Early Intervention for Hearing-Impaired Children-From Policy to Practice: An Integrative Review

Globally, many countries have endorsed the World Health Organisation's (WHO) early intervention (EI) guidelines through their legislation with contextual variations. Sensitive evaluation of gaps within EI-recommended systems is essential, especially in the translation of policy into practice across high-income and low- to middle-income country (LMIC) contexts, including South Africa. The main objective was to explore and identify the current evidence reflecting the application of hearing-specific government policy regarding EI and early education (EE) for hearing-impaired/d/Deaf/hard-of-hearing (HI/D/HH) children aged six and below.

An integrative review was conducted on peer-reviewed articles that examined policy in practice regarding EI for HI/D/HH children aged six and below. Studies were accessed via four databases (Ebscohost, Sabinet, Scopus, and ScienceDirect) and one search engine (Google Scholar) between 2014 and 2024. Qualitative evaluation ensued of themes identified deductively.

Twenty-six peer-reviewed studies were included. Deductive thematic analysis revealed six derived themes: EI timing, early hearing detection and intervention (EHDI)/EI mechanisms; EI services, EE, family considerations, and policy. Five of the 26 directly scrutinised government policy in its EI/EE practical application. Articles reflected the need for consideration of the complex processes that allow for policy actualisation, such as adequate infrastructure and family considerations.

A bottom-up approach to policy actualisation, with grass-roots contextual considerations such as EI access and caregiver concerns, may improve policy application. Current findings have implications, particularly for LMIC contexts including South Africa, where EI and EE policy scrutiny regarding hearing impairment/deafness specificity is imperative for understanding its application alignment.