Hearing Loss and Access to Hearing Care Services : A New Zealand-Sikh Community Perspective

Abstract

Objective: To identify ethnic-specific influences on prevalent attitudes, perceptions and beliefs influencing hearing conservation behaviour among the ethnic-Indian Sikh population in New Zealand. Introduction: Hearing loss continues to be an ‘invisible disability’ that is frequently ignored in favour of attention to other health issues. There is limited data and a lack of previous research focussing on the ethnic Indian-Sikh population in New Zealand concerning hearing loss and hearing-care. This population is one of the largest growing minority and migrant groups in New Zealand. As such, it is vital to research attitudes, perceptions and behaviours of the ethnic-Indian Sikh minority group towards hearing loss and hearing-care behaviour to help inform the development of targeted strategies that promote hearing-care. Methods: The study was carried out in three main stages; (1) semi-structured interviews with 16 participants from different age groups; (2) a questionnaire survey that was distributed via an online and hard-copy format and (3) hearing screening procedure that was conducted at a Gurudwara to establish an early measure of hearing loss in a cohort representing the Sikh community. A thematic analysis of interview transcripts was conducted, and these themes were theorised according to the COM-B (Capability, Opportunity, Motivation-Behaviour) health behaviour model. The questionnaire data was analysed to provide descriptive statistics and tests of association. Finally, the results of the audiometric hearing tests were reported. Results: Hearing screenings identified higher rates of hearing loss in older participants. The hearing questionnaire identified common sources of loud sounds, including machinery, cultural festivals and loud music. There was frequent exposure to loud sounds amongst younger participants. Furthermore, several themes pertaining to the COM-B model were identified. Themes relevant to capability included a lack of knowledge, awareness and negative perceptions about hearing conservation behaviours. Factors associated with opportunity included social stigma and structural barriers such as cost, transportation and accessibility. Additionally, motivational factors included negative perceptions about hearing protection and a fear and lack of trust with audiological services. Conclusions: The current study identified several modifiable factors, such as cost, transportation and a lack of knowledge and awareness about hearing and hearing-conservation behaviours. These influenced behaviours towards hearing loss and access to hearing-care services. Implementation of health strategies must focus on eliminating barriers to enable greater access to hearing-care services by the ethnic-Indian Sikh community. Furthermore, the current study highlights the importance of developing a culturally responsive model of hearing-care services, particularly for Sikhs and ethnic minority groups in New Zealand.