Theses and Dissertations (Speech-Language Pathology and Audiology)

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Are listening difficulties in children related to speech recognition in noise and binaural intelligibility level difference?
(University of Pretoria, 2019-08) Swanepoel, De Wet; Mahomed-Asmail, Faheema; De Sousa, Karina; u15011985@tuks.co.za; Frisby, Caitlin
In both clinical practice and the literature, parent reports and poor speech recognition in noise performance are commonly associated with listening difficulty (LiD). However, the relationship between these reports and skills is unclear. This study investigated the relationship between questionnaire measures of LiD and psychoacoustic measures of speech recognition in noise. Four hundred and forty-six typically developing, normal-hearing (pure-tone thresholds ≤ 20 dB HL) school children (73.8% male), 6-13 years old, were recruited. Diotic and antiphasic speech reception thresholds (SRTs), and the difference between them, the digits in noise binaural intelligibility level difference (DIN-BILD), were determined using the South African English DIN. Parents completed the Evaluation of Children's Listening and Processing Skills questionnaire (ECLiPS) (246/446) and teachers the Children's Auditory Processing Performance Scale (CHAPPS) (429/446) questionnaires to identify children with possible LiD. The ECLiPS classified 36/246 (14.6%), and the CHAPPS 103/429 (23.1%) children with LiD by questionnaire published criteria. Both questionnaires were obtained for 229 participants, of which 3.1% (7/229) were classified with LiD based on both CHAPPS and ECLiPS scores. There was no significant relationship between the DIN-BILD or speech recognition in noise (antiphasic and diotic conditions) and ECLiPS or CHAPPS total scores across the 246 ECLiPS and 429 CHAPPS participants. Age had a significant effect on BILD, SRTs and CHAPPS total score. LID, determined by total scores on parent and teacher questionnaires, was not predictive of BILD or poor speech recognition in noise. LiD is a heterogeneous construct for which a DIN test could inform abilities but not identify the condition.
A systematic review to determine if text messages about health and development in infants and young children affect caregiver behaviour
(University of Pretoria, 2019) Van der Linde, Jeannie; Pillay, Bhavani; Swanepoel, De Wet; richardson.brittany96@gmail.com; Richardson, Brittany Paige
Access to appropriate information can result in improved health and development outcomes for children. Providing information about health and developmental care via mobile devices (mHealth) can serve not only as curative healthcare but also as preventative health care in developing countries. Through mHealth programs, messages are sent by SMS or voice-recorded message. By reviewing the current state of evidence, the study aims to investigate if text messaging about health and development in young children has an effect on caregiver behaviour. This systematic review was conducted according to the PRISMA-P statement guidelines. Five databases were used to conduct this study and the search was not limited to a specific time period. Key words were used in various combinations within the different databases. Thematic analysis was used to organise and synthesize the information extracted from the selected studies.This review included 19 studies. Study designs included Randomised Control Trials (RCT’s) (n=13, 68.4%), observational studies (n=3, 15.8%), and non-randomised control trials (n=3, 15.8%). Message content included educational information regarding health and development (89.5%), reminders (36.8%) and caregiver support (52.6%). Current evidence summarised from this review supports text messaging as an effective tool to change caregiver behaviour and child outcomes across a range of health and Early Childhood Development (ECD) related topics as the findings suggest increased caregiver comfort with basic infant health and development decisions. This may be attributable to information received via text message from health care professionals. Early childhood development has more limited evidence in terms of quantity and quality. More research is required in ECD and generally in low-to-middle income (LMIC) contexts.
Developmental outcomes of HIV-exposed infants in a low-income South African context
(University of Pretoria, 2019-11) Kruger, Esedra; Van der Linde, Jeannie; carmen.vaneck@gmail.com; De Beer (nèe van Eck), Carmen Cornelia
Background: Effective Human Immunodeficiency Virus (HIV) transmission prevention strategies have led to a growing population of vulnerable HIV-exposed (HE) infants in sub-Saharan Africa, however uncertainty exists in literature regarding their developmental outcomes. Objective: The aim was to determine the developmental outcomes of six- to 12-month-old HE infants in a low-income South African context, when compared to HIV-unexposed (HU) counterparts. Method: In this prospective cross-sectional, group comparison study, the development of 41 HE and 40 HU infants (mean age = 8.4 months, SD = 2.1 months) from a low-income context was assessed. Caregivers were interviewed using a background interview and the Vineland Adaptive Behavior Scales, Third Edition (Vineland-3) to evaluate infants’ communication, daily living, socialisation and motor skills. Results: Based on the overall test scores, the majority of HE participants had age-appropriate development (90.2%; n=37). Some HE participants, however, presented with delays in the domains of communication (9.8%; n=4), daily living skills (2.4%; n=1), socialisation (19.5%; n=8) and motor development (7.3%; n=3). HU participants also demonstrated some domain-specific delays, thus delays were present in both groups. No statistically significant differences were found between the development of HE and HU participants. Conclusion: Findings were reassuring and suggested that the development of HE participants were similar to that of HU counterparts. Developmental differences may, however, only emerge with age, therefore large-scale longitudinal research is recommended. It is suggested that the entire sample was vulnerable, highlighting the importance of developmental surveillance and early intervention in low-income contexts, irrespective of HIV and antiretroviral exposure.
