecting supra-threshold processing…”

Digital Approaches to Automated and Machine Learning Assessments of Hearing: Scoping Review

“…Untreated hearing loss restricts language development and educational potential in children and is associated with a more rapid cognitive decline in adults [ 13 ]. It may lead to social isolation, lower socioeconomic status, increased social disparities, and decreased health, resulting in lower quality of life at the individual level and substantial costs at the community level [ 14 , 15 ]. Importantly, treating hearing loss in midlife has been identified as the largest potentially modifiable risk factor for developing dementia in later life [ 16 ].…”