Less germs, less mucus, less snot: teachers' and health workers' perceptions of the benefits and barriers of ear health programs in lower primary school classes

Abstract

This study explored health and education professionals' perceptions of the health benefits and barriers of different ear health programs used in lower primary school classes in two district education areas in the Goldfields South East Health Region, Western Australia. Health and education staff providing services to children in kindergarten to year three primary school classes were sent a questionnaire about ear health programs provided in their school. Sixty-one questionnaires were returned from 43 teachers, 14 community health nurses, three Aboriginal health workers and one teacher's assistant. Some schools implemented all the ear health programs examined at all year levels while others implemented only one of the programs. Teachers, community health nurses and Aboriginal health workers identified that all ear health programs were beneficial to students. Reported physical health benefits included reduced ear infections, early detection of ear infections and improved hearing. Behavioural benefits included improved concentration, alertness and attention in the classroom. Barriers to implementing the programs were obtaining consent from parents/carers, student transience and attendance, time to implement and conduct the programs and human and physical resources. Evaluation methods used varied from no evaluation for the Breathe Blow Cough and tissue spearing programs to limited data collection for audiometry, otoscopy and ear toilet programs. Respondents perceived that ear health programs were effective in improving health and behavioural outcomes for children. A formal pre-post evaluation to provide objective data to confirm this is needed to inform policy around this important health issue.

The role of Indigenous Health Workers in ear health screening programs for Indigenous children: a scoping review

“…30,35,36,[46][47][48][51][52][53] As documented in the literature, studies consistently reported high levels (ranging from 42% to 64%) of OM among Indigenous children. 26,27,33,42,49 Some included studies reported increased OM knowledge and correct diagnosis resulted in improved child behaviour, 22,31,38,43 school performance, 22,38 family life 22,38 and physical health. 43 Three studies primarily focused on strengthening ear health screening skills and confidence for IHWs 9,15,51 and one study stressed the importance of providing specialised training for non-Indigenous Health Workers to generate a better understanding of Indigenous health contexts.…”

“…26,27,33,42,49 Some included studies reported increased OM knowledge and correct diagnosis resulted in improved child behaviour, 22,31,38,43 school performance, 22,38 family life 22,38 and physical health. 43 Three studies primarily focused on strengthening ear health screening skills and confidence for IHWs 9,15,51 and one study stressed the importance of providing specialised training for non-Indigenous Health Workers to generate a better understanding of Indigenous health contexts. 35 Challenges research teams faced in maintaining the success of their screening programs included the resource-intensive nature of programs, 30 high healthcare and teaching staff turnover, 35,40 limited OM knowledge in communities and schools, 39,40 service accessibility 35,39 and limited evaluation methods.…”

“…35 Challenges research teams faced in maintaining the success of their screening programs included the resource-intensive nature of programs, 30 high healthcare and teaching staff turnover, 35,40 limited OM knowledge in communities and schools, 39,40 service accessibility 35,39 and limited evaluation methods. 35,43 Potential solutions to these challenges included supportive infrastructure, 24 funded staff and staff training opportunities, 24,37,51 as well as strategic multi-level collaborations across health, environmental and educational departments, especially in remote areas. 5,28,37,41,44 Authors highlighted the importance of community control and support for successful programs and research 25,41,45 and the importance of engaging in local contexts.…”

“…Program evaluation was the most common study design (N=11), 3,7,9,23,24,[28][29][30][31][32][33] followed by descriptive reports (N=8), 5,15,22,25,[34][35][36][37] exploratory studies (N=4), [38][39][40][41] cohort studies (N=4), 6,26,27,42 cross-sectional studies (N=3) 27,[43][44][45] and feasibility studies (N=3) [46][47][48] ; the remaining studies used a variety of analytical techniques and study designs. The language used to define IHWs varied across the studies, with Aboriginal health worker or AHW being employed most frequently (N=14) 6,15,22,[25][26][27]29,32,33,38,39,43,46,49 and Indigenous health worker or IHW the second mos...…”

“…6,54 IHWs contributed to the development and design of two research projects 23,37 and assisted with research coordination in six studies. 6,25,27,39,46,54 While nine studies included IHWs as participants, 9,28,[38][39][40][41]43,44,51 these studies did not ask the IHWs about their specific involvement in ear health programming, rather they were asked about the impact of hearing loss on family life, perceptions of OM among communities, and to evaluate training or screening programs. Further, in seven out of nine studies that included IHWs as participants, IHWs did not constitute the majority of respondents and the respondents' Indigenous status was not clarified, making it impossible to determine which data reflected IHW perspectives.…”