Characteristics and help-seeking behaviour of persons failing a national hearing screening test
(University of Pretoria, 2019-11) Swanepoel, De Wet; De Sousa, Karina; Mahomed-Asmail, Faheema; dannyschonborn11@gmail.com; Schönborn, Danielle
A digits-in-noise test was launched as the smartphone hearing screening of South Africa (hearZA™) in 2016. This study investigated characteristics, help-seeking behaviour, and follow-up actions of individuals who failed the hearing screening, considering their stage of behavioural change. The study had two phases; phase one was a retrospective, cross-sectional intervention readiness (stage of change) analysis of 3092 listeners who failed the test. Phase two was a prospective survey of 59 participants to investigate follow-up actions after a failed test. In the retrospective study, the majority of listeners were in the precontemplation stage (75.5%), while the remaining were in contemplation (9.7%), preparation (8.2%), and action (6.6%) stages. Age and stage of change were significant predictors of the digits-in-noise speech recognition threshold (DIN SRT) (p < .05). SRTs deteriorated significantly (p < .05) with increasing age, and listeners in the precontemplation stage were significantly younger than in other stages (p < .05). In the prospective study, 1007 potential participants were contacted through electronic mail or short message services to complete the survey; however, only 59 did so. Of those, most (82.4%) did not think they have a hearing loss. Only, 13.6% followed up with an audiologist. Older individuals presented with poorer DIN SRTs and were in a more advanced stage of change. The majority that did not follow up after failing the screening test did not believe they had a hearing problem. A combination of factors, including poor DIN SRT, older age, and more advanced stage of change predisposed participants to follow up with audiological care.
A comparison of the LS CE-Chirp and click evoked auditory brainstem response stimuli for neuro-diagnostic assessment in order to determine the preferable stimulus
(University of Pretoria, 2019) Biagio de Jager, Leigh; Heinze, Barbara M.; paige.tucker77@gmail.com; Tucker, Paige
Purpose: To compare LS CE-Chirp and click evoked neuro-diagnostic auditory brainstem responses (ABR) for the purpose of determining the preferable stimulus for assessment. This is necessary for the improvement of neural synchrony and compensation for the delay of the sound wave whilst it travels through the cochlea. This will facilitate more successful, efficient and effective neurological ABR assessments. Method: This was a within subject comparative, exploratory research design. Participants included 34 normal-hearing individuals (aged 18-25 years, mean age 22.12 years). A comparison was completed between the ABR wave formations evoked by the click and LS CE-Chirp stimuli at 80 dBnHL at stimulus repetition rate of 27.4 Hz and 61.1 Hz with maximum permissible residual noise levels of 40 nV. Results: The LS CE-Chirp evoked ABR displayed later absolute latencies and shorter interpeak latencies compared to the click-evoked ABR. Significantly larger amplitudes were consistent for the LS CE-Chirp wave formations (p<0.001) with the exception of the wave I for the rarefaction polarity. Residual noise levels were consistently higher for the LS CE-Chirp stimuli, however, there was no correlation present between the amplitudes and the comparative residual noise levels. Conclusions: The LS CE-chirp stimulus elicited considerably larger waveform amplitudes, which facilitate more accurate and timely ABR assessments compared to the click. The lack of correlation between amplitude and residual noise levels suggested independence of residual noise levels, and therefore were likely due to the increased neural synchrony inherent to the chirp stimuli. The click stimulus is still advocated for during neuro-diagnostic assessments as despite the larger LS CE-Chirp amplitudes, further research regarding the correlation with auditory-neural pathology is required before the routine use of the LS CE-Chirp stimulus can be advocated over the well-established click stimulus for neuro-diagnostic purposes.
