Ear and hearing care programs for First Nations children: a scoping review
Kai Nash1, Rona Macniven2, Liesa Clague3
1The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia. kai.nash@mq.edu.au.
Insights
Ear and hearing care programs for First Nations children are vital for early detection of otitis media. Many programs focus on detection and management, but require better evaluation and community involvement for long-term success.
Area of Science:
- Public Health
- Indigenous Health
- Audiology
Background:
- Ear and hearing care programs are crucial for the early detection and management of otitis media (middle ear disease).
- Otitis media and associated hearing loss disproportionately affect First Nations children, impacting speech, language, social, cognitive, educational, and life outcomes.
- This review examines ear and hearing care programs for First Nations children in high-income colonial-settler countries to understand strategies for reducing otitis media burden and improving equitable access to care.
Purpose of the Study:
- To chart the strategies employed by ear and hearing care programs for First Nations children.
- To map program focus across the care pathway: prevention, detection, diagnosis/management, and rehabilitation.
- To identify factors contributing to the longer-term sustainability and success of these programs.
Main Methods:
- A comprehensive database search was conducted in March 2021 across multiple academic databases (Medline, Embase, Global Health, APA PsycInfo, CINAHL, Web of Science Core Collection, Scopus, Academic Search Premier).
- Included programs were developed or operational between January 2010 and March 2021.
- Search terms included 'First Nations children,' 'ear and hearing care,' and 'health programs, initiatives, campaigns, and services.'
Main Results:
- Twenty-seven articles described twenty-one distinct ear and hearing care programs.
- Program strategies focused on connecting patients to specialist services, enhancing cultural safety, and increasing access to care.
- Evaluation measures were predominantly limited to outputs or service-level outcomes, not patient-based outcomes. Funding and community involvement were identified as sustainability factors but were often limited.
Conclusions:
- Programs primarily target detection and diagnosis/management stages of the care pathway, with some limited strategic approaches.
- Many programs rely on potentially unsustainable funding sources and evaluate success based on outputs rather than patient outcomes.
- Future programs require integration into existing systems, policy alignment, and governance by First Nations communities for long-term sustainability and community-needs alignment.
Background:
Ear and hearing care programs are critical to early detection and management of otitis media (or middle ear disease). Otitis media and associated hearing loss disproportionately impacts First Nations children. This affects speech and language development, social and cognitive development and, in turn, education and life outcomes. This scoping review aimed to better understand how ear and hearing care programs for First Nations children in high-income colonial-settler countries aimed to reduce the burden of otitis media and increase equitable access to care. Specifically, the review aimed to chart program strategies, map the focus of each program against 4 parts of a care pathway (prevention, detection, diagnosis/management, rehabilitation), and to identify the factors that indicated the longer-term sustainability and success of programs.
Method:
A database search was conducted in March 2021 using Medline, Embase, Global Health, APA PsycInfo, CINAHL, Web of Science Core Collection, Scopus, and Academic Search Premier. Programs were eligible or inclusion if they had either been developed or run at any time between January 2010 to March 2021. Search terms encompassed terms such as First Nations children, ear and hearing care, and health programs, initiatives, campaigns, and services.
Results:
Twenty-seven articles met the criteria to be included in the review and described a total of twenty-one ear and hearing care programs. Programs employed strategies to: (i) connect patients to specialist services, (ii) improve cultural safety of services, and (iii) increase access to ear and hearing care services. However, program evaluation measures were limited to outputs or the evaluation of service-level outcome, rather than patient-based outcomes. Factors which contributed to program sustainability included funding and community involvement although these were limited in many cases.
Conclusion:
The result of this study highlighted that programs primarily operate at two points along the care pathway-detection and diagnosis/management, presumably where the greatest need lies. Targeted strategies were used to address these, some which were limited in their approach. The success of many programs are evaluated as outputs, and many programs rely on funding sources which can potentially limit longer-term sustainability. Finally, the involvement of First Nations people and communities typically only occurred during implementation rather than across the development of the program. Future programs should be embedded within a connected system of care and tied to existing policies and funding streams to ensure long term viability. Programs should be governed and evaluated by First Nations communities to further ensure programs are sustainable and are designed to meet community needs.
