Barriers to Adult Cochlear Implant Referral and Uptake in New Zealand

Abstract

Background: Cochlear implantation is a safe and cost-effective rehabilitation method for adults with severe-to-profound hearing loss who receive minimal benefits from hearing aids. However, cochlear implant (CI) uptake remains low globally and in New Zealand (NZ). Aims: This research has two aims. The first aim is to identify and describe the potential barriers to adult CI referral in NZ. The second aim is to identify and describe the potential barriers to CI uptake for adults referred to the Northern Cochlear Implant Programme (NCIP). Methods: This research has two parts. Part One is a survey of hearing healthcare professionals working with adults in NZ. Part Two is a retrospective chart review of adults referred to the NCIP for consideration of public candidacy for cochlear implantation over a three-year period. Results: Two categories of barriers to adult CI referral were identified. The first was “Hearing Healthcare Professional Related”, which included “Lack of Knowledge, Confidence, and Motivation” and “Other”. The second was “Client Related”, which included “Lack of Accessibility”, “Low Awareness and Negative Emotions”, and “Lack of Culturally Appropriate Services”. The aided speech perception performance threshold for candidacy, particularly the requirement of ≤30% aided Consonant-Nucleus-Consonant Word Recognition Score in the better hearing ear or binaurally, was identified as a barrier to CI uptake for adults referred to the NCIP. Conclusions: The results of this study highlight the complexity of the client journey from referral to candidacy evaluation and examine various external and client-related barriers to CI referral and uptake in NZ. This research helps to inform future training for hearing healthcare professionals and policy decision-making at an organisational level for the NCIP and at the national level for the public hearing healthcare system to improve CI provision in NZ. Particularly, easing the aided speech perception performance threshold for candidacy may provide an immediate improvement to CI provision for adults referred to the NCIP. It provides a foundation for future research to better understand and improve CI provision in NZ.