Nurses’ management of stroke-related oropharyngeal dysphagia in a rural province of South Africa
(University of Pretoria, 2019-10) Kruger, Esedra; Van der Linde, Jeannie; Pillay, Bhavani; kerryknight30@gmail.com; Knight, Kerry
Background: Early identification of stroke-related oropharyngeal dysphagia (OPD) using screening by nurses can prevent adverse patient outcomes in lower-middle-income countries (LMICs). Nurses are essential in the OPD management team and should ideally be able to screen and prioritise dysphagia management in stroke patients. Objective: The aim of this study was to describe nurses’ identification and management practices of patients with OPD following a stroke in a rural province of South Africa. Qualified nurses from various healthcare levels in a rural province of South Africa were invited to complete a previously published hard copy survey on signs, symptoms, complications, and management of stroke-related OPD. A sample of 130 participants were included. The majority of participants (n=66; 50.8%) had ten or more years of experience. Results: The mean scores of correct responses for each section were: 8.7/13 (66.7%) for signs and symptoms, 4.7/10 (47.3%) for complications and 3.8/7 (54.2%) for management practices. There were no significant differences between groups for the signs and symptoms section and the complications section. Secondary healthcare nurses demonstrated significantly better knowledge than primary (p=0.022) and tertiary (p=0.010) level nurses regarding management of OPD. Overall, secondary level nurses had significantly higher scores than the other levels. Conclusions: Moderate knowledge of identification and management of stroke-related OPD among nurses across all health care levels was evident. Interdisciplinary collaboration between nurses and speech-language therapists can improve team members’ continued professional development and refining of skills in decision-making regarding stroke-related OPD in LMICs.
Feeding characteristics of infants in a primary health care clinic in South Africa
(University of Pretoria, 2019-10) Kruger, Esedra; Van der Linde, Jeannie; nicholefuls@gmail.com; Fuls, Nichole
BACKGROUND There is a limited amount of literature on the feeding characteristics and nature of possible feeding difficulties of infants in a primary health care (PHC) in South Africa. OBJECTIVE To describe feeding characteristics and determine the nature of feeding difficulties of infants in a PHC setting in South Africa. METHOD Two hundred infants aged six to 12 months (mean age = 8.54, Standard Deviation = 2.18) received a feeding screening by a speech-language therapist at a well-baby clinic in a semi-urban area using the Montreal Children’s Hospital-Feeding Scale (MCH-FS). A clinical feeding evaluation using the Schedule of Oral Motor Assessment (SOMA) was completed with 13 infants who failed the screen. RESULTS The MCH-FS identified 13 participants with feeding difficulties (6.5%) of which 11 were diagnosed with oral motor dysfunction (OMD) using the SOMA. The 6.5% (n=13) that failed, had mild (n=8;61.5%), moderate (n=2;15.4%), and severe (n=3;23.1%) feeding difficulties, as reported by caregivers using the MCH-FS. The MCH-FS revealed that distraction during mealtimes/following (n=42;21%), food refusal (n=31; 15.5%), caregiver unease about feeding (n=29;14.5%), and problems with vomiting, gagging or spitting (n=28;14%), were characteristics of feeding in this sample. Participants in the age groups six (n=3;27.3%) and 10 months (n=3;27.3%) were prone to OMD. Complementary feeding was introduced appropriately between six and eight months in the majority of the sample (n=122;82%). CONCLUSION The study was the first of its kind to describe the feeding characteristics of a group of infants during the transitional feeding stage in late infancy in South Africa. The findings may be used as a starting point for larger scale studies in a similar setting, investigating the development of future caregiver education and health care professional training programmes regarding transitional feeding.
Improving hearing aid access, use and outcomes in adults
(University of Pretoria, 2024-07-07) Swanepoel, De Wet; Mahomed-Asmail, Faheema; u13182006@tuks.co.za; Mothemela, Bopane
The thesis outlines how alternative audiology service delivery model including the community based hearing aid fitting model can be employed to improve access to hearing loss treatment. This overall promotes hearing healthcare wellness to broader communities, regardless of affordability.
Incidence and nature of functional voice disorders in adults at an Interdisciplinary voice clinic
(University of Pretoria, 2024-04) van Der Linde, Jeannie; Milton, Carmen; yusrabhaila@gmail.com; Bhaila, Yusra Mahmud
Abstract Introduction: Functional Voice Disorders (FVDs) are types of voice disorders that arise from improper use of the vocal mechanism. It is characterized by the absence of anatomical or neurological abnormalities. Despite their prevalence, the incidence and nature of FVDs, particularly among occupational voice users, have been inadequately reported globally. This study sought to address this gap by describing the incidence and nature of FVDs in adults attending an interdisciplinary voice clinic in Pretoria, South Africa. Methodology: A retrospective quantitative research design was employed. Data was sourced from a voice clinic's secure medical database. Patients over eighteen years with confirmed FVDs diagnosed between January 2017 and July 2022 were included. Statistical analysis was conducted using SPSS, utilising both descriptive and inferential statistics. Results: Of the total 516 patients with voice disorders seen between January 2017 and July 2022, 16.67% had FVDs, with muscle tension dysphonia being the most prevalent primary diagnosis. The most common secondary diagnosis was laryngeal pharyngeal reflux (39.5%). Patients with FVDs presented with a variety of signs and symptoms, with hoarseness being the most common. No significant differences were found between occupational voice users and non-occupational voice users. Conclusion: The study’s findings emphasised the need for understanding the landscape of FVDs in South Africa. It highlighted the importance of interdisciplinary care and the need for further research to optimise prevention and management strategies. Furthermore, it underscores the significance of addressing these disorders on a global scale, particularly in low- and middle-income countries, by outlining research gaps among these populations.
