Social determinants of health associated with attitudes towards hearing loss and hearing aids in older adults fitted in a Latin American country: validation of the ALHQ questionnaire into Spanish

Fuentes‐López, Eduardo; Fuente, Adrián; Luna-Monsalve, Manuel; Cañete, Oscar M.

doi:10.1080/14992027.2022.2097133

Cited by 3 publications

(4 citation statements)

References 44 publications

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“…The requirements for inclusion as a CI candidate in the Chilean LRS policy are likely to exclude many candidates in a country with critical social inequalities [ 10 ]. This is in line with findings from previous studies in Chile with adults using hearing aids, suggesting an association between higher education and socioeconomic variables and better social support and positive attitudes towards hearing loss or hearing aids [ 41 ].…”

Section: Discussionsupporting

confidence: 92%

A country-wide health policy in Chile for deaf adults using cochlear implants: Analysis of health determinants and social impacts

Bustos-Rubilar,

Kyle,

Luna

et al. 2023

PLoS ONE

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Background Post-lingual deafness represents a critical challenge for adults’ well-being with substantial public health burdens. One treatment of choice has been cochlear implants (CI) for people with severe to profound hearing loss (HL). Since 2018, Chile has implemented a high-cost policy to cover CI treatment, the “Ley Ricarte Soto" (LRS) health policy. However, wide variability exists in the use of this device. To date, no related study has been published on policy evaluation in Chile or other Latin American countries. Objectives This study aimed to evaluate the impact of the LRS policy on the treatment success and labour market inclusion among deaf or hard of hearing (DHH) adults using CI. We examined and characterised outcomes based on self-reports about treatment success and occupation status between 2018 and 2020. Design We performed a prospective study using hospital clinical records and an online questionnaire with 76 DHH adults aged >15 who had received CIs since the introduction of the LRS policy in 2018. Using univariate and multivariate regression models, we investigated the relationship between demographic, audiological, and social determinants of health and outcomes, including treatment success for social inclusion (International Outcome inventory for Hearing Aids and CIs assessment: IOI-HA) and occupation status for labour market inclusion. Results Our study showed elevated levels of treatment success in most of the seven sub-scores of the IOI-HA assessment. Similarly, around 70% of participants maintained or improved their occupations after receiving their CI. We found a significant positive association between treatment success and market inclusion. Participants diagnosed at younger ages had better results than older participants in both outcomes. Regarding social determinants of health, findings suggested participants with high social health insurance and a shorter commute time to the clinic had better results in treatment success. For labour market inclusion, participants with high education levels and better pre- CI occupation had better post-CI occupation status. Conclusions In evaluating the LRS policy for providing CIs for DHH adults in Chile, we found positive effects relating to treatment success and occupation status. Our study supports the importance of age at diagnosis and social determinants of health, which should be assessed by integrating public services and bringing them geographically closer to each beneficiary. Although evidence-based guidelines for candidate selection given by the LRS policy might contribute to good results, these guidelines could limit the policy access to people who do not meet the requirements of the guidelines due to social inequalities.

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Section: Discussionsupporting

confidence: 92%

A country-wide health policy in Chile for deaf adults using cochlear implants: Analysis of health determinants and social impacts

Bustos-Rubilar,

Kyle,

Luna

et al. 2023

PLoS ONE

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“…The extended candidate selection process can explain this lack of association with the LRS high-cost policy, which includes specific social, educational, and psychological requirements (18). More than 80% of our sample have at least secondary education completed, which is exceptionally high considering the average in the country (40). Similarly, the higher BDI mean in our sample (mean=0.51, SD=0.11) compared with the national average (0.34) demonstrates that our participants had more advantageous conditions.…”

Section: Discussionmentioning

confidence: 47%

A country-wide health policy in Chile for deaf adults using cochlear implants: analysis of health determinants and social impacts