Adaptation of a developmental milestone resource for caregivers from low-income communities in South Africa
(University of Pretoria, 2024-02-19) Eccles, Renata; du Toit, Maria; Shabnam, Abdoola; ashleyrosechesworth@gmail.com; Bellini, Ashley
Caregiver access to relevant developmental milestone resources is critical in ECD. In this iterative design study, six members of an expert panel (n=6; female; 5 White, 1 Black) reviewed and adapted the CDC developmental milestone checklist for South African caregivers of children two months to three years 11 months, living in low-income communities. Participants found most of the developmental milestones to be applicable but requiring contextual adaptation to be relevant for use by caregivers in low-income communities. Four themes were identified from the adaptations made: language use, access to test items, context, and developmental literacy. International developmental milestone tools require adaptation and contextualization to address the unique challenges and circumstances that children in low- income communities face.
Consumer perspective on improving hearing aids : a qualitative study
(University of Pretoria, 2024-06-19) Mahomed Asmail, Prof. Faheema; Swanepoel, Prof. De Wet; Manchaiah, Prof. Vinaya; desainabeelah@gmail.com; Desai, Nabeelah
Optimal hearing aid fittings are central to the management of hearing loss. While research studies using quantitative scales typically report high hearing aid user satisfaction rates, other studies show poor uptake and sustained usage of hearing aids. While quantitative research is valuable, nuanced factors influencing hearing aid user experiences can be minimised. This underscores a need for the qualitative exploration of holistic hearing aid experiences, to promote successful outcomes. In light of this, the present study aimed to describe user perspectives on desired changes to hearing aids, in order to make them more useful. An open- ended question from a cross-sectional online survey was retrospectively analysed using inductive, qualitative content analysis. Participants were adult hearing aid users in the United States (U.S.), who had obtained their hearing aids either through the traditional hearing healthcare professional (HHP) mediated prescription route, or through the OTC service delivery model. The survey was disseminated over email through the Hearing Tracker forum database and through Lexie Hearing, an OTC hearing aid company. Results showcased a rich variety of information and highlighted diverse viewpoints. 628 participant responses were manually coded and categorised to form domains. The mean age of the surveyed population was 66 years old (13. 4 SD). The majority were bilateral, behind-the-ear hearing aid users. Three domains illustrating desired hearing aid changes emerged from the data. The (i) hearing aid features domain (n= 635 responses) illustrated challenges surrounding hearing aid usability (appearance and comfort), durability (Ingress Protection (IP) ratings) and digital functionality (Bluetooth connectivity). The (ii) sound quality domain (n=282 responses) described challenges surrounding sound recognition and clarity (as an independent concept from volume) as well as the performance of noise reduction technology. The (iii) service- delivery domain (n=378 responses) described user concerns about affordability, audiologist credibility and overall hearing aid industry market transparency. Participants expressed satisfaction with hearing aid technological developments, similar to previous studies indicating high satisfaction rates, but expressed a strong desire for further improvements, to better align hearing aids and services with their needs. Key areas for improvement include cost accessibility, physical device aesthetics and comfort, technical functioning, user autonomy, sound clarity and collaboration and trust between patients and HHPs. While some participant suggestions such as those surrounding aesthetics are known, novel information regarding features enhancing user autonomy and promoting industry transparency, were highlighted. Against the backdrop of an evolving hearing aid industry, the findings of this study can assist HHPs in being informed facilitators for both, health consumers and their patients. Consideration should be given to intervention solutions which promote principles of Person- Centred Care (PCC), enhance patient self-efficacy and maintain transparency.
Preliminary normative data for adult English first and second language speakers in South Africa on the "RSA low linguistically loaded central auditory processing test battery"
(University of Pretoria, 2002) Campbell, Nicole Githa; Saleh, Safia
English: The lack of standardized test materials in the 11 official languages of South Africa led to the development of the "RSA low linguistically loaded central auditory processing test battery" as an interim measure until these tests can be developed. This study aimed at collecting and comparing preliminary normative data for English first and second language speakers in South Africa on this test battery and to compare the results with the available USA normative data. Thirty two participants were included in the study and were divided into two research groups depending on their proficiency in English. A between group research design was used to collate and compare the data. Results indicated that the two research groups performed equivalently on all tests apart from the Dichotic Digits test for the right ear and a qualitative comparison with the USA normative data showed lower scores for tests not involving speech stimuli. Accent and presentation levels affected the results but not significantly. Results point to the possibility of using the test battery reliably with population groups whose first language is not English but who have a good proficiency in the language and reiterates the need for development of specific test materials in all the official languages.
The hearing aid effect across socioeconomically diverse settings
(University of Pretoria, 2023) Mahomed-Asmail, Faheema; Swanepoel, De Wet; moipone.motlhamare.mm@gmail.com; Motlhamare, Cathrine
Hearing aids serve as the prescribed intervention for addressing the majority of hearing losses, yet their adoption and usage encounter resistance among individuals. This is largely attributed to the hearing aid effect (HAE), wherein negative stereotypes are linked to hearing aid users. While existing research has explored the HAE in relation several factors little is known about how factors like rural or urban settings and level of education influence it. This study aims to address this gap by investigating the hearing aid effect across diverse rural and urban populations with varying educational backgrounds. A quantitative cross-sectional questionnaire was completed by 322 participants (urban=161, rural=161) selected through purposive snowball sampling. Participants were required to complete the Bipolar Semantic Differential Scale based on photographs of a model wearing seven hearing devices, namely standard behind-the-ear hearing aid (BTE HA) with an earmould; mini BTE HA with a slim tube (ST), in-the-canal (ITC) HA, Airpod, receiver-in-canal (RIC); completely-in-canal (CIC) HA; and Personal sound amplification product (PSAP). Comparisons were made between the mean scores obtained for the various devices to those of the standard BTE hearing aid. Findings show that the hearing aid effect exists and there are significant differences (p < 0.01) between the rural and urban populations in ratings for attributes such as age and hardworking. Significant differences (p < 0.01) were also noted across levels of education; those with tertiary education, compared to those with primary and secondary education, found the model to be younger when wearing an Airpod and to be more hardworking when wearing a ST hearing aid. This study concluded that there is a neutral to positive view of hearing devices. These findings highlight the significance of considering patients' socioeconomic circumstances when prescribing hearing aids. Nevertheless, further research is required to investigate the underlying reasons behind the differences in perception between rural and urban residents.
Impact of paediatric cochlear implantation on family life : a conceptual framework informed by parents
(University of Pretoria, 2023) Le Roux, Talita; Eikelboom, Robert H.; chanedb50@gmail.com; De Beer, Chané
Numerous studies have investigated the effect of permanent childhood hearing loss and cochlear implantation on parents and siblings, but there is limited evidence available regarding the effect of paediatric cochlear implantation on family life, known as the routine interactions and activities that families have together. The aim of this study was to generate a conceptual framework that describes the impact of paediatric cochlear implantation on family life as perceived by parents. Participants included parents of paediatric (<18 years) cochlear implant recipients who had been implanted for at least 12 months. A total of 29 parents participated in this research study. A participatory mixed-method design, namely concept mapping was used. Concept mapping involves six steps namely (1) preparation, (2) generation of ideas via brainstorming, (3) structuring of ideas via grouping and rating, (4) analysis and representation, (5) interpretation and (6) utilization of the results. Brainstorming sessions were held in-person and online, and as individual and group sessions. Parents attended one brainstorming session via their preferred mode, wherein they generated statements describing the changes in family life that occurred since their child received their cochlear implants. Parents then grouped and rated these statements to identify concepts. Data analysis involved multidimensional scaling and hierarchical cluster analysis to create a conceptual framework. In total, 99 unique statements described the impact of paediatric cochlear implantation on family life. The grouping activity yielded six concepts, namely i) “Financial Outlay and Supports”; ii) “Education and Therapy”; iii) “Responsibilities and Sacrifices”; iv) “Extended Family and Community”; v) “Spouses and Siblings” and vi) “Achievements and Enrichments”. Statements grouped in “Financial Outlay and Supports”, “Achievements and Enrichments” and “Spouses and Siblings” were rated as the most important possible changes to be aware of prior to proceeding with paediatric cochlear implantation, while statements in “Achievements and Enrichments” was rated as the most positive and statements in “Financial Outlay and Supports” and “Extended Family and Community” as the most negative in terms of family life experiences. This study highlights the multiple areas of family life affected by the diagnosis of permanent childhood hearing loss and subsequent paediatric cochlear implantation. To improve patient-and-family-centred care, these factors need to be considered during pre-implantation and successive counselling of a paediatric CI recipient and their family members
Impact of adult cochlear implantation on the partner relationship : a conceptual framework Informed by patient and partner perceptions
(University of Pretoria, 2023-09-03) Le Roux, Talita; Eikelboom, Robert H.; lambinon.che@gmail.com; Lambinon, Ché
The use of cochlear implants (CIs) as a treatment approach for moderate to profound hearing loss in adults has an impact not only on the CI recipients themselves but also on their partners. Objectives: This study aimed to describe the impact of cochlear implantation on the partner relationship as perceived by adult CI recipients and their intimate partners. Furthermore, this study aimed to generate a conceptual framework for informing future research directions and clinical adult cochlear implantation interventions. Methods: A concept mapping approach was used to generate, analyse and interpret participants’ data. This methodology is a collaborative, mixed-method approach which enables the elicitation of diverse content. Participants attended group and individual sessions to generate, sort and rate statements that describe the changes in their relationship post-implantation. Adults between the ages of 19 and 65 years were targeted. Participants consisted of 15 CI recipients (mean age: 51.6; SD: 8.2) and 12 partners (mean age: 50.9; SD 8.1). Partners cohabitated and had daily interaction with the CI recipient for a minimum of 12 months prior to cochlear implantation. CI recipients had a minimum of 12 months’ experience with a CI prior to data collection, were oral communicators and received cochlear implantation services at two CI centres in South Africa. Results: By examining their perspectives, a conceptual framework emerged. Participants’ data revealed five concepts: Social Interactions, Partner Involvement, Communication, Emotional Adjustment, and Relationship Intimacy. Participants’ evaluation of these concepts revealed varying degrees of importance and positivity/ negativity. The Relationship Intimacy cluster emerged as most important and positive. Study findings underscore the post-implantation improvements in the partner relationship in terms of social interactions, communication dynamics, and emotional adjustment. Conclusion: The study reinforces the significance of understanding the impact of cochlear implantation on the partner relationship and emphasises the need for comprehensive support and counselling strategies. Relationship Intimacy was regarded as pivotal, suggesting its significant role in enhancing couples’ relationships post-implantation. While CI recipients experienced enhanced autonomy, partners’ roles evolved, encompassing assistance and support. Importantly, participants indicated both positive and negative changes in relationship dynamics due to cochlear implantation. This holistic perspective is essential for ensuring patient-and family-centered care (PFCC) and maximising the benefits of cochlear implantation for both CI recipients and their partners.