Bustos-Rubilar

Kyle

Luna

et al. 2023

Preprint

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Background: Post-lingual deafness represents a critical challenge for adults' well-being with substantial public health burdens. One treatment of choice has been cochlear implants (CI) for people with severe to profound hearing loss (HL). Since 2018, Chile has implemented a high-cost policy to cover CI treatment, the Ley Ricarte Soto (LRS) health policy. However, wide variability exists in the use of this device. To date, no study has been published on policy evaluation in Chile or other Latin American countries. Objectives: This study aimed to evaluate the impact of the LRS policy on the treatment success and labour market inclusion among deaf or hard of hearing (DHH) adults using CI. We examined and characterised outcomes based on self-reports about treatment success and occupation status between 2018 and 2020. Design: We performed a prospective study using hospital clinical records and an online questionnaire with 76 DHH adults aged >15 who had received CIs since the introduction of the LRS policy in 2018. Using univariate and multivariate regression models, we investigated the relationship between demographic, audiological, and social determinants of health and outcomes, including treatment success for social inclusion (International Outcome inventory for Hearing Aids and CIs assessment: IOI-HA) for social inclusion and occupation status for labour market inclusion. Results: Our study showed elevated levels of treatment success in most of the seven sub-scores of the IOI-HA assessment. Similarly, around 70% of participants maintained or improved their occupations after receiving their CI. We found a significant positive association between treatment success and market inclusion. Participants diagnosed at younger ages had better results than older participants in both outcomes (P=0.078 and P= 0.011, respectively). Regarding social determinants of health, finding suggested participants with high social health insurance and a shorter commute time to the clinic (p=0.070 and p=0.086, respectively) had better results in treatment success. For labour market inclusion, participants with high education levels and better pre- CI occupation (p=0.069 and p=0.021, respectively) had better post-CI occupation status, and findings suggested an impact of high education levels. Conclusions: In evaluating the LRS policy for providing CIs for DHH adults in Chile, we found positive effects relating to treatment success and occupation status. Our study supports the importance of age at diagnosis and social determinants of health, which should be assessed by integrating public services and bringing them near each beneficiary. Although evidence-based guidelines for candidate selection given by the LRS policy might contribute to good results, these parameters could limit the policy access to people who do not meet the requirements of the guidelines due to social inequalities

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“…Hearing aid abandonment is multifactorial, in which the role of clinical variables and hearing aid-related technology has been investigated ( 2 ). Recently, the importance of broader social determinants of health in abandonment has been recognized ( 11 , 39 ), as well the effect of sociodemographic variables on other individual/clinical predictors such as attitudes toward hearing loss and hearing aid use ( 29 ) and self-efficacy ( 21 ). In this present study, we included geographic access as another sociodemographic variable related to hearing aid abandonment.…”

Section: Discussionmentioning

confidence: 99%

“…To evaluate attitudes toward hearing aids and hearing loss, we utilized the Spanish version of the Hearing Attitudes in Rehabilitation Questionnaire (S-ALHQ) developed by Fuentes-López et al ( 29 ). This questionnaire comprises 22 assertions that are organized into five subscales: Denial of Hearing Loss , Negative Associations , Negative Coping Strategies , Manual Dexterity and Vision , and Hearing-Related Esteem .…”

Section: Methodsmentioning

confidence: 99%

Association between the home-to-healthcare center distance and hearing aid abandonment among older adults

Fuentes-López,

Galaz-Mella,

Ayala

et al. 2024

Front. Public Health

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BackgroundAccess to audiology services for older adults residing in sparsely populated regions is often limited compared to those in central urban areas. The geographic accessibility to follow-up care, particularly the influence of distance, may contribute to an increased risk of hearing aid abandonment.ObjectiveTo assess the association between the home-to-healthcare-calibration-center distance and hearing aid abandonment among older adults fitted in the Chilean public health system.Methods455 patients who received hearing aids from two public hospitals in two regions were considered. Univariate and multivariate Poisson regression models with robust variance estimation were used to analyze the association between the geographical distance and hearing aid abandonment, accounting for confounding effects.ResultsApproximately 18% of the sample abandoned the hearing aid, and around 50% reported using the hearing aid every day. A twofold increase in distance between home and the hearing center yielded a 35% (RR = 1.35; 95% CI: 1.04–1.74; p = 0.022) increased risk of hearing aid abandonment. Also, those in the second quintile had a 2.17 times the risk of abandoning the hearing aid compared to the first quintile (up to 2.3 km). Under the assumption that patients reside within the first quintile of distance, a potential reduction of 45% in the incidence of hearing aid abandonment would be observed. The observed risk remained consistent across different statistical models to assess sensitivity.ConclusionA higher distance between the residence and the healthcare center increases hearing aid abandonment risk. The association may be explained by barriers in purchasing supplies required to maintain the device (batteries, cleaning elements, potential repairs, or maintenance).

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Social determinants of health associated with attitudes towards hearing loss and hearing aids in older adults fitted in a Latin American country: validation of the ALHQ questionnaire into Spanish

Cited by 3 publications

References 44 publications

A country-wide health policy in Chile for deaf adults using cochlear implants: Analysis of health determinants and social impacts

A country-wide health policy in Chile for deaf adults using cochlear implants: Analysis of health determinants and social impacts

A country-wide health policy in Chile for deaf adults using cochlear implants: analysis of health determinants and social impacts

Association between the home-to-healthcare center distance and hearing aid abandonment among older adults

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