Neonatal hearing screening using a smartphone-based otoacoustic emission device : a comparative study
(University of Pretoria, 2023-12) De Jager Biagio, Leigh; Le Roux, Talita; andanigluggy@gmail.com; Madzivhandila, Andani Gluggy
Early identification and intervention for childhood hearing loss assists in the reduction of delays in speech and language development. Otoacoustic emissions (OAEs) are commonly used for identifying hearing loss through newborn hearing screening (NHS). Recent technological advances in NHS have created more feasible and accessible services, however no objective smartphone-based screening applications (apps) have been validated. This study aimed to compare the screening outcomes of a smartphone-based OAE screening device to a commercially available OAE screening device. More specifically, the within-participant outcomes of the OAEs, in terms of screening concordance, signal, noise, and SNRs were compared to measure equivalence between the two devices. NHS at two tertiary public healthcare hospitals was conducted over a period of 8 months. The primary investigator followed a one-step screening protocol by means of which only OAEs were performed on each infant rather than a two-step screening protocol of OAEs and automated auditory brainstem responses (AABR). All infants less than three months of age were eligible for the study. DPOAE and TEOAE screenings were performed using the Otodynamics ILO v6 device (comparator) and the hearX OAE device. The screening technology namely the hearOAE and Otodynamics ILO, was used in an alternating manner on each day of the data collection period. Every participant was required to undergo OAE screening, which included either Distortion Product Otoacoustic Emission (DPOAE) screening or Transient Evoked Otoacoustic Emission (TEOAE) screening. A total of 176 infants (352 ears) (48.9% female) underwent TEOAE and DPOAE newborn hearing screening by a dedicated screener. The mean age at the time of screening was 4.5 days (SD 11.3). Statistically significant within-participant differences for DPOAE were measured for infants in the Neonatal Intensive Care Unit (NICU) on the pass/refer outcomes where infants who spent time in the NICU were 3.09 times more likely to refer DPOAE screening using the hearOAE device (p=0.029). Inter-device DPOAE comparison indicated no statistically significant difference in the refer rate between the devices (p=0.238). Similarly, inter-device differences for TEOAEs were measured for pass/refer outcomes. A statistically higher NHS pass rate was measured for TEOAEs with the hearOAE compared to the Otodynamics ILOs (p=0.009). The inter-device, within-participant diagnostic concordance was 89.7% and 85.0% for DPOAE and TEOAE respectively. The current study concluded that the hearOAE yielded outcomes comparable to the Otodynamics ILO v6 in terms of the overall pass and/or refer outcome. This verifies the performance of the novel smartphone-based OAE device and may facilitate increased accessibility of NHS services as mHealth is becoming a recognised alternative method in NHS programs globally.
Perceptions of hearing healthcare : a qualitative analysis of satisfied and dissatisfied online reviews
(University of Pretoria, 2023-08-31) Swanepoel, De Wet; Biagio de Jager, Leigh; sanchvbruggen@gmail.com; Van Bruggen, Sanchia
Online review platforms have become increasingly popular among healthcare consumers for providing feedback. The aim of this study was to comprehensively describe the hearing healthcare experience through the exploration of satisfied and dissatisfied consumer feedback as reported on Google reviews. This study employed a thematic analysis on open-text responses from Google regarding hearing healthcare clinics across 40 United States (U.S.) cities. Purposive sampling led to a sample that consisted of 500 5-star (satisfied) and 234 1-star (dissatisfied) reviews. Thematic analysis yielded nuanced dimensions of the hearing healthcare consumer experience, grouped into distinct domains, themes, and subthemes. Six common domains –overall experience, clinical outcomes, standard of care, facilities, audiologist, and administrative and support staff - were identified from the satisfied (5-star) and dissatisfied (1-star) consumer reviews. A seventh domain, ‘Inclusivity’, was identified amongst dissatisfied consumer reviews, describing interactions tainted by discrimination based on race, mode of communication, age, and insurance type. The overall experience domain revealed emotions, ranging from contentment and gratitude to dissatisfaction and waning loyalty. The findings highlighted the pivotal contribution of wellbeing, hearing- and product-related outcomes to the consumer experience, whilst consumers also shared expectations for punctuality, person-centred care, affordability of services, and efficient communication. Furthermore, facility quality, cleanliness and general atmosphere of institutions were identified as important ‘exterior’ factors. Professional competence displayed both by audiologists and support staff were prominent themes. Findings emphasize the critical dimensions of satisfied and dissatisfied hearing healthcare consumer experiences, identifying areas for service refinement, informing more person centric service-delivery in hearing healthcare.
Partner’s perceptions of aphasia on communication interaction in their relationship
(University of Pretoria, 2023-08-31) Pillay, Bhavani; Kruger, Esedra; sonikavanderriet@gmail.com; Van der Riet, Sonika
Background: Aphasia can cause changes in a relationship as communication forms the basis of interactions. Reduced talking and sharing of thoughts may result in emotional disconnection, or alternatively, partners may grow closer as they support each other through challenging experiences. Method: This case series design included five dyads where one of the partners has chronic stroke-related aphasia. Individual semi-structured interviews were conducted along with a short paper-based survey. Results: Three main themes developed from thematic analysis: changes in aspects of conversation interaction in couples with aphasia; communication challenges experienced by couples with aphasia and their attempts to resolve it; conflict experienced by couples with aphasia and perceptions of their partners’ support. All couples have perceived a shift in listener-speaker ratios and decreased engagement on emotionally significant topics since the onset of aphasia. Couples are making efforts to improve their communication interaction, but the majority still experience difficulties in successful resolution of communication breakdowns. Conclusions: Aphasia alters communication interactions between persons with aphasia and significant others. This study emphasises the importance for speech-language therapists to include both partners of the couple affected by aphasia during the rehabilitation process to enhance quality conversation interactions and a balanced distribution of listener-speaker roles. A collaborative framework of care focused on functional approaches to aspects of dyadic interactions may facilitate enhanced everyday communication in couples living with aphasia.
Perceptions, knowledge, and perceived competencies of South African speech-language therapists to render transgender voice and communication training
(University of Pretoria, 2023) Van der Linde, Jeannie; du Toit, Maria; Milton, Carmen; u15015085@tuks.co.za; Maasz, Johan Jacobus
Background: Speech-language therapists (SLTs) receive extensive education and training on voice and voice disorders in general. Therefore, they are ideally situated to render transgender voice and communication training (TVCT), and it forms part of their scope of practice. Research has, however, identified a lack of confidence in SLTs to render this service due to a perceived lack of education, training, knowledge, and clinical exposure in high income countries. Limited research exists in middle-income countries. Aim: To determine the perceptions, knowledge, and perceived competencies of South African SLTs to work with transgender clients and provide TVCT. Methods: A cross-sectional open online survey design using non-probability purposive and convenience sampling was used. Fully qualified and practising South African SLTs were asked to volunteer on social media platforms. Results: Most participants agreed that TVCT falls within their scope of practice (n=42, 84%), viewing it as their ethical responsibility (n=40, 80%) as well as a medical or educational necessity (n=34, 68%). However, most participants reported feeling inadequately prepared to provide TVCT (n=34, 68%) due to insufficient education and training in this field, with 23 participants (45.1%) reporting that they had not received any education or training on the topic. Most participants also reported knowing how to use pronouns that reflect all genders (n=29, 64.4%). However, most also reported not asking their clients what their preferred pronouns are before engaging in assessment or treatment (n=27, 44.5%) indicating a knowledge-practice gap. Conclusions: Participants held positive attitudes towards TVCT yet felt unprepared to render the service due to insufficient education, training, and exposure, revealing a crucial professional development need. Participants presented with appropriate cultural competence towards the LGBTQ+ community, however, further research is required to obtain more in-depth knowledge of the possible underlying causes of the knowledge-practice gap noted.
Public hearing health services in Mauritius : perceptions, barriers and facilitators
(University of Pretoria, 2023-10-26) Pottas, Lidia; Soer, Maggi E. (Magdalena Elizabeth); taslimafoondun@gmail.com; Foondun, Taslima
Hearing loss (HL) is a global public health challenge that affects all age groups. The need for accessing hearing health services across the world remains thus undisputed. There is currently limited published context-specific information regarding HL and hearing health services in the public health sector of Mauritius. The lack of local data on HL and hearing health services in Mauritius motivated the researcher to gather preliminary high-quality data on this topic in the public healthcare sector of Mauritius. Aim The aim of this study was to investigate HL in the public healthcare sector of Mauritius, with particular emphasis on hearing health services. Study 1 described the audiological profile of patients referred to the audiology unit of a public hospital over 3 years in order to provide stakeholders with information on the ear and hearing health services in the public healthcare sector of Mauritius. Study 2 and Study 3 investigated the knowledge of and attitudes toward HL among PCPs and CHWs of the public healthcare sector of Mauritius, respectively. Finally, Study 4 investigated the barriers to and facilitators of implementing an audiology service delivery model in the public healthcare sector of Mauritius. Methods A total of four studies were conducted to achieve the main aim of the study. Study 1 made use of a retrospective design and convenience sampling to review the audiological data of 1474 patients who attended the audiology unit of a public hospital between January 3, 2019 and October 1, 2021. Study 2 employed a quantitative survey research methodology with a crosssectional descriptive design to collect data among 320 PCPs who were selected using nonprobability purposive sampling from the public healthcare sector of Mauritius. PCPs completed a 16-item web-based survey questionnaire constructed using Google Forms about their knowledge of and attitudes toward HL. Study 3, similarly to Study 2, employed a nonexperimental, cross-sectional, descriptive survey design to gather information about the knowledge of and attitudes toward HL among CHWs. Using non-probability purposive sampling, 125 CHWs were selected from the community level of the public healthcare sector of Mauritius and filled in a 15-item paper-based survey adapted from Hussein et al. (2018). 20 Study 4 used an exploratory-descriptive research methodology, with qualitative methods of analysis, to explore the barriers of and facilitators to implementing an audiology service delivery model in the public healthcare sector of Mauritius. Using convenience sampling, four audiologists of the public healthcare sector participated in individual, semi-structured interviews. Results According to Study 1, 189 children (48.9%) presented with conductive HL, with significantly more cases of conductive HL observed in 2020. Due to the national lockdown which occurred as a result of the novel CoronaVirus disease (COVID-19), the traditional in-person nature of appointments in the audiology unit where research took place may have limited the uptake of hearing aids in 2020 in adults. Only 25.3% of children were fitted with hearing aids. Many cases of HL were undetected, which highlighted inequities in the delivery of hearing health services in Mauritius in children, especially in the identification of HL. In Study 2, insufficient knowledge was demonstrated by PCPs in the early identification of and intervention for HL, professionals who are responsible for conducting hearing assessments, and the different hearing tests used to assess hearing sensitivity. PCPs evidenced adequate knowledge regarding whether hearing tests are invasive or not. Additionally, PCPs displayed positive attitudes toward HL. The chi-squared test showed significant associations between knowledge of and attitudes toward HL. Ear, nose, and throat (ENT) specialists and paediatricians showed significantly higher scores than other PCPs for both knowledge of and attitudes toward HL. The third study showed that 62.8% of CHWs demonstrated good experience and general knowledge of HL. However, the overall knowledge regarding the aetiological factors of HL was limited. The majority of CHWs (92.6%) showed overwhelmingly positive attitudes toward HL. Simple regression analysis showed that general knowledge of HL (p = 0.015) and knowledge of risk factors and identification of HL (p = 0.005) significantly predicted attitudes toward HL. The chi-squared test showed that knowledge of HL and attitudes toward HL were significantly associated with working experience and practice setting (p = 0.004). The results of Study 4 showed audiologists’ awareness of the extensive resources pertaining to audiology service delivery in the public healthcare sector of Mauritius, the need for an 21 increased access to hearing health services for the Mauritian population and audiologists’ professional ethics and duty of care. Concerns were highlighted where there is a need to adopt consistent guidelines in audiology practice due to the differences in the norms adopted for screening and diagnostic testing by the audiologists. Conclusion To the researcher’s knowledge, this is the first study that provided comprehensive baseline data regarding local information on hearing health as well as HL in the public healthcare sector of Mauritius. The findings of the study support the need for the implementation of a sustainable program for the early identification of and intervention of HL in the public healthcare sector of Mauritius, both at the secondary (early identification and intervention) and tertiary tiers of prevention (interventions to address HL). It is crucial for the relevant authorities, stakeholders, and decision-makers to invest in educating primarily PCPs and CHWs about the causes, risk factors, and identification of HL, both in children and in adults. This is particularly important to ensure that individuals with HL obtain timely diagnosis and management at an early age. Since the public healthcare sector’s extensive availability of resources is conducive to early hearing detection and intervention, this calls for changes to improve healthcare services to the Mauritian population by introducing a HL program consistent with international norms and guidelines, for both children and adults. A model for an early hearing detection and intervention program in the public healthcare sector is proposed as well as a training program for the interdisciplinary team that will be involved in a successful early hearing detection and intervention program, for both children and adults.

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